{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T08:04:39Z","timestamp":1789286679002,"version":"build-2803163510"},"reference-count":14,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T00:00:00Z","timestamp":1780876800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T00:00:00Z","timestamp":1780876800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["UM1TR004400"],"award-info":[{"award-number":["UM1TR004400"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["headachejournal.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Headache"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>In a randomized, placebo\u2010controlled study, intravenous metoclopramide 20\u2009mg\u2009+\u2009diphenhydramine 25\u2009mg (M+D) improved post\u2010concussion symptoms 1 h later among patients seeking care in an emergency department (ED) following head trauma. We performed a secondary hypothesis\u2010generating analysis of those data to determine whether M+D is effective against cognitive and affective symptoms in addition to somatic symptoms, and whether post\u2010treatment symptomatology is associated with 1\u2010week and 1\u2010month outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We enrolled patients in two urban EDs in the Bronx, NY. Enrollment commenced in August 2017 and concluded in March 2020. Patients were included in the initial randomized controlled trial if they experienced head trauma and reported a new onset headache of at least moderate or severe intensity. We assessed post\u2010concussion symptoms at 1 h, 1 week, and 1 month after treatment using the Post\u2010Concussion Symptom Scale (PCSS), a 22\u2010item instrument on which each symptom is graded as zero (none) through 6 (severe). We determined the impact of treatment, time, and their interaction on PCSS score. We repeated this analysis among the somatic, cognitive, and affective domains of the PCSS scale. Finally, we determined if post\u2010treatment PCSS scores in the ED were associated with any severe symptom 1 week and 1 month later.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Eighty\u2010one participants received M+D; of those, 30 (37.0%) were female. Their mean age was 43.3 (standard deviation 16.1) years. All 81 provided 1\u2010h data; 72 (89.9%) provided 1\u2010week data; and 61 (75.3%) provided 1\u2010month data. Seventy\u2010nine received placebo; of those, 23 (29.1%) were female. Their mean age was 45.7 (SD 17.3) years. All 79 provided 1\u2010h data; 67 (84.8%) provided 1\u2010week data; and 54 (68.4%) 1\u2010month data. At 1 h, the overall mean PCSS score was 20.8 (SD 20.2); at 1 week it was 17.4 (SD 23.0); and at 1 month it was 19.5 (SD 27.7). Participants who received M+D reported lower post\u2010concussion symptom scores on the PCSS at 1\u2009h (9.2\u2009units lower, 95% confidence interval [CI]: 2.0, 16.4) but not at 1 week (7.2, 95% CI: \u22120.4, 14.9) or 1 month (2.4, 95% CI: \u22125.9, 10.8). In the main mixed\u2010effects model, there was a significant effect of treatment (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.008), indicating overall lower PCSS scores in the M+D group across follow\u2010up, although not for time (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.289) or treatment\u2010by\u2010time interaction (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.175). The treatment effect remained significant in the affective (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002) and cognitive (0.010) domains. PCSS scores prior to ED discharge were associated with severe symptoms at 1 week (adjusted odds ratio [OR] 1.02, 95% CI: 1.01, 1.04), but not 1 month (adjusted OR 1.02, 95% CI: 1.00, 1.04).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this exploratory secondary analysis, M+D improved post\u2010concussive symptoms 1 h after treatment, including affective and cognitive post\u2010concussion symptoms. PCSS scores after treatment are associated with 1\u2010week but not 1\u2010month outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/head.70119","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T05:07:16Z","timestamp":1780981636000},"page":"1859-1867","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of\n                    <scp>IV<\/scp>\n                    metoclopramide + diphenhydramine on post\u2010concussion symptoms. A secondary analysis of data from an\n                    <scp>ED<\/scp>\n                    \u2010based randomized study"],"prefix":"10.1111","volume":"66","author":[{"given":"Victoria","family":"Cao","sequence":"first","affiliation":[{"name":"Medical College Albert Einstein College of Medicine, Montefiore  Bronx New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8697-1041","authenticated-orcid":false,"given":"Elimelech","family":"Strassman","sequence":"additional","affiliation":[{"name":"Yeshiva College Yeshiva University  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Chertoff","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Albert Einstein College of Medicine, Montefiore  Bronx New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexis","family":"Cortijo\u2010Brown","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Albert Einstein College of Medicine, Montefiore  Bronx New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"McGregor","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Albert Einstein College of Medicine, Montefiore  Bronx New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew R.","family":"Williams","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Albert Einstein College of Medicine, Montefiore  Bronx New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8500-4075","authenticated-orcid":false,"given":"Michael P.","family":"Jones","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Albert Einstein College of Medicine, Montefiore  Bronx New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2753-5860","authenticated-orcid":false,"given":"Benjamin W.","family":"Friedman","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Albert Einstein College of Medicine, Montefiore  Bronx New York 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