Optimal Management of Concussion Symptoms

Initial Management

The American Academy of Neurology recommends complete physical rest for the first 24-48 hours after concussion, as well as cognitive rest, including limiting activities requiring concentration such as reading, video games, computer use, television, and exposure to loud music or bright lights 1
Avoid medications except acetaminophen as recommended by a physician, and avoid alcohol, illicit drugs, or other substances that might interfere with cognitive function and recovery 1

Patients should return to the emergency department if experiencing repeated vomiting, worsening headache, problems remembering or confusion, focal neurologic deficits, abnormal behavior, increased sleepiness or loss of consciousness, or seizures 2

A structured return to activity protocol should be followed, with each step taking a minimum of 24 hours, and including no activity, light aerobic exercise, sport-specific training, non-contact training drills, full contact practice, and return to normal activity/play 1

Graded physical exercise should be considered for persistent symptoms, with exercise gradually increasing in intensity and complexity over time, and performed at least once weekly for a minimum of 4 weeks 4, 5
Vestibular rehabilitation is recommended for patients with persistent vestibular dysfunction, including otolith manipulating procedures, habituation exercises, adaptation exercises, and balance training, administered at least once weekly for a period of 4 weeks 4, 5
Manual therapy for neck and spine should be considered for persistent symptoms, especially when neck pain is present, including mobilization and/or manipulation of the spine or other joints 4, 5

Baseline cognitive and postural stability testing should be considered for athletes in high-risk sports, and the term "ding" should not be used to describe concussion as it diminishes the seriousness of the injury 6
Students may require academic accommodations such as temporary leave of absence, shortened school days, reduced workloads, extended time for assignments and tests, and postponement of standardized testing 1

Returning to activity too soon before symptoms have resolved, inadequate rest in the initial 24-48 hours, ignoring symptoms or lack of proper medical evaluation, and strict rest beyond 48 hours, which can be detrimental to recovery 1, 7, 8

Chronic headaches, dizziness and balance problems, vision problems, increased sensitivity to noise and/or light, depression or mood swings, memory problems, difficulty concentrating, sleep difficulties, and persistent fatigue should be monitored, and referral to a specialist in traumatic brain injury is recommended if these symptoms persist beyond 3 weeks 2, 3