What does recovery look like?

Most adults and youth experience a full recovery within days to a few weeks. For some, it can take up to 3 months for all symptoms to resolve. Healthcare providers will check your symptoms, monitor your progress, and decide if or when they need to see you again.

What factors can prolong recovery?

There has been a lot of research over the past few years to help identify people at risk from prolonged symptoms (> 3 months) after a concussion. Most people recover quickly, although recovery differs from person to person. Interestingly, most of the warning signs are not medical findings but related to how a person thinks, feels, and how they progressively return to activities.

Getting better from a concussion may take longer if you:

  • Are a teenager or older adult
  • Are female
  • Have had a concussion before
  • Have a history of migraine headaches
  • Have trouble sleeping
  • Have mental health concerns such as anxiety or depression
  • Have a claim for compensation in relation to the injury
  • Have been previously diagnosed with a learning disability or attention deficit/hyperactivity disorder (ADHD)
  • Show symptoms of vestibular or visual abnormalities
  • Avoid movement or activity due to the fear of doing damage
  • Continue rest and inactivity instead of gradual return to life

The Dos

The first two days:

  • Do rest and take it easy for the first 48 hours
  • Do eat healthy foods and stay hydrated
  • Do reduce screen time, including looking at computer, phone, tablet, and TV screen

The first two weeks:

  • Do manage stress and do things that make you feel calm and relaxed
  • Do gradually return to your normal routines
  • Do get support and help from others
  • Do take breaks if you experience symptoms

The Don’ts

The first two days:

  • Don’t be awakened every hour – increased sleep is normal and necessary for recovery
  • Don’t stay in a dark room and avoid light and noise
  • Don’t be alone in case of a medical emergency
  • Don’t drive or ride a bike, scooter, or skateboard

The first two weeks:

  • Unless directed by a medical provider, don’t play contact sports or do activities that could cause another concussion
  • Don’t push too hard or resume activities all at once
  • Unless directed by a medical provider, don’t use nonprescription drugs, including alcohol

Symptom Management during the Recovery Phase

Sometimes people may need to see additional healthcare providers experienced in treating concussion patients to help manage specific symptoms and optimize recovery.

Headache: Some people experience migraine or tension-type headaches following a concussion, some may experience both. Medication treatments for the management of headache are divided into acute (medication taken for immediate relief) and preventative (medication taken to reduce the severity and frequency of headaches).

Additional lifestyle modifications that can help improve chronic daily headaches include:

  • Improving sleep habits – focus on good sleep quality and increased quantity.
  • Address any underlying stress, low mood, and/or worry which can exacerbate chronic pain.
  • Eat well and remain hydrated.

Vision: Vision difficulties following concussion are common and may include double or blurred vision, difficulty following moving targets, difficulty tracking or reading, scanning, eye strain, and sensitivity to bright lights. A referral to occupational therapy services may be necessary to assist with determining visual functioning, how the visual impairment is affecting functional performance, and potentially provide a referral to a neuro-optometrist for treatment interventions.

Strategies for Visual Problems:

  • Wear polarized sunglasses when outside
  • Change the brightness and make font/print size larger on electronic devices
  • Reduce glare on computer screens with the use of an anti-glare filter on computer screen
  • Limit time on the computer and reading as this can increase eye strain
  • Use a blank piece of paper under the line you are reading to help the eyes smoothly track one line to the next
  • Incorporate visual breaks to rest the eyes

Sleep Disturbance: There are multiple types of sleep difficulties that are common in patients who sustained a concussion, including sleeping too much (i.e., hypersomnia), difficulty falling asleep, staying asleep, or waking early (i.e., insomnia), or nightmares, particularly for those individuals that sustained a concussion in a serious accident or assault. Although medications can be prescribed to assist with sleep, it is often preferable to initially implement sleep hygiene strategies.

Sleep Hygiene Strategies:

  • Go to bed and wake up around the same time every day. Aim for 7-9 hours of sleep per night and set bedtime and wake up alarms to help you stick to a schedule.
  • Refrain from watching television or using screens (e.g., smart phone, tablet) at least 30 minutes prior to bedtime.
  • Limit napping time to 20-25 minutes.
  • Engage in a “winding down” routine at a consistent time each evening.
  • Avoid caffeine in the afternoon.
  • Listen to a relaxing recording to help you fall asleep, such as nature sounds, soft piano, or guided meditation.
  • If you cannot get to sleep within 20 minutes, get up and do something calming (e.g., stretching, herbal tea, reading) until you feel sleepy again. Do not start doing work or anything activating.
  • The app CBT-i Coach can help you practice the above strategies, as well as track your sleep over time.

Dizziness: Some individuals may experience feelings of lightheadedness, vertigo, or unsteadiness. How best to treat dizziness depends on the type(s) of dizziness one is experiencing. A medical provider, such as a vestibular specialist or physical therapist, will conduct vision and balance tests to determine where the issues are stemming from. Take time and slow down when doing things like getting out of bed, bending down, or turning the head. Sometimes an anti-vertigo or anti-nausea medication will be prescribed.

Cognitive: For most people, cognitive difficulties secondary to a concussion resolve within a few days to weeks, and a referral for neuropsychological evaluation is not necessary. Sometimes patients may experience prolonged symptoms, or the patient may have a history of multiple head injuries. If this is the case, a referral could be made to Neuropsychology Services at Frazier Rehab Institute for a more thorough evaluation.

Mood: It is not uncommon for individuals to experience low mood or worry after a concussion. Being active by planning activities and exercise can help to improve mood and gives one less time to worry about things. Also implementing different relaxation strategies, such as deep breathing, progressive muscle relaxation, or guided imagery can help to improve mood. Depending on the severity of one’s mood, a referral for mental health treatment, such as Cognitive Behavioral Therapy (CBT), may be necessary.

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