Editing Concussion (section)

==Treatment==
Adults and children with a suspected concussion require a medical assessment with a doctor or nurse practitioner to confirm the diagnosis of concussion and rule out more serious head injuries. After life-threatening head injuries, injuries to the cervical spine, and neurological conditions are ruled out, exclusion of neck or head injury, observation should be continued for several hours. If repeated vomiting, worsening headache, dizziness, seizure activity, excessive drowsiness, double vision, slurred speech, unsteady walk, or weakness or numbness in arms or legs, or signs of [[basilar skull fracture]] develop, immediate assessment in an emergency department is needed.<ref name="Mc2017" /><ref name=Peds2010/> Observation to monitor for worsening condition is an important part of treatment.<ref name="Marshall2023" /> While it is common advice that someone who is concussed should not be allowed to fall asleep in case they go into a [[coma]], for general cases this is not supported by current evidence.<ref>{{Cite news |last=Hammond |first=Claudia |date=June 18, 2016 |title=Should you let someone with concussion fall asleep? |url=https://www.bbc.com/future/article/20160616-should-you-let-someone-with-concussion-fall-asleep |access-date=June 29, 2024 |work=[[BBC]]}}</ref><ref>{{Cite news |last=Bennett |first=Max |date=February 21, 2014 |title=Is It Safe to Sleep After Getting a Concussion? |url=https://www.discovermagazine.com/health/is-it-safe-to-sleep-after-getting-a-concussion |access-date=June 29, 2024 |work=[[Discover (magazine)|Discover]]}}</ref> People may be released after assessment from their primary care medical clinic, hospital, or emergency room to the care of a trusted person with instructions to return if they display worsening symptoms or those that might indicate an emergent condition ("red flag symptoms") such as change in consciousness, convulsions, severe headache, extremity weakness, vomiting, new bleeding or deafness in either or both ears.<ref name="NICE1">{{cite web |url=http://www.nice.org.uk/nicemedia/pdf/CG56publicinfo.pdf |publisher=National Institute for Health and Clinical Excellence |title=Information about NICE clinical guideline |date=September 2007 |access-date=2008-01-26 |archive-date=2013-02-22 |archive-url=https://web.archive.org/web/20130222032613/http://www.nice.org.uk/nicemedia/pdf/CG56publicinfo.pdf |url-status=live }}</ref><ref name="Ontario Neurotrauma Foundation_2019" /><ref name="Marshall2023" /> Education about symptoms, their management, and their normal time course, may lead to an improved outcome.<ref name="ComperBisschop" />{{Update inline|date=July 2020|reason=}} 

=== Rest and return to physical and cognitive activity ===
Physical and cognitive rest is recommended for the first 24–48 hours following a concussion after which injured persons should gradually start gentle low-risk physical and cognitive activities that do not make current symptoms worse or bring on new symptoms.<ref name="Mc2017" /><ref>{{cite journal | vauthors = DeMatteo C, Bednar ED, Randall S, Falla K | title = Effectiveness of return to activity and return to school protocols for children postconcussion: a systematic review | journal = BMJ Open Sport & Exercise Medicine | volume = 6 | issue = 1 | pages = e000667 | date = February 2020 | pmid = 32153982 | pmc = 7047486 | doi = 10.1136/bmjsem-2019-000667 }}</ref> Any activity for which there is a risk of contact, falling, or bumping the head should be avoided until the person has clearance from a doctor or nurse practitioner.<ref name="Marshall_2018">{{cite web | vauthors = Marshall S, Bayley M, McCullagh S, Berrigan L, Fischer L, Ouchterlony D, Rockwell C, Velikonja D | date = 2018 | title = Guideline for Concussion/Mild Traumatic Brain Injury and Persistent Symptoms: 3rd Edition (for Adults 18+ years of age) | url = http://braininjuryguidelines.org/concussion/ | publisher = Ontario Neurotrauma Foundation | access-date = 2020-08-05 | archive-date = 2021-06-08 | archive-url = https://web.archive.org/web/20210608185436/https://braininjuryguidelines.org/concussion/ | url-status = live }}</ref><ref name="Mc2017" /><ref name="Ontario Neurotrauma Foundation_2019" /> Low-risk activities can be started even while a person has symptoms.<ref name="Ontario Neurotrauma Foundation_2019" /><ref name="www.cdc.gov_2020" /><ref name=":1" /> Resting completely for longer than 24–48 hours following concussion has been shown to be associated with longer recovery.<ref name="Zimmerman_2021" />

