What are the generalized concise recommendations for a patient with a concussion (mild traumatic brain injury)?

From the Guidelines

For a patient with a concussion, removal from activities posing a risk of reinjury and gradual return to normal activities as symptoms allow is crucial. According to the 2024 American Heart Association and American Red Cross guidelines for first aid 1, a broad consensus of health care organizations recommends removing the person with a concussion from sports and other activities posing a risk of reinjury until the injured person has fully recovered.

Key Recommendations

• Initially, limit physical and cognitive activities for 24-48 hours, then gradually return to normal activities as symptoms allow.
• Avoid screens, bright lights, and loud noises that may worsen symptoms.
• Take acetaminophen (500-1000mg every 6 hours as needed) for headaches, but avoid NSAIDs like ibuprofen and aspirin in the first 24-48 hours as they may increase bleeding risk.
• Stay hydrated and maintain regular sleep patterns.
• Do not drive, operate heavy machinery, or consume alcohol until fully recovered.
• Return to sports should follow a stepwise protocol, beginning only when symptom-free at rest, and progressing through light aerobic activity, sport-specific exercise, non-contact training, full-contact practice (after medical clearance), and finally game play.

Warning Signs

• Loss of consciousness, severe or worsening headache, repeated vomiting, altered mental status, seizure, neurological signs and symptoms, and skull fracture are all associated with an increased risk of life-threatening brain injury such as epidural hematoma, subdural hematoma, open skull fracture, or brain edema, which may require hospital treatment 1.
• Seek immediate medical attention if symptoms worsen, or if experiencing severe headache, repeated vomiting, seizures, increasing confusion, or unusual behavior. The Centers for Disease Control and Prevention guideline on the diagnosis and management of mild traumatic brain injury among children also supports the idea of gradual return to activity, counseling patients to return to full activity when they return to premorbid performance if they have remained symptom-free at rest and with increasing levels of physical exertion 1.

From the Research

General Recommendations for Concussion Patients

• Rest is often recommended for patients with concussion, but the duration and type of rest are still debated 2, 3
• Complete rest exceeding 3 days is probably not helpful, and gradual resumption of preinjury activities should begin as soon as tolerated 3
• Supervised exercise may benefit patients with persistent symptoms 3
• Medications and supplements may be used to help manage or minimize disruptive symptoms, but are not routinely used in most concussions that recover within days to weeks 4

Activity Resumption and Return to Normal Daily Activity

• An initial period of moderate physical and cognitive rest may improve outcomes during the acute postinjury phase 5
• Gradual increase in activity may potentially 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
• Graded return-to-activity progression is recommended, but significant variability in the use of assessment tools and compliance with recommended guidelines exists 5

Management and Treatment of Concussion

• Concussion treatment plans may include temporary academic adjustments, physical therapy, vestibular and ocular therapy, psychological support, and graded noncontact exercise 4
• Standardized clinical tools have been developed and validated for assessment of acute concussion across injury settings 6
• Consensus guidelines provide guidance regarding injury management and approaches to ensure safe return to activity after acute concussion 6