If someone has just taken a blow to the head and you suspect a concussion, the most important first aid steps are to stop all activity, keep the person still, and watch closely for danger signs that require emergency care. Most concussions don’t need an ER visit, but the first 48 hours demand careful monitoring and rest.
Recognize Concussion Symptoms
A concussion doesn’t always involve losing consciousness. In fact, most don’t. The symptoms can be subtle and may take minutes or even hours to appear. Physical signs include headache, dizziness, balance problems, nausea or vomiting, sensitivity to light or noise, blurred vision, and fatigue. Thinking changes show up as trouble concentrating, feeling foggy or slowed down, difficulty with memory, or struggling to think clearly.
Emotional and behavioral shifts are easy to miss but just as telling. The person may seem unusually irritable, anxious, sad, or more emotional than normal. Symptoms also shift over time. Headaches and nausea tend to appear early, while sleep problems and mood changes often surface a week or two later.
Know the Danger Signs That Need 911
Some symptoms signal a more serious brain injury. Call 911 or go to an emergency department immediately if you see any of the following:
- Seizures or convulsions
- Loss of consciousness, increasing drowsiness, or inability to stay awake
- A headache that keeps getting worse and won’t go away
- Repeated vomiting
- Slurred speech, weakness, numbness, or loss of coordination
- One pupil larger than the other, or double vision
- Increasing confusion, agitation, or unusual behavior
- Inability to recognize people or places
For infants and toddlers, add inconsolable crying and refusal to eat or nurse to this list. Any of these signs mean you’re dealing with something beyond a standard concussion, and the person needs professional evaluation right away.
Immediate First Aid Steps
While you’re assessing the situation or waiting for help, follow these steps:
Stop all activity. If this happened during a sport, game, or any physical activity, the person should come out immediately and not return. If it happened in a fall or accident, don’t let them shake it off and keep going.
Keep the person still. Have them lie down with their head and shoulders slightly elevated. Don’t move them unless they’re in immediate danger. If there’s any chance of a neck or spine injury, avoid moving the neck at all and wait for emergency responders.
Handle any bleeding carefully. If there’s an open wound on the scalp, apply gentle pressure with a clean cloth. However, if you suspect a skull fracture, do not press directly on the wound.
Watch breathing and alertness. Monitor the person continuously. If they stop breathing, show no signs of movement, or become unresponsive, begin CPR.
Pain Relief: What’s Safe and What’s Not
For headaches following a concussion, acetaminophen (Tylenol) is the recommended pain reliever. Do not give ibuprofen (Advil, Motrin) or aspirin. Both of these medications can increase the risk of bleeding, which is especially dangerous when the brain may be bruised or swollen. Stick with acetaminophen until a healthcare provider says otherwise.
The First 48 Hours at Home
A family member or caregiver needs to closely monitor the person for the first 24 to 48 hours, watching for any of the danger signs listed above. This means checking in regularly, including during the night.
You may have heard you should keep a concussed person awake. That’s outdated advice. Current guidelines no longer recommend frequent night waking. Sleep is actually important for recovery. What matters is that someone is nearby and able to notice if the person’s condition changes, like if they become difficult to rouse or start vomiting in their sleep.
During these first two days, the person should rest both physically and mentally. That means limiting screen time, including phones, TV, video games, and computers. One study found that adolescents and young adults who avoided screens for the first 48 hours after a concussion recovered faster, with a higher likelihood of symptom resolution by day 10 compared to those who used screens freely. The screen-abstinent group still used devices for a few minutes a day, so the goal is significant reduction rather than absolute zero.
Reading, homework, and other mentally demanding tasks should also be scaled back during this window. The brain needs energy to heal, and cognitive strain during the acute phase can prolong symptoms.
Why a Second Hit Is So Dangerous
One of the most critical things to understand about concussion first aid is that recovery isn’t optional. After a concussion, the brain undergoes metabolic changes that make it significantly more vulnerable to further injury. A second concussion before the first has healed can cause a condition called second impact syndrome, which involves rapid, severe brain swelling.
The brain typically needs 7 to 10 days for its internal chemistry to return to normal, though younger people may need longer. This is why anyone with a suspected concussion should be completely removed from the activity that caused the injury and should not return to contact sports or high-risk activities until fully recovered and cleared by a healthcare provider.
Returning to Normal Activity
Recovery from a concussion follows a gradual progression, not an on/off switch. The international standard is a six-step return-to-play protocol, with each step taking a minimum of 24 hours. If symptoms return at any step, the person drops back to the previous level.
- Step 1: Return to regular daily activities like school or work, with clearance from a healthcare provider to begin progressing.
- Step 2: Light aerobic activity only, such as 5 to 10 minutes of walking, light jogging, or a stationary bike. No weight lifting.
- Step 3: Moderate activity that increases heart rate with body and head movement, like moderate jogging or reduced-intensity weightlifting.
- Step 4: Heavy non-contact activity, including sprinting, regular weightlifting, and sport-specific drills without contact.
- Step 5: Full practice with contact, in a controlled setting.
- Step 6: Return to competition.
This protocol exists because rushing back is the single biggest risk factor for a prolonged or dangerous outcome. Even if someone feels fine after a day or two, the brain may still be healing. The latest international consensus on concussion in sport, published in 2022, also highlights that early aerobic exercise (light, symptom-limited activity) actually benefits recovery once the initial 48-hour rest period has passed. Complete bed rest beyond two days is no longer recommended and may even slow things down.
Symptoms That Linger
Most concussions resolve within two to four weeks. If symptoms persist beyond four weeks, the person should be evaluated with a thorough clinical assessment. Ongoing headaches, dizziness, and balance problems may benefit from specific rehabilitation targeting the neck and vestibular system (your inner balance sensors). Persistent cognitive or emotional symptoms can also be addressed with targeted therapies, but the first step is a proper evaluation to identify exactly what’s driving the lingering issues.