=== Return-to-school ===
The resumption of low-risk school activities should begin as soon as the student feels ready and has completed an initial period of cognitive rest of no more than 24–48 hours following the acute injury.<ref name="Zimmerman_2021">{{cite journal | vauthors = Zimmerman SD, Vernau BT, Meehan WP, Master CL | title = Sports-Related Concussions and the Pediatric Patient | journal = Clinics in Sports Medicine | volume = 40 | issue = 1 | pages = 147–158 | date = January 2021 | pmid = 33187605 | doi = 10.1016/j.csm.2020.08.010 | s2cid = 226947984 | doi-access = free }}</ref><ref name="DeMatteo_2020">{{cite journal | vauthors = DeMatteo C, Bednar ED, Randall S, Falla K | title = Effectiveness of return to activity and return to school protocols for children postconcussion: a systematic review | journal = BMJ Open Sport & Exercise Medicine | volume = 6 | issue = 1 | pages = e000667 | date = 2020 | pmid = 32153982 | pmc = 7047486 | doi = 10.1136/bmjsem-2019-000667 }}</ref> Long absences from school are not suggested, however; the return to school should be gradual and step-wise.<ref name="DeMatteo_2020" /> Prolonged complete mental or physical rest (beyond 24–48 hours after the accident that lead to the concussion) may worsen outcomes,<ref name="DeMatteo_2020" /> however, rushing back to full school work load before the person is ready, has also been associated with longer-lasting symptoms and an extended recovery time.<ref name="Purcell_2019">{{cite journal | vauthors = Purcell LK, Davis GA, Gioia GA | title = What factors must be considered in 'return to school' following concussion and what strategies or accommodations should be followed? A systematic review | journal = British Journal of Sports Medicine | volume = 53 | issue = 4 | pages = 250 | date = February 2019 | pmid = 29500251 | doi = 10.1136/bjsports-2017-097853 | s2cid = 3694730 | doi-access = free }}</ref> Students with a suspected concussion are required to see a doctor for an initial medical assessment and for suggestions on recovery, however, medical clearance is not required for a student to return to school.<ref name="Ontario Neurotrauma Foundation_2019" /> Since students may appear 'normal', continuing education of relevant school personnel may be needed to ensure appropriate accommodations are made such as part-days and extended deadlines.<ref name="Zimmerman_2021" /> Accommodations should be based on the monitoring of symptoms that are present during the return-to-school transition including headaches, dizziness, vision problems, memory loss, difficulty concentrating, and abnormal behavior.<ref name="Zimmerman_2021" /><ref name="Purcell_2019" /> Students must have completely resumed their school activities (without requiring concussion-related academic supports) before returning to full-contact or competitive sports.<ref name="Ontario Neurotrauma Foundation_2019" />

=== Return-to-sport ===
For persons participating in athletics, it is suggested that participants progress through a series of graded steps.<ref name="Mc2017" /> These steps include:
* Stage 1 (Immediately after injury): 24–48 hours (maximum) of relative physical and cognitive rest.<ref name="Mc2017" /> This can include gentle daily activities such as walking in the house, gentle housework, and light school work that do not make symptoms worse. No sports activities.
* Stage 2: Light aerobic activity such as walking or stationary cycling
* Stage 3: Sport-specific activities such as running drills and skating drills
* Stage 4: Non-contact training drills (exercise, coordination, and cognitive load)
* Stage 5: Full-contact practice (requires medical clearance) 
* Stage 6: Return to full-contact sport or high-risk activities (requires medical clearance)

At each step, the person should not have worsening or new symptoms for at least 24 hours before progressing to the next. If symptoms worsen or new symptoms begin, athletes should drop back to the previous level for at least another 24 hours.<ref name="Mc2017" />

Intercollegiate or [[Professional sports|professional]] athletes, are typically followed closely by team athletic trainers during this period but others may not have access to this level of health care and may be sent home with minimal monitoring.

