From the Guidelines
If you suspect a concussion, seek medical evaluation immediately, as prompt assessment and management can significantly impact morbidity, mortality, and quality of life. A concussion is a mild traumatic brain injury caused by a blow or jolt to the head that disrupts normal brain function 1. The primary treatment involves rest, both physical and cognitive, especially in the first 24-48 hours, to allow the brain to recover from the temporary disruption in normal brain cell function and blood flow, which leads to an energy crisis at the cellular level that requires rest to resolve 1.
Key Recommendations
- Rest is crucial: Both physical and cognitive rest are essential in the initial 24-48 hours after a concussion to facilitate recovery and minimize the risk of further injury or prolonged symptoms 1.
- Gradual Return to Activities: Gradually return to normal activities as symptoms improve, following the healthcare provider's guidance to prevent exacerbation of symptoms and ensure a safe return to full activity 1.
- Pain Management: For pain management, acetaminophen (Tylenol) is preferred at regular doses (325-650mg every 4-6 hours, not exceeding 3000mg daily) to minimize the risk of bleeding associated with NSAIDs like ibuprofen 1.
- Warning Signs: Warning signs that require immediate medical attention include worsening headache, repeated vomiting, seizures, increasing confusion, or unusual behavior, as these could indicate a more severe injury or complication 1.
Prevention and Long-term Considerations
Prevention involves wearing appropriate protective gear during sports, using seatbelts, and making living spaces fall-proof to reduce the risk of concussions and other injuries 1. It's also important to note that while most concussions resolve within 7-10 days, some may take weeks or months, and a small percentage may experience persistent postconcussive symptoms, emphasizing the need for ongoing medical evaluation and support as needed 1.
Given the potential for long-term difficulties with memory, concentrating, fatigue, headache, and other neurological sequelae following repeated concussions, it is crucial to prioritize caution and adhere to guidelines for return to play and other activities to minimize risk 1.
From the Research
Definition and Diagnosis of Concussion
- Concussion is a type of traumatic brain injury that can be diagnosed using standardized clinical tools 2
- A structured method for diagnosis includes a history, physical examination, and additional tests as clinically indicated to help identify underlying symptom generators 3
Management and Treatment of Concussion
- Rest recommendations for concussed individuals should be tailored to each head-injured individual, and activity in the initial stages of concussion recovery may be beneficial in reducing postconcussion symptom duration and severity 4
- Treatment for concussion and persistent postconcussive symptoms (PPCS) should be individualized, based on predominant signs and symptoms, and can include subsymptom threshold aerobic exercise, cervical physical therapy, vestibulo-ocular rehabilitation, behavioral and cognitive psychotherapy, and some symptom-specific pharmacological therapies 3
- Medications used in postconcussion syndrome are typically used to help manage or minimize disruptive symptoms while recovery proceeds, and may include analgesics such as ibuprofen and acetaminophen 5, 6
Rehabilitation and Return to Activity
- A 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 4
- Graded noncontact exercise, physical therapy, and vestibular and ocular therapy may be included in the concussion treatment plan to help athletes return to activity 6
- Patients who receive routine analgesia administration, such as ibuprofen and acetaminophen, may be more likely to return to school or activity sooner than those who do not receive these medications 5