Concussion: What to do in the first hours and days

Concussion research has advanced significantly in recent years, and we now know that your early actions impact your recovery speed. The advice many still receive is outdated. Lying still, avoiding screens, and waiting for it to pass can sometimes prolong recovery. A concussion can be hard to assess yourself. Symptoms vary, and the force of the impact does not always reflect how you will feel afterward. Here is the latest research-based knowledge on what to do, what to avoid, and when to seek help.

Seek emergency help if there are warning signs

Above all: certain symptoms require immediate assessment at an emergency room. Call 112 or go directly to the emergency room if you or someone else experiences:

• Loss of consciousness, even briefly
• Convulsions or seizures
• Rapidly worsening headache
• Repeated vomiting
• Confusion that does not improve
• Difficulty waking up or abnormal reactions
• Unequal pupils
• Weakness in arms or legs
• Difficulty speaking

These signs may indicate a more serious brain injury requiring urgent evaluation. Do not hesitate to seek help.

Contact your doctor

If you do not have alarming symptoms but suspect a concussion, you should contact your GP within 24 hours. A medical assessment is important, partly to rule out more serious injury.

An important detail is that not all doctors necessarily have updated knowledge on concussion treatment and management. Therefore, it is perfectly legitimate to ask your doctor if they have the right expertise in this area. Many are told to just go home and rest for 14 days. We explain below why that advice is outdated.

The first 24-48 hours

The first and most important recommendation is to rest. This means you should reduce the demands on both your brain and body for the first 24 to 48 hours.

However, rest does not mean lying in a dark room without any stimulation. That mindset is outdated. It is about minimizing what causes a moderate to severe worsening of your symptoms and finding a calm level you can tolerate.

Practically speaking, this means:

• Stay home from work or school
• Minimize screen use if it worsens symptoms, but you do not need to avoid them entirely
• Avoid strenuous physical exertion and sports, especially activities with a risk of head trauma
• Ensure you get enough sleep. Sleep is the brain's most important tool for recovery
• Eat and drink normally

You do not need to stay awake all night to "keep an eye on yourself." That recommendation is also outdated for the vast majority of concussions. Daily activities that do not result in more than a mild worsening of symptoms related to the current concussion are perfectly fine and are actually recommended.

Gradually increased physical activity has proven to be an effective part of treatment. As early as 24 hours after the injury, you can safely begin to resume daily life and your usual routines, such as school, work, or leisure activities, at a calm pace. It depends on your symptoms and should be done gradually. For some, it makes sense to wait a little while with school and work. The most important thing is that you do not just push through.

Within the first 48 hours, light activities that do not cause a severe worsening of symptoms, such as calm walks or moderate cycling on a stationary bike, can have a beneficial effect on your recovery.

Pain relief: What can you take?

It is common to experience headaches or neck pain following a concussion, and some people require pain relief during the initial period.

In Denmark, paracetamol is recommended as the first choice for mild to moderate pain. If paracetamol does not provide sufficient relief, ibuprofen or another NSAID may be relevant in some cases. However, these should only be used for the shortest possible time and following a specific assessment, especially if you have stomach ulcers, kidney disease, are taking blood-thinning medication, or have an increased risk of bleeding.

If you need pain relief over a longer period, you should contact your doctor. Frequent use of both over-the-counter medication and migraine medication can increase the risk of medication-overuse headaches, which can themselves help maintain the headache.

As a rule of thumb, you should not take pain relief medication several days a week for an extended period without consulting a doctor.

If you are in doubt about which medication is right for you, we recommend that you contact your own doctor or your local pharmacy.

Monitor your symptoms

During the first few days, you should regularly check how you are doing. It is normal for symptoms to fluctuate, but overall they should be moving in the right direction. However, this cannot be expected to happen in the first few days, as some people may experience symptoms for several weeks.

Remember that a mild worsening of symptoms that subsides after a few hours is natural and not dangerous.

If you have pushed yourself a little too hard and experience a more significant worsening, it is still not dangerous and does not mean you have caused damage to your brain. Take a short break, adjust the activity that is worsening your symptoms, and try again.

Contact your doctor again if:

• Symptoms worsen significantly You develop new symptoms You are very confused or difficult to wake The headache increases sharply

Gradual return to daily life

Returning gradually to daily life is not just about filling your days. It helps you rebuild a rhythm, build tolerance to light, sound, and cognitive demands, and gives your day a purpose. Research shows that an earlier return to meaningful activities promotes both physical and mental recovery.

A good rule of thumb is that you should only increase your activity level when you feel ready and your symptoms have reduced at your current level. If symptoms return severely, scale back again. This is not a setback, but a natural part of the process.

Typically, you follow these steps:

1. Daily activities that only cause mild symptom worsening. This often applies from the first hour after the concussion up to 48 hours. Walking and stationary cycling are recommended here Gradual challenge, such as taking longer walks, cycling for longer periods, looking at screens or reading for longer at a time, or more social activity Gradual return to work on reduced hours with lighter tasks. You can also begin to increase physical and social activities Increase working hours and the difficulty of tasks. More strenuous physical activity Full return to work, school, and sports

You do not need to be symptom-free before moving up a step. However, you must feel ready to progress for the right reasons, and not because your boss, friends, or family expect it. A mild worsening when you move up a step is normal. If the worsening is too severe, simply take a step back.

What you should avoid in the initial period

There are a number of things that can delay your recovery and improvement, which you should avoid during the initial period:

• Contact sports and activities with a risk of further head impact
• Alcohol
• Excessive physical or mental exertion
• Ignoring symptoms and pushing through
• Avoiding everything entirely out of fear

A new concussion while you are still recovering from the first can have serious consequences. This is not an area where you should test your limits.

If symptoms do not improve

Most people are symptom-free within two to four weeks. If you find that your symptoms are not improving or are worsening, it is important to seek help again. Persistent symptoms after four weeks may indicate post-concussion syndrome, a condition that may require specialized assessment and treatment.

The sooner you get the right help, the better the prognosis.

Are you experiencing symptoms that are not improving? Read about the treatment of concussion and post-concussion syndrome at Hemi here.