What is the immediate treatment for a brain concussion?

Immediate Treatment for Brain Concussion

A person with signs and symptoms of a concussion should be immediately removed from activity (play/sports) and not allowed to return to activity until evaluated by a healthcare professional. 1

Initial Assessment and Management

Primary Evaluation

• Assess severity using Glasgow Coma Scale (GCS), specifically the motor response, pupil size and reactivity 1
• Look for signs of severe head injury requiring emergency medical services activation:
  • Loss of consciousness
  • Worsening headache
  • Vomiting
  • Altered mental status
  • Seizures
  • Visual changes
  • Swelling or deformities of the scalp 1

Immediate Actions

1. Remove from activity: Immediately stop participation in any physical activity 1
2. Rest: Provide physical and cognitive rest in the acute phase
3. Avoid second injury: Any risk of an early second injury should be strictly avoided as it can worsen outcomes 1
4. Monitor: Observe for deteriorating physical or mental status 2

Medical Management

For Mild Concussion (No Severe Warning Signs)

• Physical rest: Limit activities that increase symptoms
• Cognitive rest: Reduce mental exertion that worsens symptoms
• Hydration: Maintain adequate fluid intake
• Avoid:
  • Alcohol
  • Non-prescribed sedatives
  • Activities with risk of head injury 1

For Severe Symptoms or Warning Signs

• Activate EMS immediately if any of the following are present:
  • Loss of consciousness
  • Repeated vomiting
  • Worsening headache
  • Altered mental status
  • Seizures
  • Focal neurological deficits 1

Diagnostic Considerations

• Concussion remains a clinical diagnosis made by a healthcare provider familiar with concussion recognition and evaluation 2
• Brain CT scan is indicated for patients with severe symptoms or deteriorating condition to rule out intracranial hemorrhage 3
• Routine spinal immobilization is not recommended for patients with concussion without specific indications 1

Follow-Up Care

• No same-day return to play for anyone diagnosed with a concussion 2
• Schedule follow-up with healthcare professional before returning to activities 1
• Return to activity should follow a gradual, step-wise progression only after symptoms have resolved 2
• Students may require academic accommodations such as reduced workload and extended time for tests 2

Common Pitfalls to Avoid

1. Premature return to activity: This can prolong recovery and increase risk of second injury 2
2. Overlooking subtle symptoms: Cognitive and emotional symptoms may be less obvious than physical ones
3. Inadequate rest: Insufficient physical and cognitive rest in early stages can delay recovery
4. Failing to schedule follow-up: All concussion patients should have structured follow-up care 1
5. Using rigid cervical collars or spine boards: These are not routinely recommended for concussion patients without specific indications 1

Special Considerations

• Recovery time varies significantly between individuals - most recover within 1-2 weeks, but some may take longer 4
• Women may have different recovery patterns than men due to cerebral sex differences in blood flow, glucose metabolism, and inflammatory responses 4
• Youth athletes may have more prolonged recovery and greater susceptibility to catastrophic injury 2
• Pre-existing conditions like mood disorders, learning disorders, attention-deficit disorders, and migraine headaches can complicate diagnosis and management 2

By following these guidelines, the immediate treatment of concussion focuses on preventing further injury, monitoring for serious complications, and creating conditions for optimal recovery.