If you or someone near you has just had a concussion, the first priority is ruling out a more serious brain injury, then shifting into a recovery approach that balances rest with light activity. Most concussions resolve within a few weeks, but what you do in the first hours and days matters for how quickly you recover.
Know the Danger Signs First
Most concussions are not life-threatening, but some head injuries cause bleeding or swelling inside the skull that requires emergency treatment. Call 911 or go to an emergency department if you notice any of these signs after a bump, blow, or jolt to the head:
- Seizures or convulsions
- Repeated vomiting
- A headache that keeps getting worse and won’t go away
- Slurred speech, weakness, numbness, or loss of coordination
- One pupil larger than the other, or double vision
- Increasing confusion, restlessness, or agitation
- Inability to recognize familiar people or places
- Loss of consciousness, extreme drowsiness, or inability to stay awake
For infants and toddlers, the same red flags apply, plus inconsolable crying or refusal to nurse or eat. These danger signs can appear immediately or develop over the first several hours, which is why someone should keep an eye on you (or the injured person) during the first night.
The First 48 Hours
Older advice told people to lie in a dark room and avoid all stimulation. That’s no longer recommended. Current guidelines call for a brief period of reduced activity, not total shutdown. Limit screen time for the first one to two days, and avoid activities that are physically or mentally demanding. But don’t isolate yourself in a dark room all day or stay in bed doing nothing.
Light physical activity, like short walks, is actually encouraged even if you still have mild symptoms. The 2022 International Consensus Statement on Concussion in Sport found stronger evidence that light aerobic exercise within the first 48 hours benefits recovery. If your symptoms get noticeably worse during an activity, scale back temporarily, but don’t avoid all movement.
Stay connected to friends and family. Social isolation during recovery can worsen mood-related symptoms like irritability, sadness, and anxiety, all of which are common after a concussion.
Pain Relief: What’s Safe and What’s Not
For headaches, acetaminophen (Tylenol) is the go-to option. Do not take ibuprofen (Advil, Motrin) or aspirin in the early days after a concussion. Both of these thin the blood and may increase the risk of bleeding inside the skull. Check with a healthcare provider before taking anything beyond acetaminophen, especially if your headache is severe or persistent.
Sleep and Overnight Monitoring
You may have heard that you shouldn’t let a concussed person fall asleep. Sleep is actually important for brain recovery, and there’s no reason to avoid it. What matters is that someone checks on the injured person periodically during the first night to make sure they’re rousable and not showing any of the danger signs listed above. If the person can be woken, responds normally, and then goes back to sleep, that’s fine. If they can’t be woken or seem confused when roused, that warrants an emergency visit.
Getting Back to School or Work
Returning to mental activity follows a gradual approach, similar to returning to sports. The goal is to do as much as you can tolerate without making symptoms significantly worse. For students, this typically means working with the school to set up temporary accommodations. Practical adjustments include reducing homework to essential assignments only, allowing extra time on tests (and limiting tests to one per day), providing written class notes or permission to record lectures, and offering rest breaks during the school day.
If light sensitivity is an issue, wearing sunglasses indoors or sitting away from windows can help. If noise is a problem, a quiet space for studying, testing, or lunch makes a difference. These supports should be available to all teachers so the student gets consistent help throughout the day. As symptoms improve, accommodations are gradually removed until the student is back to a normal routine.
For adults returning to work, the same principle applies. Start with shorter days or reduced workloads if full days trigger symptoms, then build back up.
Returning to Sports
Athletes follow a specific six-step progression, and each step takes at least 24 hours. You only move to the next step if no new symptoms appear. This means a full return to competition takes a minimum of six days, often longer.
- Step 1: Resume regular daily activities (school, work) and get clearance from a healthcare provider to begin the progression.
- Step 2: Light aerobic activity only, like 5 to 10 minutes on a stationary bike, walking, or light jogging. No weight lifting.
- Step 3: Moderate activity that increases heart rate with body or head movement, such as moderate jogging, brief running, and lighter-than-usual weightlifting.
- Step 4: Heavy non-contact activity, including sprinting, high-intensity biking, your regular weightlifting routine, and sport-specific drills.
- Step 5: Full practice with contact (if the sport involves it), in a controlled setting.
- Step 6: Return to competition.
If symptoms return at any step, drop back to the previous step and try again after another 24 hours of being symptom-free. A healthcare provider should supervise this entire process.
How a Concussion Is Assessed
There’s no single blood test or brain scan that definitively diagnoses a concussion. CT scans and MRIs are used to rule out bleeding or structural damage, but a concussion itself typically doesn’t show up on imaging. Instead, healthcare providers use standardized assessment tools that test several areas of brain function: memory (both immediate and delayed recall), concentration, orientation, balance, coordination, and eye movement. They also evaluate a checklist of 22 common symptoms ranging from headache and dizziness to fogginess, trouble sleeping, and feeling “not right.”
These assessments are most useful when compared to a baseline taken before injury, which is why many sports programs now do preseason testing.
When Symptoms Don’t Go Away
Most concussion symptoms clear up within a few weeks, but in some people, they persist for three months or longer. This is called persistent post-concussive symptoms, and it typically becomes apparent within the first 7 to 10 days. Symptoms can occasionally last a year or more.
Persistent symptoms don’t necessarily mean the brain injury was more severe. They can involve ongoing headaches, difficulty concentrating, dizziness, sleep problems, or mood changes. Targeted rehabilitation approaches can help, including specific exercises for people dealing with neck pain, dizziness, or balance problems after a concussion. If your symptoms aren’t improving after several weeks, a provider experienced in concussion management can guide treatment rather than simply continuing the “wait and rest” approach.