What is the recommended treatment for a concussion?

Treatment for Concussion

The recommended treatment for concussion includes a brief period of 24-48 hours of relative rest followed by a gradual return to activities, with careful monitoring of symptoms and a stepwise progression back to normal functioning. 1

Initial Management (First 24-48 Hours)

• Relative rest for 24-48 hours - Not complete bed rest, but reduction in physical and cognitive activities 1, 2, 3
• Avoid activities that worsen symptoms 1
• Avoid NSAIDs and aspirin immediately after injury due to theoretical risk of intracranial bleeding 1
• Monitor for warning signs of more serious injury (worsening headache, repeated vomiting, seizures, increasing confusion) 1
• No routine neuroimaging unless intracranial injury is suspected 1

Progressive Return to Activity (After Initial 24-48 Hours)

Physical Activity Progression

1. Light aerobic exercise (walking, stationary cycling) at subsymptom threshold 1, 4
2. Sport-specific training (running, skating) without risk of head impact 1
3. Non-contact training drills 1
4. Full contact training (after medical clearance) 1
5. Return to full activity/sport 1

Each step should take a minimum of 24 hours. If symptoms return, drop back to previous asymptomatic level and try again after 24 hours 1

Cognitive Activity Progression

1. Limited cognitive activity initially (reading, screen time) 1, 4
2. Gradual return to school/work with accommodations as needed 1
3. Consider temporary academic accommodations 1:
   • Shortened school day
   • Reduced workload
   • Extended time for assignments/tests
   • Postponing standardized testing

Treatment for Specific Persistent Symptoms

For symptoms persisting beyond 2 weeks:

• Vestibular rehabilitation for dizziness/balance issues 1
• Graded physical exercise supervised by healthcare professionals 1, 5
• Manual therapy for neck pain and headaches 1
• Psychological treatment for emotional symptoms 1
• Oculomotor vision therapy for visual disturbances 1
• Interdisciplinary coordinated rehabilitation for complex cases 1

Important Considerations

• Avoid returning to play while symptomatic - "When in doubt, sit them out!" 1
• Complete symptom resolution should occur before returning to contact sports 1
• Avoid elective surgery for at least 4 weeks after concussion 6
• No medications are FDA-approved specifically for concussion treatment 2
• Prolonged complete rest is detrimental and can worsen outcomes 2, 3

Common Pitfalls to Avoid

1. Prescribing complete rest until all symptoms resolve - This outdated approach can prolong recovery 3, 4
2. Returning to activities too quickly - Can exacerbate symptoms and prolong recovery 1
3. Ignoring cognitive rest - Mental exertion can worsen symptoms just like physical exertion 1
4. Failing to provide adequate education to patients and families about expected recovery 1
5. Using medications to mask symptoms to allow premature return to activities 1

The most recent evidence strongly supports early, controlled, subsymptom threshold activity rather than prolonged rest, with a gradual and monitored return to both cognitive and physical activities 4, 5. This approach has been shown to reduce recovery time by approximately 4.6 days compared to strict rest protocols 4.