What are the symptoms and treatment options for a concussion (mild traumatic brain injury)?

From the Guidelines

If you suspect a concussion, seek medical attention immediately, and rest is the primary treatment, both physical and cognitive, for 24-48 hours followed by a gradual return to normal activities as symptoms improve, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. The symptoms of a concussion include headache, nausea, impaired balance, difficulties concentrating, confusion, emotional lability, and fatigue, and repeated concussions may lead to long-term difficulties with memory, concentrating, fatigue, headache, and other neurological sequelae 1. When it comes to treatment, rest is the primary approach, with a gradual return to activities, and acetaminophen (Tylenol) can be used for headaches, while avoiding NSAIDs like ibuprofen due to the potential risk of bleeding 1. It's also crucial to stay hydrated and eat regularly, and symptoms typically include headache, confusion, dizziness, nausea, sensitivity to light and noise, and sometimes memory problems or mood changes 1. Most concussions resolve within 7-10 days, but some may take weeks or months, and return to sports or physical activities should follow a stepwise protocol, beginning with light aerobic exercise and gradually increasing intensity only when symptom-free at each stage, as outlined in the 2024 American Heart Association and American Red Cross guidelines for first aid 1. Multiple concussions can have cumulative effects, so prevention through proper equipment and technique in sports is crucial, and the brain needs time to heal; returning to activities too soon risks prolonged symptoms or second impact syndrome, which can be life-threatening 1. Some key points to consider in the management of concussions include:

• The importance of immediate removal from activity if a concussion is suspected, and not allowing return to activity until evaluated by a healthcare professional 1
• The need for a gradual return to activities, with a stepwise protocol to ensure safe progression 1
• The potential benefits of nonpharmacological treatments, such as graded physical exercise, vestibular rehabilitation, and psychological treatment, for persistent postconcussion symptoms 1
• The importance of individualized treatment approaches, taking into account the specific needs and circumstances of each patient 1

From the Research

Symptoms of Concussion

• Concussion is a physiological brain injury with physical, cognitive, and emotional sequelae 2
• Symptoms of concussion can include headaches, dizziness, sleep disturbance, psychiatric symptoms, and cognitive issues 3
• Persistence of symptoms beyond the generally accepted time frame for recovery is called post-concussion syndrome (PCS) 2, 4
• PCS is not a single entity; it is a group of disorders that requires specific forms of therapy 2

Treatment Options for Concussion

• Rest has been the mainstay of the treatment for concussion and PCS 2, 4
• Active treatment of concussion and PCS, including sub-symptom threshold aerobic exercise, cervical physical therapy, vestibular therapy, vision therapy, cognitive rehabilitation, and cognitive behavioral therapy, has emerged as an effective approach 5, 6
• Treatment options may also include pharmacological management, or a combination of treatments 5
• Individualized treatment, based on predominant signs and symptoms, is recommended 6
• A multidisciplinary approach to clinical management may be required 6

Management of Post-Concussion Syndrome

• Management of concussion and PCS relies on identifying underlying symptom generators 5
• Treatment approaches depend on the clinician's ability to differentiate among the various conditions associated with PCS 4
• Early education, cognitive behavioral therapy, and aerobic exercise therapy have shown efficacy in certain patients 4
• An algorithm can be used to aid clinicians in the evaluation and treatment of concussion and PCS, and in the return-to-activity decision 4