What are the guidelines for at-home management of a concussion (mild traumatic brain injury)?

From the Guidelines

Home management of a concussion involves rest and gradual return to activities, with an initial 24-48 hours of physical and cognitive rest, followed by a gradual resumption of normal activities as tolerated, stopping if symptoms worsen, as recommended by the Centers for Disease Control and Prevention 1. The most recent and highest quality study, published in 2024 by the American Heart Association and American Red Cross, emphasizes the importance of removing individuals with concussion from activities that pose a risk of reinjury until they have fully recovered, and provides guidelines for first aid and return to activity 1. Key aspects of home management include:

• Initially, physical and cognitive rest for 24-48 hours, avoiding screens, reading, and mentally demanding tasks
• Gradually resuming normal activities as tolerated, stopping if symptoms worsen
• Taking acetaminophen (Tylenol) 325-650mg every 4-6 hours as needed for headaches, but avoiding NSAIDs like ibuprofen and aspirin due to bleeding risk
• Staying hydrated and maintaining regular sleep patterns
• Monitoring for worsening symptoms such as severe headache, repeated vomiting, seizures, increasing confusion, or unusual behavior, which require immediate medical attention A systematic review of clinical practice guidelines for pediatric mild traumatic brain injury, published in 2024, also recommends a period of relative rest for 24 to 48 hours immediately following acute mTBI, and provides guidance on discharge advice, follow-up, and return to play/recreation and school 1. Recovery typically takes 7-10 days for adults and longer for children and adolescents, and this approach allows the brain to heal while preventing complications from prolonged inactivity, as supported by the 2018 Centers for Disease Control and Prevention guideline on the diagnosis and management of mild traumatic brain injury among children 1.

From the Research

At Home Management of Concussion

• The management of concussion at home can be challenging, but research suggests that a gradual increase in activity may aid in returning to normal daily activity sooner than those who avoid both physical and cognitive activity during the acute stage of a traumatic brain injury 2.
• It is essential to evaluate and manage concussion symptoms, including headaches, dizziness, sleep disturbance, psychiatric symptoms, and cognitive issues 3.
• Medications used in postconcussion syndrome are typically used to help manage or minimize disruptive symptoms while recovery proceeds, but are not routinely used in most concussions that recover within days to weeks 4.

Symptom Management

• Acute postconcussive headaches can be managed with routine analgesia administration, such as ibuprofen and acetaminophen, which has been shown to be feasible and effective in reducing headache days, episodes, and intensity 5.
• Exercise has been recommended as an appropriate therapy for adolescents with acute concussion/mTBI, while strict rest and high-intensity physical activity may have detrimental effects 6.

Rehabilitation and Return to Activity

• Rehabilitation and return to activity protocols for concussion/mTBI are not well-established, and more research is needed to evaluate the effects of these interventions 6.
• A gradual return to activity, including physical and cognitive exercises, may be beneficial in aiding recovery, but individual patient needs should be considered 2, 6.