Concussion - Treating concussion

There are a number of self-care techniques you can use to relieve mild concussion symptoms. If more serious symptoms start to develop, seek immediate medical treatment.

Some self care techniques for mild symptoms of concussion are outlined below.

• Apply ice to the head injury to help reduce swelling. Do not apply ice directly to your scalp as this could damage the skin. Instead, wrap the ice in a washcloth or towel. Alternatively, a bag of frozen vegetables such as peas could be used. Apply the ice every two to four hours and leave in place for 20-30 minutes.
• Take paracetamol to control pain. Do not use the non-steroidal anti-inflammatory drug (NSAID) type of painkillers, such as ibuprofen or aspirin, as these can sometimes cause bleeding at the site of the injury.
• Take plenty of rest and, where possible, avoid stressful situations.
• Avoid drinking any alcohol or taking recreational drugs.
• Only return to work, college or school when you feel you have completely recovered.
• Only drive a car or ride a bike when you feel you have completely recovered.
• Do not play any contact sports such as football or rugby for at least three weeks without talking to your GP (see below for more information on returning to sport).
• Make sure you have someone to stay with you for the first 48 hours after the injury, in case you experience more serious follow-up symptoms (see below).

When to seek follow-up advice

Sometimes the symptoms of a more serious brain injury do not occur for several hours or possibly days after the initial injury has taken place.

So it is important you remain alert for signs and symptoms that could suggest a more serious injury has occurred.

If you or someone in your care has any of the signs or symptoms listed below, go to your nearest accident and emergency (A&E) department as soon as possible:

• unconsciousness or lack of consciousness, such as problems keeping your eyes open
• mental confusion such as forgetting who or where you are
• any drowsiness that goes on for longer than one hour when you would normally be wide awake
• any problems understanding or speaking
• any loss of balance or problems walking
• any weakness in one or both arms or legs
• any problems with eyesight
• a very painful headache that will not go away
• any vomiting
• any fits or seizures
• clear fluid coming out of the ear or nose
• bleeding from one or both ears
• sudden deafness in one or both ears

Returning to sports

Despite being one of the most common sport-related injuries, there is no internationally agreed consensus on advice about when it is safe to return to playing a contact sport, such as rugby, after a concussion.

Most national sporting federations and organisations recommend a 'step-wise' approach where you wait until you are free of symptoms and then resume a low level of physical activity. If the symptoms do not return, you can step up to a more intense level of activity.

If symptoms are still under control, continue to step up through the levels, eventually returning to playing the sport.

A 2008 conference of experts in sports medicine recommended these steps:

1. Complete rest until symptoms have passed.
2. Light aerobic exercise such as walking and cycling.
3. Sport-specific exercises such as running drills for football or rugby (but no activity that involves impact to the head).
4. Non-contact training such as passing drills for football.
5. Full training including physical contact such as tackling.
6. Return to play.

Each step should take 24 hours, so if you are symptom-free you should be able to return to play within a week.

If you do experience a return of symptoms, rest for 24 hours, drop down to a previous step, and then attempt to move up again.