From the Guidelines
Immediate care for a concussion patient should focus on rest and monitoring, with the patient being immediately removed from activity and not allowed to return until evaluated by a healthcare professional, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. The patient should rest physically and cognitively for 24-48 hours, avoiding screens, reading, and mentally demanding activities.
- Acetaminophen (Tylenol) can be used for headache pain at a dose of 650mg every 6 hours as needed, but NSAIDs like ibuprofen should be avoided due to bleeding risk.
- The patient should not be left alone for the first 24 hours, and a responsible adult should wake them every 2-3 hours during sleep to check for worsening symptoms.
- Warning signs requiring immediate emergency care include worsening headache, repeated vomiting, increasing confusion, seizures, weakness/numbness in limbs, or unusual behavior changes. For patients with signs or symptoms of severe head injury, such as loss of consciousness, worsening headache, vomiting, altered mental status, seizures, visual changes, swelling, or deformities of the scalp, EMS should be activated 1. Gradual return to normal activities should only begin when symptoms improve, typically starting with light cognitive tasks and progressing to more demanding activities over days to weeks. Hydration is important, and alcohol should be avoided. These measures help manage symptoms while the brain heals from the temporary disruption to normal function caused by the concussion. It is also essential to educate patients about postconcussive symptoms, which may include chronic headaches, dizziness, nausea, vision problems, increased sensitivity to noise and/or light, depression or mood swings, anxiety, irritability, memory problems, difficulty concentrating or paying attention, sleep difficulties, and feeling tired all the time 1. Patients experiencing these symptoms should refrain from strenuous mental or physical activity until they are symptom-free and may require referral to a specialist in traumatic brain injury 1.
From the Research
Immediate Care Instructions for Concussion
When a patient presents to urgent care with a concussion, the following care instructions should be considered:
- Immediate removal from activity is recommended, as it is associated with shorter clinical recovery and less severe symptoms 2
- Patients should be advised to rest and avoid activities that may exacerbate symptoms, but complete rest exceeding 3 days is probably not helpful 3
- Gradual resumption of pre-injury activities should begin as soon as tolerated, with the exception of activities that have a high risk of further head injury 3
Symptom Management
- Acute post-concussive headaches can be managed with routine analgesia administration, such as acetaminophen or ibuprofen 4
- Patients should be instructed on how to use a headache diary to track symptoms and monitor progress
- Supervised exercise may benefit patients with persistent symptoms 3
Discharge Advice
- Discharge advice should be well-informed and evidence-based, and should include guidelines on returning to sport or activity following concussion 5
- Patients should be advised to follow up with their primary care provider if symptoms persist or worsen
- Primary care providers play an important role in the medical assessment, management, and prevention of concussion, and should be familiar with national best practice guidelines 6