What are the guidelines for adolescent mild traumatic brain injuries (mTBI) or concussions?

From the Guidelines

Guidelines for adolescent concussions prioritize prompt recognition, appropriate rest, and gradual return to activities, with a focus on minimizing cognitive and physical overexertion while encouraging a prompt return to school to avoid prolonged school absence, as recommended by the Centers for Disease Control and Prevention guideline on the diagnosis and management of mild traumatic brain injury among children 1.

Key Recommendations

• If a concussion is suspected, the adolescent should immediately stop all physical activity and be evaluated by a healthcare professional.
• Initial management includes physical and cognitive rest for 24-48 hours, followed by a gradual return to normal activities as symptoms improve.
• Pain can be managed with acetaminophen (Tylenol) at appropriate doses, but ibuprofen and aspirin should be avoided due to bleeding risk.
• Sleep hygiene is important for recovery, with regular sleep schedules and adequate rest.
• Return to school should be gradual, with accommodations like reduced workload, extended time for assignments, and frequent breaks as needed.
• Return to sports follows a stepwise progression: light aerobic activity, sport-specific exercise, non-contact training drills, full-contact practice, and finally return to competition, with each step taking at least 24 hours and requiring symptom-free status before advancing, as supported by the clinical practice guideline recommendations in pediatric mild traumatic brain injury: a systematic review 1.

Considerations for Recovery

• Adolescent brains are still developing and more vulnerable to concussion effects, with potentially longer recovery times than adults.
• Multiple concussions require more conservative management and may warrant consideration of sport modification or cessation.
• The use of biomarkers outside of the research setting for the diagnosis of children with mild traumatic brain injury is not recommended, as stated in the clinical practice guideline recommendations in pediatric mild traumatic brain injury: a systematic review 1.
• Healthcare professionals should inform the family on warning signs of more serious injury, description of injury and expected course of symptoms and recovery, instructions on how to monitor postconcussive symptoms, prevention of further injury, management of cognitive and physical activity/rest, instructions regarding return to play/recreation and school, and clear clinician follow-up instructions, as recommended by the Centers for Disease Control and Prevention guideline on the diagnosis and management of mild traumatic brain injury among children 1.

From the Research

Guidelines for Adolescent Concussions

• The management of adolescent concussions is a complex issue, and there are various guidelines and studies that provide insight into the best practices for treatment [ 2, 3, 4, 5, 6 ].
• According to a study published in 2017, routine analgesia administration was found to be feasible and effective for post-concussive headache management in children and youth [ 2 ].
• However, a 2022 study found that exposure to ibuprofen, acetaminophen, or both in the acute phase does not decrease the risk of headache at 7 days post-concussion [ 3 ].
• Another study published in 2025 found that prescribed early physical activity and behavioral management did not improve post-concussion outcomes in the first two weeks following injury [ 4 ].
• A 2022 survey of emergency department physicians found that treatment for refractory post-concussion headaches in the pediatric ED is highly variable, with most selecting intravenous treatments [ 5 ].
• A 2025 study found that over-the-counter analgesic use after concussion was associated with faster recovery and lower symptom severity, regardless of medication type [ 6 ].

Treatment Options

• Acetaminophen and ibuprofen are commonly used to treat post-concussive headaches in adolescents [ 2, 3, 6 ].
• Intravenous treatments, such as metoclopramide and physiologic saline, are also used in some cases [ 5 ].
• Non-opioid analgesics, such as NSAIDs, may be prescribed for short-term headache relief, but clinicians should be cautious of long-term medication overuse [ 3 ].

Recovery and Symptom Severity

• Early analgesic administration has been shown to be associated with faster recovery and lower symptom severity [ 6 ].
• However, a 2022 study found that exposure to ibuprofen, acetaminophen, or both in the acute phase does not decrease the risk of headache at 7 days post-concussion [ 3 ].
• Prescribed early physical activity and behavioral management did not improve post-concussion outcomes in the first two weeks following injury [ 4 ].