=== Medications ===
Medications may be prescribed to treat headaches, sleep problems and depression.<ref name=ComperBisschop/> [[Analgesic]]s such as [[ibuprofen]] can be taken for headaches,<ref name=AndersonT/> but [[paracetamol|paracetamol (acetaminophen)]] is preferred to minimize the risk of intracranial hemorrhage.<ref>{{cite journal | vauthors = Reymond MA, Marbet G, Radü EW, Gratzl O | title = Aspirin as a risk factor for hemorrhage in patients with head injuries | journal = Neurosurgical Review | volume = 15 | issue = 1 | pages = 21–25 | year = 1992 | pmid = 1584433 | doi = 10.1007/BF02352062 | s2cid = 19344720 }}</ref> Concussed individuals are advised not to use [[alcohol (drug)|alcohol]] or other [[drug]]s that have not been approved by a doctor as they can impede healing.<ref>{{cite web |url=https://www.cdc.gov/concussion/feel_better.html |ref=cdcfeelbeter |date=March 8, 2010 |publisher=Center of Disease Control |location=Atlanta, GA |title=What Can I Do to Help Feel Better After a Concussion? |access-date=September 9, 2017 |archive-date=April 28, 2021 |archive-url=https://web.archive.org/web/20210428054612/http://www.cdc.gov/concussion/feel_better.html |url-status=live }}</ref> Activation database-guided EEG biofeedback has been shown to return the memory abilities of the concussed individual to levels better than the control group.<ref>{{cite journal | vauthors = Thornton KE, Carmody DP | title = Efficacy of traumatic brain injury rehabilitation: interventions of QEEG-guided biofeedback, computers, strategies, and medications | journal = Applied Psychophysiology and Biofeedback | volume = 33 | issue = 2 | pages = 101–124 | date = June 2008 | pmid = 18551365 | doi = 10.1007/s10484-008-9056-z | url = http://www.neurofeedbackclinic.ca/journals/Traumatic_Brain_Injuries/brain04.pdf | access-date = 2012-07-03 | url-status = live | s2cid = 7262160 | archive-url = https://web.archive.org/web/20210307220217/https://www.neurofeedbackclinic.ca/journals/Traumatic_Brain_Injuries/brain04.pdf | archive-date = 2021-03-07 }}</ref>

About one percent of people who receive treatment for mTBI need surgery for a brain injury.<ref name="BorgHolm04">{{cite journal | vauthors = Borg J, Holm L, Cassidy JD, Peloso PM, Carroll LJ, von Holst H, Ericson K | title = Diagnostic procedures in mild traumatic brain injury: results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury | journal = Journal of Rehabilitation Medicine | volume = 36 | issue = 43 Suppl | pages = 61–75 | date = February 2004 | pmid = 15083871 | doi = 10.1080/16501960410023822 | doi-access = free }}</ref>

=== Return to work ===
Determining the ideal time for a person to return to work will depend on personal factors and job-related factors including the intensity of the job and the risk of falling or hitting one's head at work during recovery.<ref name="Marshall2023" /> After the required initial recovery period of complete rest (24–48 hours after the concussion began), gradually and safely returning to the workplace with accommodations and support in place, should be prioritized over staying home and resting for long periods of time, to promote physical recovery and reduce the risk of people becoming socially isolated.<ref name="Marshall2023" /> The person should work with their employer to design a step-wise "return-to-work" plan.<ref name="Marshall2023" /> For those with a high-risk job, medical clearance may be required before resuming an activity that could lead to another head injury.<ref name="Marshall2023" /> Students should have completed the full return-to-school progression with no academic accommodations related to the concussion required before starting to return to part-time work.<ref name="Ontario Neurotrauma Foundation_2019" />