The most important thing to do immediately after a concussion is stop whatever activity caused it, watch for danger signs that require emergency care, and rest for the first 24 to 48 hours. Most concussions resolve on their own, but the actions you take in the first few hours and days directly affect how quickly you recover.
Rule Out a Medical Emergency First
Not every head injury needs an emergency room visit, but some do. Call 911 or go to the nearest emergency department if you notice any of these danger signs after a bump, blow, or jolt to the head:
- Seizures or convulsions (shaking or twitching)
- Loss of consciousness, increasing drowsiness, or inability to stay awake
- One pupil larger than the other, or double vision
- A headache that keeps getting worse and won’t go away
- Repeated nausea or vomiting
- Slurred speech, weakness, numbness, or loss of coordination
- Inability to recognize people or places
- Unusual behavior, growing confusion, restlessness, or agitation
For infants and toddlers, all of the above apply, plus inconsolable crying or refusal to nurse or eat. These danger signs can appear immediately or develop over hours, which is why close monitoring matters even when someone initially seems fine.
Monitor Closely for the First 48 Hours
Concussion symptoms are often most severe right after the injury, but some don’t show up for hours or even a full day later. During the first 48 hours, someone who knows the injured person well should check on them regularly and watch for changes in how they act, think, or feel. You’re looking for anything that seems off from their baseline: increased irritability, confusion, difficulty concentrating, or worsening headache.
There’s a common belief that you need to wake someone up every two hours through the night after a concussion. Current guidelines don’t specifically require this if the person was evaluated by a healthcare provider and showed no danger signs. Sleep is actually beneficial for recovery. That said, if the person wasn’t medically evaluated, or if symptoms were worsening before they fell asleep, checking on them periodically overnight is a reasonable precaution. If at any point they’re difficult to wake, that’s a danger sign requiring emergency care.
Rest Your Brain and Body
The first 24 to 48 hours after a concussion call for significantly dialing back both physical and mental activity. This means avoiding anything that demands concentration or sustained attention: work tasks, homework, reading dense material, playing video games, or scrolling through your phone. It also means no exercise, no weight lifting, and no physical activity that makes you sweat.
A randomized clinical trial of 125 adolescent and young adult patients found that those who avoided screens (television, phones, video games, computers, and tablets) for the first 48 hours after a concussion had faster symptom resolution than those who used screens as tolerated. That 48-hour screen break is now a standard recommendation.
This doesn’t mean you need to lie in a dark room doing absolutely nothing. Brief, light activity like short walks, gentle conversation, or listening to calm music is fine for most people. The goal is relative rest, not sensory deprivation. Prolonged strict rest beyond the first couple of days can actually slow recovery rather than help it.
Managing Headache Pain Safely
Headaches are one of the most common concussion symptoms, and you’ll likely want pain relief. Acetaminophen (Tylenol) is generally considered the safest option. Some providers have historically cautioned against NSAIDs like ibuprofen (Advil, Motrin) in the very early hours after a head injury due to concerns about their blood-thinning properties, though recent research suggests ibuprofen may also be safe and effective. When in doubt, start with acetaminophen and ask your healthcare provider about alternatives at your follow-up visit.
Avoid alcohol entirely during recovery. It slows healing and can worsen symptoms like balance problems, confusion, and sleep disruption.
Getting Back to School or Work
Most people can return to school or work within one to two days of a concussion, and research shows that delaying the return too long may actually lead to a longer recovery. The key is going back with temporary adjustments in place rather than jumping straight into a full workload.
Useful accommodations include reducing assignments to essential tasks only, getting extra time on tests or deadlines, limiting tests to one per day, receiving written instructions instead of verbal ones, and taking rest breaks throughout the day. As symptoms improve, these supports can be gradually removed. If symptoms flare up during the day, that’s a signal to scale back and try again the next day with lighter demands.
Returning to Physical Activity
Getting back to exercise and sports follows a structured six-step progression, with each step requiring at least 24 hours before advancing. You should only begin this process after a healthcare provider gives clearance and your everyday activities (school, work) are no longer triggering symptoms.
- Step 1: Return to regular daily activities like school or work without symptoms.
- 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 with more head and body movement, like moderate jogging or reduced-weight lifting.
- Step 4: Heavy non-contact activity, including sprinting, full weightlifting routines, and sport-specific drills.
- Step 5: Full practice with contact, in a controlled setting.
- Step 6: Return to competition.
If symptoms return at any step, stop, rest, and drop back to the previous level. This progression exists because returning too quickly carries the risk of a second concussion before the first has healed, which can cause significantly more severe and longer-lasting damage.
What to Expect at a Medical Evaluation
When you see a healthcare provider after a concussion, the evaluation typically includes a physical exam, a clinical interview about your symptoms, balance testing, and assessments of memory and concentration. Newer screening tools also test how your eyes and inner-ear balance system are functioning: you may be asked to track a moving object smoothly, shift your gaze quickly between two targets, or focus on something close to your face. Difficulty with these tasks, or symptoms triggered by them, helps confirm the diagnosis and identify specific areas that need monitoring.
Most concussions don’t require brain imaging like a CT scan or MRI. These are reserved for situations where a more serious injury, like bleeding in the brain, is suspected based on danger signs. A normal scan doesn’t rule out a concussion, since concussions involve functional changes in the brain that standard imaging can’t detect.
Schedule a follow-up with your regular healthcare provider even if you feel fine after a few days. Some symptoms linger or evolve, and having a baseline check-in helps catch issues like persistent balance problems, sleep disruption, or difficulty concentrating that might benefit from targeted treatment.