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What are the treatment options for a concussion?

Dr. Jeanne Morrison, PhD
Family Practitioner

Once a concussion is diagnosed, the focus turns to treating the symptoms. There are no medications or surgeries to heal the concussion; instead, resting and avoiding of the activity that caused the concussion are recommended. For pain associated with your concussion, like a headache, acetaminophen is an acceptable treatment. Do not, however, take aspirin or other blood thinners. These medications can increase your risk for a brain bleed.

A concussion is first treated with rest and removal from activities where the child could hit his or her head again, such as sports and playground activities. After a concussion, it’s important to rest both the body and the brain. To rest the brain, cut back on school, electronics and thinking activities for a few days until your child starts to feel better (confining him or her to a dark room with nothing to do isn’t necessary).

Doctors have a number of treatments for kids who are taking longer than a week or two to recover from a concussion. Your child might work with a clinical psychologist, who can help him or her keep up with school while still recovering from the concussion. A special type of physical therapy, called vestibular therapy, can help with dizziness and vision problems. Neck injury might make concussion symptoms worse, so treating the neck with physical therapy may help. Sometimes doctors use medications and supplements to help with concussion symptoms. They might team up with other specialists to help recovery as well, including a neurologist, neuro-optometrist, cardiologist, neurosurgeon, spine or orthopedic doctor or psychologist.

The best treatments for a concussion are rest and time. If a concussion is suspected, remove an athlete from play.

An athlete must pass through six stages to return to play. If at any point the athlete has a recurrence of symptoms, he or she should return to the previous stage and remain symptom-free for at least 24 hours or until symptoms go away before continuing to the next stage.

Stage 1: Complete physical and cognitive rest
Stage 2: Light aerobic exercise (walking, stationary cycle, swimming, etc.)
Stage 3: Sport-specific drills (Non-impact drills such as throwing in baseball, or running drills for lacrosse)
Stage 4: Noncontact training drills like passing drills
Stage 5: Following a physician's clearance, full contact training
Stage 6: Normal play resumes

This answer provided for NATA by the Washington State University Athletic Training Education Program.

The best treatment option for a concussion is to let the brain heal by resting and avoiding any activities that could hurt the brain again. A concussion gets better with time.

Dr. Christopher C. Giza, MD
Pediatrician

Treatment for student athletes who get a concussion begins with protecting them by letting them rest. That can be a day or two with limited or no work to limit the symptoms. If they feel better they can do more; if they feel crummy they should maybe stay home from school, but they shouldn't be kept home for weeks or months. That becomes very disruptive to their education and their socialization.

After a couple of days of rest they can start an active and beginning recovery phase where they may start doing some cognitive effort at home and they may do some partial activity in school. Their symptoms will be monitored during this entire time period. Then there is gradually increasing activity. There is more cognitive effort when they are back to school. They may even be able to start exercise that doesn't risk contact. No one ever got a concussion from riding an exercise bike or walking the dog. As they are getting better they should be encouraged to start returning to physical activity whether or not they are going to go back to a contact sport.

Then, ultimately there's a return to normalcy, whatever that is for each individual, so they go back to normal school, their symptoms are better, and they can then begin a gradual return to the sport of their choice.

Return to play isn't a one-step thing. Return to play starts out with symptom-limited rest, and then exertion is added at different levels. They may start out by adding aerobic exercise like riding an exercise bike or easy swimming, then a balance or vestibular component. They may start to run. They may bike more aggressively. They may do activities that require more balance.

The last level would be non-contact training, so they can kick the ball around in soccer as long as people aren't kicking the ball toward them. They can add resistance training. They need to run plays maybe on a field where they have to be thinking about what they are doing. Full contact clearance doesn't occur until after completing this last level, and they have to practice at full contact before they can go to full contact competition.

This content originally appeared online at UCLA Health.

Healthcare providers follow a “Return to Learn” and a “Return to Play” set of guidelines as we follow a patient’s progress after concussion. This is a graded process that requires a minimum of five days to complete, but typically takes a bit longer. These guidelines are important because if the child goes back to athletic pursuits too soon, he could sustain a second head injury (Second Impact Syndrome), a rare, but devastating, brain injury that may result in permanent brain damage or death. Luckily, about 9 out of 10 athletes will be back to normal within two weeks.

The first step in this treatment process is rest from academic and athletic pursuits because the brain needs time to rest and heal after a concussion. This may involve missing a few days of school as well as avoiding TV, video games, cell phones or tablets. We recommend a low-stimulus environment with the affected person avoiding anything that requires intense thinking as well as avoiding any exercise. In addition to rest, the Return to Learn and Play guidelines recommend a gradual return to school and activity that can advance in intensity as long as the child stays symptom free. If symptoms of the concussion return, the patient should take a step back in the Return to Learn and Play guidelines.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.