After a concussion, the most important steps are to stop whatever activity caused the injury, watch for emergency warning signs, and give your brain a period of relative rest for the first 48 hours. You don’t need to lie in a dark room or avoid all activity, but you do need to scale back anything physically or mentally demanding while your brain heals.
Watch for Danger Signs First
Not every concussion needs an emergency room visit, but some head injuries are more serious than they initially appear. In the minutes and hours after the injury, watch for these warning signs that require a 911 call or an immediate trip to the ER:
- Seizures or convulsions
- One pupil larger than the other, or double vision
- Repeated vomiting
- Slurred speech, weakness, numbness, or loss of coordination
- A headache that keeps getting worse and won’t go away
- Increasing confusion, agitation, or inability to recognize people or places
- Loss of consciousness, extreme drowsiness, or inability to stay awake
For infants and toddlers, all of the above apply, plus inconsolable crying and refusal to nurse or eat. If none of these danger signs are present, you can typically manage recovery at home, but you should still see a healthcare provider within a day or two to confirm the diagnosis and get clearance for returning to normal activities.
The First 48 Hours: Relative Rest
The outdated advice was to lie in a dark, quiet room for days. Current guidelines recommend the opposite approach: relative rest, not total shutdown. Complete sensory deprivation doesn’t help recovery and may actually slow it down.
For the first one to two days, limit screen time and cut back on activities that require heavy concentration, especially if they make your symptoms worse. That means shorter stretches of reading, working, or studying, with breaks in between. You don’t need to avoid these activities entirely. Just dial them back and stop if symptoms flare.
Light physical activity is not only safe but beneficial. Short walks are a good starting point, even if you’re experiencing mild symptoms. The key boundary is to avoid anything that risks another blow to the head (contact sports, biking, skateboarding) and to temporarily scale back if an activity noticeably worsens how you feel.
Stay socially connected. Isolation tends to make recovery harder, not easier. Talking with friends and family, spending time with others, and maintaining some normalcy are all fine.
Sleep Is Safe and Important
One of the most persistent myths about concussions is that you need to wake the person every hour or two to check on them. There is no evidence that waking someone after a concussion is needed or beneficial. Rest is a crucial part of healing, and disrupting a full night’s sleep is counterproductive.
It’s perfectly fine to quietly check on someone while they sleep. Look for normal breathing patterns and peaceful rest. You don’t need to wake them up to do this. If you notice abnormal breathing, wake them immediately and seek medical attention.
Managing Pain and Headaches
Headaches are the most common concussion symptom. For pain relief in the first couple of days, ask your healthcare provider which option is best for you. Some providers prefer acetaminophen early on because certain anti-inflammatory medications can carry a small risk of increased bleeding, though this guidance varies. The important thing is not to self-medicate heavily or mask symptoms that might be worsening.
What to Eat and Drink
Staying well-hydrated helps manage fatigue and headaches during recovery. Start hydrating first thing in the morning and keep it consistent throughout the day. Aim for water and electrolyte beverages that are low in sugar. Fruits, vegetables, and broths also contribute to hydration.
A few things to avoid in the first few days: caffeine (especially in the first 24 to 72 hours), alcohol (which is significantly associated with longer recovery times), and sugary snacks or drinks, which can worsen symptoms and interfere with sleep quality. Some evidence supports magnesium for symptom management in the first 48 hours, and omega-3 fatty acids and creatine for cognition and headache reduction, but talk to your provider before adding supplements.
Returning to School or Work
Most people can return to school or work within one to two days, but with temporary adjustments. Jumping straight back into a full workload tends to aggravate symptoms. Useful accommodations include reducing assignments to essential tasks only, allowing extra time on tests and projects, limiting tests to one per day, providing written instructions or class notes, and allowing a phone to record lectures or meetings.
As symptoms improve, gradually increase the mental workload. Think of it as a dimmer switch, not an on/off toggle. If a full day at school or work triggers a spike in headaches or brain fog, shorten the day and build back up.
Returning to Sports and Exercise
Light exercise starting a couple of days after injury has been shown to speed recovery. Riding a stationary bike, light jogging, or easy walking are good options. The critical rule is no contact sports until you are completely symptom-free and cleared by a healthcare provider.
For athletes, the standard return-to-play process follows a six-step progression, with each step lasting a minimum of 24 hours:
- Step 1: Back to regular daily activities (school, work) with provider clearance to begin the progression
- Step 2: Light aerobic activity only, like 5 to 10 minutes on an exercise bike or light jogging. No weight lifting.
- Step 3: Moderate activity with more head and body movement. Moderate jogging, brief running, reduced weight lifting.
- Step 4: Heavy non-contact activity. Sprinting, high-intensity biking, full weight lifting routine, sport-specific drills.
- Step 5: Full-contact practice in a controlled setting.
- Step 6: Return to competition.
If symptoms return at any step, stop, rest, and drop back to the previous step once symptoms have cleared. New or returning symptoms are a sign you’re pushing too hard.
Children and Toddlers Need the Same Approach
The core principles for kids are the same as for adults: relative rest without isolation, light physical activity like short walks, limited screen time for the first day or two, and no return to sports or risky play until a provider gives the green light. The main difference is that young children may not be able to articulate what they’re feeling, so you’ll need to watch their behavior more closely. Increased irritability, changes in eating or sleeping patterns, loss of interest in favorite activities, or balance problems can all signal that symptoms are still present.
Don’t keep your child home in bed all day. Let them move around, see friends, and engage in quiet activities. Just keep them away from anything that risks another head injury.