From the Guidelines
Concussion treatment and management should prioritize active management and treatment of persistent postconcussion symptoms (PPCS) through individual disciplines targeting specific problems and interdisciplinary rehabilitation, as recommended by the most recent and highest quality study 1. The approach to concussion treatment and management involves several key components, including:
- Initial physical and cognitive rest for 24-48 hours, followed by a gradual, symptom-limited return to daily activities
- Use of acetaminophen (500-1000mg every 6 hours as needed) for headache management, while avoiding NSAIDs like ibuprofen in the first few days due to bleeding risk
- Importance of sleep hygiene, without regular awakenings to check symptoms
- A step-wise return to activity protocol, including light cognitive activities, school/work with accommodations, light aerobic exercise, sport-specific exercise, non-contact training drills, full-contact practice (after medical clearance), and return to competition
- Each step typically takes 24-48 hours, with a return to the previous step if symptoms worsen
- Hydration, proper nutrition, and avoiding alcohol are crucial for recovery
- Most concussions resolve within 7-10 days, but some may take weeks or months, and persistent symptoms beyond 2-4 weeks warrant referral to a concussion specialist, as supported by recent guidelines 1. The latest clinical policy approved by the American College of Emergency Physicians (ACEP) board of directors in 2023 1 emphasizes the importance of identifying patients requiring follow-up care for postconcussive syndrome or delayed sequelae after ED discharge, highlighting the need for a comprehensive approach to concussion management. Key considerations in concussion treatment and management include:
- Early information and advice
- Graded physical exercise
- Vestibular rehabilitation
- Manual treatment of neck and spine
- Oculomotor vision treatment
- Psychological treatment
- Interdisciplinary coordinated rehabilitative treatment, as outlined in recent systematic reviews and meta-analyses 1.
From the Research
Concussion Treatment and Management
- Concussion is a common problem that can be managed by nonneurologists, and its symptoms include headaches, dizziness, sleep disturbance, psychiatric symptoms, and cognitive issues 2
- Management of concussion includes rapid removal from play, symptomatic treatment, and return to learn/play recommendations, and inappropriate management may lead to recurrent concussions, prolonged recovery, and potential long-term consequences 3
- Rest recommendations for the concussed population are discussed, and research suggests that activity in the initial stages of concussion recovery may be beneficial in reducing postconcussion symptom duration and severity 4
- Medications used in postconcussion syndrome are typically used to help manage or minimize disruptive symptoms while recovery proceeds, and medications and supplements remain a small part of the concussion treatment plan 5
Key Components of Concussion Management
- Evaluation and management of concussion, including treatment of the most common symptoms 2
- Identification, diagnosis, management, and referral of patients with concussion 3
- Use of standardized clinical tools for assessment of acute concussion across injury settings 6
- Gradual increase in activity to aid in returning to normal daily activity sooner 4
- Temporary academic adjustments, physical therapy, vestibular and ocular therapy, psychological support, and graded noncontact exercise as part of the concussion treatment plan 5
Importance of Proper Management
- Understanding the key features of diagnosis, postinjury assessment tools, symptomatic treatment, and management of concussion is essential for primary care providers 3
- Consensus guidelines provide guidance regarding injury management and approaches to ensure safe return to activity after acute concussion 6
- Inappropriate management may lead to recurrent concussions, prolonged recovery, and potential long-term consequences 3