A randomized cohort study of the efficacy of PO magnesium in the treatment of acute concussions in adolescents

Am J Emerg Med. 2021 Jun;44:419-422. doi: 10.1016/j.ajem.2020.05.010. Epub 2020 Jul 9.


Introduction/study objective: Concussions are becoming a growing concern in society today with one out of every five adolescents being affected. This accounts for 1.6 to 3.8 million emergency department visits annually. The current standard of care involves an initial period of mental rest with symptomatic care and symptom-based return to daily activities/sports. High dose IV magnesium has been proven to be neuroprotective in severe TBI. We hypothesized that oral magnesium replacement following a concussion will decrease the overall symptomatic period allowing a quicker return to functional baseline.

Methods: We used a randomized cohort study involving patients aged 12-18 who presented within 48 h after a concussion. Our study design had a treatment arm including acetaminophen, ondansetron, and magnesium PO and a placebo arm of acetaminophen and ondansetron. We then utilized the Post- Concussion Severity Score (PCSS) to evaluate the extent of the patient's symptoms. This score was collected immediately prior to obtaining medications, 1 h, 48 h, and 120 h after starting the study. The study relied on outpatient follow up through phone conversations, and a Sports Medicine clinic locally.

Results: Our data shows that there was a statistically significant decrease in the PCSS at 48 h (p = 0.016) in the magnesium group relative to the placebo treatment arm. This study does imply that magnesium supplementation has potential benefit in treatment of concussions acutely.

Conclusion: Oral magnesium replacement decreases symptoms acutely following a concussion and should be provided with symptomatic management following a concussion in the emergency setting.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Acetaminophen / therapeutic use
  • Administration, Oral
  • Adolescent
  • Analgesics, Non-Narcotic / therapeutic use
  • Antiemetics / therapeutic use
  • Brain Concussion / drug therapy*
  • Drug Therapy, Combination
  • Emergency Service, Hospital
  • Female
  • Glasgow Coma Scale
  • Humans
  • Injury Severity Score
  • Magnesium / administration & dosage
  • Magnesium / therapeutic use*
  • Male
  • Ondansetron / therapeutic use
  • Post-Concussion Syndrome / prevention & control
  • Risk Factors


  • Analgesics, Non-Narcotic
  • Antiemetics
  • Acetaminophen
  • Ondansetron
  • Magnesium