Over-the-counter analgesics improve postconcussion symptoms and recovery: findings from the Concussion Assessment, Research and Education (CARE) Consortium

Objectives To determine if postinjury over-the-counter (OTC) analgesic use, along with type and timing of medications, is associated with improved concussion recovery and symptom severity in National Collegiate Athletic Association (NCAA) and non-NCAA athletes. Methods This cohort study was conducted by the NCAA and Department of Defense Concussion Assessment, Research and Education Consortium from 2014 to 2022. Athletes included were those who used OTC analgesics for < 3 days and those who did not use OTC analgesics postinjury. OTC analgesic type was categorised as acetaminophen (n=463), non-steroidal anti-inflammatory drugs (NSAIDs, n=77), both (n=34) and no OTC analgesic use (n=848). Concussion recovery was measured as days from injury to clearance to return to unrestricted play (time to URTP). Symptom and headache severity were derived from the Sports Concussion Assessment Tool third edition (SCAT3) taken at baseline, <48 hours postinjury (median <1 day postinjury) and 3 days postinjury (median 3 days postinjury). Results There were 576 who did and 848 who did not use OTC analgesics included in the study. OTC analgesic use was associated with a higher rate of URTP adjusted HR (aHR) (aHR 1.25 (95% CI 1.11 to 1.39)) and lower 3-day postinjury SCAT3 symptom ( e α =0.70 (95% CI 0.62 to 0.79)) and headache ( e α = 0.89 (95% CI 0.84 to 0.94)) severity scores. Early OTC analgesic use (≤2 days) was associated with a higher rate of URTP compared with delayed (>2 days) use after injury (HR 1.36 (95% CI 1.22 to 1.53)). There was little association among acetaminophen, NSAIDs and both for outcome measures. Conclusions This study shows that OTC analgesic use postinjury is associated with lower symptom severity and a faster recovery after concussion.