What is the treatment for a concussion (mild traumatic brain injury)?

From the Guidelines

The primary treatment for a concussion is physical and cognitive rest followed by a gradual return to normal activities, as recommended by the most recent guidelines 1. This approach is supported by the 2024 American Heart Association and American Red Cross guidelines for first aid, which emphasize the importance of relative rest and gradual return to activities to prevent prolonged recovery or more serious injury. Initially, 24-48 hours of relative rest is recommended, avoiding activities that worsen symptoms. After this period, patients should slowly resume daily activities while staying below the threshold that triggers symptoms. Some key points to consider in the treatment of concussion include:

• Acetaminophen (500-1000mg every 6 hours as needed) can help manage headaches, but NSAIDs like ibuprofen should be avoided initially due to bleeding risk 1.
• Sleep is crucial for recovery, so maintaining regular sleep patterns is important.
• Hydration and proper nutrition also support healing.
• As symptoms improve, a step-wise return to physical activity should be followed: light aerobic exercise, sport-specific exercise, non-contact training drills, full-contact practice (after medical clearance), and finally return to competition.
• Each step typically takes 24 hours, and if symptoms return, the patient should step back to the previous level.
• Most concussions resolve within 7-10 days, though children and adolescents may take longer to recover.
• If symptoms persist beyond 10-14 days, further medical evaluation is warranted, and nonpharmacological treatments such as oculomotor visual treatment, psychological treatment, and interdisciplinary coordinated rehabilitative treatment may be considered 1.

From the Research

Treatment Approaches for Concussion

• The treatment for concussion typically involves a period of physical and cognitive rest, followed by a gradual return to activity 2, 3, 4.
• A multidisciplinary approach to management is recommended, including healthcare providers with experience in sports-related concussion 2, 5.
• Individualized treatment plans should be based on the patient's predominant signs and symptoms, and may include:
  • Subsymptom threshold aerobic exercise 5, 6
  • Cervical physical therapy 5, 6
  • Vestibulo-ocular rehabilitation 5
  • Behavioral and cognitive psychotherapy 5
  • Symptom-specific pharmacological therapies 5, 6

Investigation and Management of Persistent Symptoms

• Persistent symptoms (>10 days) are generally reported in 10-15% of concussions 2.
• Investigations may include formal neuropsychological testing and conventional neuroimaging to exclude structural pathology 2.
• Advanced neuroimaging techniques or genetic markers are not currently recommended for routine clinical use due to insufficient evidence 2.
• A graded exercise program at a level that does not exacerbate symptoms may be beneficial for patients with persistent symptoms 2, 6.

Role of Active Recovery and Rest

• The concept of "rest" has not been well defined, and there is significant variability in rest recommendations and adherence 4.
• Growing evidence suggests that an earlier return to light or moderate activity may facilitate symptomatic improvement and is not detrimental 3, 4.
• Active rehabilitation may play a role in recovery from concussion, and further research is needed to determine the optimal timing and approach 6, 4.