Mild Head Injury Home Management

Aka: Mild Head Injury Home Management, Mild Head Injury Discharge Instructions, Head Injury Precautions, Concussion Patient Education, Minor Head Injury Home-Work-School Guidelines, Mild Traumatic Brain Injury Discharge Recommendations

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II. Management

  1. Follow-up
    1. One week follow-up clinic (or immediately if warning signs occur as below)
    2. Consider Concussion specific follow-up for persistent symptoms (e.g. sports medicine, neurology, physical therapy)
  2. General precautions
    1. Avoid Alcohol and sedating medications for 3 days
    2. Remain with a reliable companion for 24 hours
    3. Avoid driving for at least the first 24 hours (and until most significant symptoms have resolved)
  3. Anticipatory Guidance
    1. See Postconcussion Syndrome
    2. Symptoms typically improve in the first 48 hours and mostly resolve over the next 1-2 weeks
      1. Common symptoms include Headache, Dizziness, Daytime Somnolence, Insomnia and inattention
      2. Emotional symptoms may include irritability, frustration, anger and restlessness
    3. Longstanding Postconcussion Syndrome may last months, and in some cases years
      1. Reduce the risk of longstanding symptoms by getting adequate physical and cognitive rest initially
      2. Symptoms should limit activity
  4. Symptomatic relief
    1. See Postconcussive Syndrome
    2. Sunglasses for photophobia
    3. Ear plugs or noise cancelling headphones for phonophobia
    4. Avoid Opioids (Narcotic Analgesics) due to worsening confusion and Nausea
    5. NSAIDs and Acetaminophen for Headache
      1. Avoid NSAIDs if risk of Intracranial Bleeding
      2. Warn patients regarding Analgesic Rebound Headache
    6. Manage other symptom causes
      1. Whiplash injury with Tension Headaches
      2. Adjustment Disorder with Depressed Mood
  5. Cognitive rest
    1. Decrease activites that require concentration or attention
    2. Limit school work, television, computer work as well as text messaging and video games
    3. Avoid excessive visual or auditory stimulation (e.g. Screen Time, movie theaters, stadiums)
    4. Example school restrictions
      1. Return to School in 1-2 days
      2. No school homework for 1 week
      3. No major school exams for 2 weeks
  6. Physical rest
    1. See Return to Play after Concussion
    2. Relative rest for first 24 to 48 hours
      1. Light activity (e.g. walking) is recommended to continue
    3. Decrease physical activities that exacerbate symptoms (avoid raising Heart Rate)
    4. Limit aerobic Exercise, weight lifting, household chores, sexual activity
    5. However, early return to non-contact light activity may speed recovery and protect against Postconcussion Syndrome
      1. Avoid strict rest or bedrest
      2. Chauhan (2023) Pediatrics 151(5): e2022059592 [PubMed]
      3. Grool (2016) JAMA 316(23): 2504-14 +PMID: 27997652 [PubMed]
  7. Get adequate sleep
    1. See Sleep Hygiene
    2. Melatonin 3-10 mg each evening
    3. Expect increased Sleepiness
    4. Expect increased difficulty initiating and maintaining sleep
  8. School recommendations
    1. Allow for reduced work load
    2. Allow more time for homework completion
    3. Allow more time for, or delay test taking
    4. Allow student to obtain class notes or outlines prior to class if possible
    5. Allow the student to take breaks in a quiet area or nurses office as needed to control Concussion symptoms
    6. Allow for early hallway pass
    7. Excuse from physical education and music classes
    8. Provide a quiet area for eating lunch
    9. Allow sunglass use during the school day
    10. Reduced computer Screen Time is recommended, to be adjusted as tolerated.
  9. Work Recommendations
    1. Allow for reduced work load.
    2. Allow the worker to take breaks (e.g. 15 to 20 min) in a quiet area as needed to control Concussion symptoms
    3. Avoid significant exertion
    4. Provide a quiet area for lunch and breaks.
    5. Allow use of Sunglasses during the work day.
    6. Reduced computer Screen Time is recommended, to be adjusted as tolerated.

III. Management: Return or call immediately for

  1. Difficult to awaken
    1. Awaken every 2-4 hours from sleep
  2. Excessive Sleepiness
  3. Convulsions or Seizures
  4. Bleeding or watery discharge from ear or nose
  5. Severe Headache
  6. Weakness or loss of feeling in arm or leg
  7. Slurred speech
  8. Repeated Vomiting
  9. Confusion or strange behavior
  10. Eye changes
    1. One pupil larger than the other (Anisocoria)
    2. Peculiar eye movements (Nystagmus, saccades)
    3. Double Vision
  11. Slow pulse (<50/minute) or rapid pulse (>110/minute)
  12. Unusual breathing pattern
  13. Urinary Incontinence or bowel Incontinence

IV. References

  1. Bengtzen, Novak and Chesnutt (2016) Crit Dec Emerg Med 30(5): 3-10
  2. Lawler (1996) J Head Trauma Rehabil 11:18-28 [PubMed]

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