A doctor’s main job after a concussion is to rule out a more serious brain injury, assess how your brain is functioning right now, and build a step-by-step plan for getting you back to normal activity. There’s no single medication or procedure that “fixes” a concussion. Instead, the visit focuses on careful evaluation and guided recovery, with the timeline and intensity of follow-up depending on how severe your symptoms are and how quickly they improve.
The Initial Assessment
The first thing a doctor does is make sure you don’t have a more dangerous injury hiding behind concussion symptoms. They’ll check your level of alertness, your ability to move your eyes normally, and whether you can track a finger without double vision. They’ll press along your neck to check for cervical spine tenderness and test your limb strength and sensation on both sides of your body.
Next comes cognitive screening. This is less like a quiz and more like a quick mental workout. You’ll be asked basic orientation questions: what month it is, today’s date, the day of the week. Then the doctor will read you a list of words and ask you to repeat them back. You may be asked to recite digits backward or say the months of the year in reverse order as quickly as you can. After at least five minutes, you’ll be asked to recall those earlier words again. These tasks test short-term memory, concentration, and processing speed, all of which a concussion can temporarily disrupt.
Balance testing rounds out the evaluation. You’ll stand in three positions (feet together, heel-to-toe, and on one leg) while the doctor watches for swaying or errors. You may also be asked to walk heel-to-toe along a line as fast as you can, then do it again while counting backward by sevens. That dual-task version reveals how well your brain handles two things at once, which is often one of the first abilities to suffer after a hit to the head.
When a CT Scan Is Needed
Most concussions do not require brain imaging. A CT scan can’t detect a concussion itself, but it can reveal bleeding or swelling that would need emergency treatment. Doctors use a well-validated set of criteria, known as the Canadian CT Head Rule, to decide who actually needs a scan. You’ll likely get one if you meet any of these conditions:
- High-risk factors: Your alertness score hasn’t returned to normal within two hours, there’s a suspected open skull fracture, signs of a fracture at the base of the skull, vomiting more than twice, or you’re over 65.
- Medium-risk factors: You can’t remember the 30 minutes before the injury, or the injury involved a dangerous mechanism (a car crash, a fall from height, being struck by a vehicle).
Using these criteria, only about a third to half of head-injury patients actually need a scan. If none of these red flags apply, your doctor will diagnose your concussion based on symptoms and the clinical exam alone.
Danger Signs That Change Everything
During and after the visit, your doctor will make sure you know which symptoms require an immediate trip to the emergency department. These signal something more serious than a concussion, such as a brain bleed:
- Seizures or convulsions
- Inability to recognize people or places
- Repeated vomiting
- Increasing confusion, agitation, or unusual behavior
- Growing drowsiness or inability to stay awake
- Slurred speech, weakness, numbness, or worsening coordination
- A headache that keeps getting worse and won’t go away
- One pupil noticeably larger than the other
For infants and toddlers, inconsolable crying or refusal to eat are additional warning signs.
What the Doctor Prescribes for Recovery
The biggest shift in concussion care over the past decade is the move away from prolonged strict rest. Current guidelines, updated at the 2022 International Conference on Concussion in Sport, recommend relative rest for only the first 24 to 48 hours. That means sticking to basic daily activities and limiting screen time, but not lying in a dark room for days.
After that initial window, your doctor will encourage light physical activity. Prescribed subsymptom threshold aerobic exercise (walking, gentle stationary cycling) within the first two to ten days has been shown to speed recovery and reduce the chance of symptoms dragging on. The key principle is to stay below the level of exertion that triggers your symptoms. If a 15-minute walk feels fine but a light jog brings back your headache, you stay at the walking level until it doesn’t.
Sleep is treated as a priority. Your doctor may recommend melatonin if you’re struggling to fall or stay asleep, since it’s safe and may offer additional benefits for brain recovery after injury. Over-the-counter pain relievers like ibuprofen can help with headaches in the short term, but frequent use is typically discouraged because it can cause rebound headaches that make it harder to tell whether you’re actually improving.
The Step-by-Step Return Plan
Whether you’re a student, an athlete, or someone who works a desk job, your doctor will lay out a graduated return plan. Each step has a clear rule: you must be symptom-free for at least 24 hours before moving to the next one. If symptoms come back at any stage, you drop back to the previous step and rest again before trying to advance.
For athletes, the typical protocol has seven stages:
- Step 1: Cognitive rest (minimal mental and physical exertion).
- Step 2: Full return to school, with accommodations if needed (extra time on tests, reduced homework, screen breaks).
- Step 3: Light aerobic activity like a stationary bike, only after medical clearance and normal results on cognitive and balance testing.
- Step 4: Individual running, sprinting, and sport-specific drills with no contact.
- Step 5: Team-based noncontact drills.
- Step 6: A full day of full-contact practice.
- Step 7: Return to competition without restrictions.
For non-athletes, the logic is the same but the steps map onto daily life. Your doctor may recommend starting with half days at work or school, then gradually increasing cognitive load (longer hours, more complex tasks, busier environments) as you tolerate it. Symptoms like headache, difficulty concentrating, and fatigue typically worsen with exertion, and letting symptom return guide your pace is the central strategy.
When Recovery Takes Longer Than Expected
Most concussion symptoms improve within two to three weeks. If yours haven’t started to subside by that point, or they’re getting worse, your doctor will begin looking at specialist referrals. The 2022 international consensus defines “persisting symptoms” as those lasting longer than four weeks, at which point a multidisciplinary evaluation is recommended.
Depending on which symptoms are lingering, you might be referred to a neurologist for ongoing headaches or cognitive trouble, a vestibular therapist for dizziness and balance problems, a neuropsychologist for formal cognitive testing, or a mental health professional if anxiety or depression have developed alongside the injury. These aren’t signs that something went wrong with your initial care. Some brains simply take longer to heal, and targeted treatment for specific symptoms tends to be more effective than a one-size-fits-all approach.
Follow-Up Visits
Your doctor will typically schedule a follow-up within one to two weeks of the initial visit. At that appointment, they’ll re-evaluate your symptoms, repeat portions of the cognitive and balance testing, and decide whether to advance your return plan or pull back. If you’re an athlete, formal clearance from a physician is required before returning to full contact. For students, the doctor may coordinate with your school to adjust or remove academic accommodations as you improve.
The overall arc of a doctor’s role in concussion care is less about doing things to you and more about monitoring your brain’s recovery, protecting you from doing too much too soon, and stepping in with targeted help if progress stalls. The injury heals on its own timeline, and the doctor’s job is to make sure that timeline is as short and safe as possible.