Concussion and return-to-activity advice — Rapid

Synopsis

Recognise concussion after direct or transmitted force, exclude dangerous structural injury, provide practical early recovery advice, and guide graded return to learning, work, driving and sport.

Suspect concussion after direct or indirect force when headache, dizziness, confusion, amnesia, imbalance, visual disturbance, nausea, emotional change or sleep symptoms appear; loss of consciousness is not required.
First exclude airway, cervical-spine and intracranial emergencies and apply NICE CT criteria; concussion is a clinical diagnosis and routine CT is often normal.
Remove a suspected player immediately and do not allow same-day return to training or competition, regardless of rapid symptom improvement.
Arrange assessment by an appropriate healthcare professional, give a responsible adult warning signs and avoid leaving the person unsupervised during the early risk period.
Use relative physical and cognitive rest for the first 24–48 hours, with sleep as needed and reduced screen, reading and work only to the extent that these substantially worsen symptoms.
Then increase ordinary daily and aerobic activity gradually below a marked symptom threshold; prolonged strict dark-room rest can delay functional recovery.
Return to education or work with temporary adjustments before unrestricted contact sport; progress stepwise and move back a stage if symptoms significantly recur.
No driving, cycling on roads, machinery, heights or other safety-critical activity while attention, vision, balance, reaction time or medication makes performance unsafe.

Key red flags

Falling consciousness, seizure, weakness, unequal pupils, repeated vomiting, worsening severe headache, neck pain or clear fluid from nose or ear requires emergency reassessment rather than home concussion management.

Any suspected sports concussion means immediate removal with no same-day return, even if symptoms settle quickly or the player passes a brief sideline screen.

Symptoms lasting more than 4 weeks, worsening after initial improvement, repeated concussion, major mood change or inability to resume education or work warrants clinician-led multidisciplinary review.

Investigation priorities

First-line clinical assessmentFirst stepFirst line

Diagnose suspected concussion and identify emergency features.

Management branches

ImmediateRecognise, remove and assess

A person develops possible concussion after direct or transmitted head force.

Stop sport or hazardous activity immediately, assess ABC and cervical spine, record GCS, pupils, symptoms, amnesia and observed behaviour.
Arrange emergency transfer for red flags or NICE CT indications and do not let a concussion screen delay treatment.
Do not permit same-day return and arrange assessment by an appropriate healthcare professional, with a responsible adult supervising early recovery.
Provide written and verbal warning signs and ensure school, work and other sporting settings know the restriction.

RecoveryResume daily life gradually

Emergency structural injury has been excluded and symptoms are stable or improving.

Use relative rest and sleep during the first twenty-four to forty-eight hours, limiting only activities that substantially aggravate symptoms.
Add light routine and aerobic activity below a marked symptom threshold, then increase cognitive and physical demands in small steps.
Use temporary education or work adjustments and progress toward full ordinary function before unrestricted contact training.

Key medicines

Paracetamol for acute headacheTake 1 g orally when required up to four times in 24 hours, leaving at least 4 hours between doses; reduce the maximum in adults under 50 kg or with frailty, malnutrition, chronic alcohol excess or hepatic risk.Count all paracetamol-containing products, avoid overdose and seek reassessment rather than repeatedly masking a worsening headache or new neurological feature.

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