Dizziness: vestibular nucleus and cerebellovestibular pathway dysfunction
Sleep disturbance: hypothalamic and reticular activating system disruption
Chronic traumatic encephalopathy (CTE) risk
Repetitive subconcussive impacts associated with tau protein accumulation
CTE diagnosed only at autopsy; causation not fully established
Single concussion insufficient evidence to cause CTE
Therapeutic Considerations
Evidence base for treatment
Strict prolonged rest: evidence shows inferior outcomes to active approach
Brief relative rest 24-48 hours then graduated activity
ACEP 2023 Clinical Policy Level B
Aerobic exercise early after injury
Reduces incidence of persisting symptoms
Improves cerebrovascular autoregulation
Evidence: Scorza and Cole 2019, multiple RCTs
Analgesics: no concussion-specific pharmacotherapy exists
Acetaminophen and NSAIDs for symptom control only
Risk of medication-overuse headache with frequent use
Biomarker and serology evidence
GFAP and UCH-L1: FDA-cleared blood test
Helps predict CT findings within 12 hours
Does not diagnose or rule out concussion
ACEP 2023 Clinical Policy Level B: serum biomarkers may be used to predict CT findings
Emerging and investigational therapies
Omega-3 fatty acids (DHA and EPA)
Strongest emerging evidence for neuroprotective benefit
Particularly for athletes exposed to repetitive head impacts
No definitive human clinical trial evidence yet for treatment
Cervical and vestibular physiotherapy
Strong evidence for benefit in vestibular-oculomotor concussion subtype
Reduces recovery time
Patient Discharge Instructions
copy discharge instructions
Discharge instructions for concussion
You have been diagnosed with a concussion
A concussion is a brain injury caused by a blow or jolt to the head
Most people recover fully within 2-4 weeks
Recovery is faster with the right care at home
Activity in the first 24-48 hours
Rest, but strict complete rest is not necessary or recommended
Light activities such as walking are acceptable if symptoms allow
Gradually increase activity as symptoms improve
Avoid activities that significantly worsen your symptoms
Return to school and work
Begin with partial days and shorter tasks
Ask your doctor for an accommodation letter if needed
Return to school before returning to contact sport
Return to sport and physical activity
Do not return to contact sport until cleared by a doctor
Follow the graduated return-to-sport program as instructed
Do not skip steps even if you feel better
Medications for headache at home
Acetaminophen 500-1000 mg every 4-6 hours as needed
Ibuprofen 400-600 mg every 6-8 hours as needed with food
Do not use pain medications more than 10 days per month to avoid rebound headache
Avoid opioid pain medications
Sleep and rest
Maintain a regular sleep schedule
It is safe to sleep after a concussion if you are awake and alert now
Your companion should check on you in the first night
Diet and hydration
Stay well hydrated
Do not skip meals
Avoid alcohol during recovery
Limit caffeine
Follow-up appointment
See your doctor within 1 week of your injury
Earlier if symptoms are worsening
Return to the emergency department immediately if any of the following occur
Headache that is getting significantly worse
Repeated vomiting
Increasing confusion, drowsiness, or difficulty waking up
Seizure or convulsions
Weakness, numbness, or tingling in arms or legs
Slurred speech
Unequal pupils
Inability to recognize people or places
Unusual behavior or agitation
Loss of consciousness
References
Guidelines and Key Sources
ACEP Clinical Policy 2023
Valente JH et al. Annals of Emergency Medicine 2023
Critical Issues in the Management of Adult Patients with Mild Traumatic Brain Injury
ACEP Board approved February 2023
Sport-Related Concussion
Leddy JJ. New England Journal of Medicine. 2025
Comprehensive review of sport-related concussion management
American Medical Society for Sports Medicine Position Statement
Harmon KG et al. Clinical Journal of Sport Medicine. 2019
Evidence-based concussion management in sport
Concussion in Sport - 6th International Conference Recommendations
Lau K. American Family Physician. 2024
Amsterdam consensus statement update
Current Concepts in Concussion
Scorza KA, Cole W. American Family Physician. 2019
Initial evaluation and management
Diagnosis and Management of Concussion
Reams N. Clinics in Sports Medicine. 2026
Action Collaborative on Traumatic Brain Injury Care
Silverberg ND et al. Annals of Family Medicine. 2025
Adapted Clinical Practice Guideline
ACR Appropriateness Criteria Head Trauma 2021 Update
Expert Panel on Neurological Imaging, Shih RY et al. JACR. 2021
Sport-Related Concussion in Children and Adolescents
Halstead ME, Walter KD, Moffatt K. Pediatrics. 2018
AAP policy statement
ACS Best Practices in Management of Traumatic Brain Injury
Manley GT et al. American College of Surgeons. 2024
Post-Traumatic Headache After Traumatic Brain Injury
Ashina H et al. Lancet Neurology. 2021
Emergency Department Risk Factors for Post-Concussion Syndrome
Lubbers VF et al. Journal of Neurotrauma. 2024
Systematic review of ED predictors
Association of Pharmacological Interventions with Symptom Burden
Feinberg C et al. JAMA Neurology. 2021
Systematic review of pharmacological treatment in mTBI
Does This Child Have a Concussion
Shah SN et al. JAMA. 2026
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.