The first and most important step in managing concussion in an athlete is to prevent that player from returning to the field of play. This means that the player must not participate in a game or in practice for the rest of the day and perhaps longer. Given the competitiveness and drive to win that many players and coaches share, this intervention can be trickier than it sounds. In some cases, it may be necessary to take away a critical piece of equipment to prevent the player from returning to the game.1
The person with a concussion should be watched closely for the first 6 to 8 hours after concussion looking for signs that the symptoms are getting worse. One commonly held misconception— indeed something that used to be recommended in medical circles—was to prevent people with concussion from falling asleep.
Preventing a person with a concussion from sleeping is no longer recommended.1
In fact, it can be helpful to the patient to sleep. On the other hand, if the player is having trouble maintaining consciousness it could suggest a more significant injury and may indicate the need for emergency medical attention (e.g., CT scan of the brain).
Signs of worsening include:
- Vomits two or more times within four to six hours of the injury
- If the headache gets significantly worse or becomes “severe”
- Has a seizure or convulsion (any abnormal or uncontrollable movements)
- Develops a stiff neck
- Weakness or numbness in any part of the body
The concussed patient should be made to rest both physically and mentally. This means no telephone, no texting, no music, no television or computer or similar stimulation for a minimum of 8 to 12 hours after concussion. This may also mean time off from school or work. If symptoms persist, the period of rest should be longer. This “neurocognitive” rest is a key component to concussion treatment.2
While a headache is a common symptom of concussion, concussed players should not be given aspirin or non-steroidal anti-inflammatory drugs (NSAIDs). These drugs, such as ibuprofen or naproxen,(at least theoretically) increase the risk of bleeding in the brain. Acetaminophen (Tylenol) does not increase the risk of bleeding and can be used for headache and concussion.1
Several other types of drugs and substances should be avoided in people with concussion. These include opioids (e.g., morphine), muscle relaxants, benzodiazepines (e.g., Ativan, Valium), and alcohol. These substances tend to impair cognitive performance and even consciousness and can make it difficult to monitor progress in someone with a concussion. Even though sleep disturbances are quite common in people with concussions, the general recommendation is that they should avoid stimulant or sleep-inducing medications shortly after the concussion occurs. A physician may manage sleep disturbances with medication, however.
There is some evidence to suggest that omega-3 fatty acids may be helpful in reducing the damage that occurs during mild traumatic brain injury/concussion.3,4,5,6 Omega-3 fatty acids, such aseicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are found in fish oils and as dietary supplements.
If symptoms of anxiety or depression emerge as a consequence of concussion, the symptoms should be treated by a professional. Treatment may include psychological therapy (i.e., talk therapy) or pharmacological therapy (i.e., medications).7
- Harmon KG, Drezner JA, Gammons M, et al. American Medical Society for Sports Medicine position statement: concussion in sport. Br J Sports Med. Jan 2013;47(1):15-26.
- McCrory P, Meeuwisse WH, Aubry M, et al. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012. Br J Sports Med. Apr 2013;47(5):250-258.
- Mills JD, Bailes JE, Sedney CL, Hutchins H, Sears B. Omega-3 fatty acid supplementation and reduction of traumatic axonal injury in a rodent head injury model. Journal of Neurosurgery. 2011;114(1):77-84.
- Tyagi E, Agrawal R, Zhuang Y, Abad C, Waschek JA, Gomez-Pinilla F. Vulnerability imposed by diet and brain trauma for anxiety-like phenotype: implications for post-traumatic stress disorders. PLoS One. 2013;8(3):e57945.
- Wu A, Ying Z, Gomez-Pinilla F. Dietary omega-3 fatty acids normalize BDNF levels, reduce oxidative damage, and counteract learning disability after traumatic brain injury in rats. Journal of neurotrauma. 2004;21(10):1457-1467.
- Wu A, Ying Z, Gomez-Pinilla F. Omega-3 fatty acids supplementation restores mechanisms that maintain brain homeostasis in traumatic brain injury. Journal of neurotrauma. 2007;24(10):1587-1595.
- Bloom GA, Horton AS, McCrory P, Johnston KM. Sport psychology and concussion: new impacts to explore. Br J Sports Med. Oct 2004;38(5):519-521.