From the Guidelines
Patients with a concussion and normal CT scans of the head and neck should follow a gradual return to normal activities while monitoring symptoms, as supported by the most recent and highest quality study 1.
Key Recommendations
- For the first 24-48 hours, rest is recommended with limited physical and cognitive exertion.
- Acetaminophen (Tylenol) 650mg every 6 hours as needed is preferred for headache pain; avoid NSAIDs like ibuprofen and aspirin initially due to bleeding risk.
- After the initial rest period, patients should gradually resume normal activities as tolerated, stopping if symptoms worsen.
- Sleep in a dark, quiet room is important for recovery.
- Patients should not drive, operate heavy machinery, consume alcohol, or take sedating medications during recovery.
- They should return to medical care immediately if experiencing worsening headache, repeated vomiting, increasing confusion, slurred speech, weakness/numbness, seizures, or unusual behavior.
Considerations for Anticoagulated Patients
- The risk of delayed intracranial hemorrhage (ICH) in anticoagulated patients with a normal initial head CT scan is low, and most studies support safe discharge with clear instructions for return precautions 1.
- However, patients on anticoagulants or antiplatelet agents should be closely monitored, and the decision to discharge should be made on a case-by-case basis.
Follow-up and Recovery
- Most concussion symptoms resolve within 7-10 days, though some patients may experience symptoms for weeks or months.
- Follow-up with a healthcare provider is recommended within 1-2 weeks to assess recovery progress.
- Patients should be informed about the possibility of postconcussive symptoms and the importance of follow-up care 1.
From the Research
Concussion Management Instructions
For patients with a normal CT head and neck, the following instructions can be provided:
- Patients should be educated on how to manage their symptoms, including headaches, dizziness, sleep disturbance, psychiatric symptoms, and cognitive issues 2
- For acute postconcussive headaches, analgesics such as ibuprofen and acetaminophen can be used for short-term headache relief 3, 4
- However, clinicians should be cautious with long-term medication overuse in patients whose headache symptoms persist 4
- Patients should be instructed on how to use a headache diary to track their symptoms and monitor their progress 3
Medication Management
- Ibuprofen and acetaminophen can be used to manage postconcussive headaches, but their effectiveness in reducing headache days and intensity may vary 3, 4
- Metoclopramide, physiologic saline, and nonsteroidal anti-inflammatory agents (NSAIDS) are commonly used treatments for refractory post-concussion headaches in the emergency department 5
- However, the effectiveness of these treatments is not well established, and further research is needed to determine the best course of treatment 5
Follow-up Care
- Patients with a normal CT head and neck should be followed up to monitor their symptoms and adjust their treatment plan as needed 2
- Patients with persistent or severe symptoms may require further evaluation and treatment, including referral to a specialist 6
- Patients with a Glasgow Coma Scale (GCS) score < or =8 may require routine repeat head CT scans to monitor for any changes in their condition 6