When to go to the ER / call emergency services

These are "don't debate it" signs. Get urgent medical care.

• Worsening headache that doesn't go away
• Repeated vomiting
• Seizure / convulsions
• Increasing drowsiness, can't wake up, or can't stay awake
• Slurred speech, weakness, numbness, or decreased coordination
• Unusual confusion, agitation, or not recognizing people/places
• One pupil larger than the other or double vision
• Severe neck pain

Source: CDC "danger signs" list for concussion/mTBI. CDC Heads Up | CDC TBI symptoms

What to do in the first 48 hours

The old advice was: lie in a dark room until you become one with the dark room. The updated consensus is kinder and more effective: relative rest for ~24–48 hours, then gradual activity. Amsterdam Consensus statement

Practical version

• Protect your brain from a second hit. No sports, no risky activities, no "I'm fine" bravado.
• Keep stimulation low. Quiet environment, dim lights if light hurts, simple conversation, naps if needed.
• Screens: limit if they spike symptoms. Short checks are usually fine; doom-scrolling is not your rehab plan.
• Hydrate and eat like a functional adult (even if your brain wants gummy bears). Small bland meals if nausea is an issue.
• Pain control: acetaminophen is commonly used early; discuss NSAIDs with a clinician if unsure. Mayo Clinic
• Book follow-up. If symptoms are not improving in a few days, get reassessed.

Day 3 onward — what actually helps

1. Light aerobic exercise (sub-symptom threshold)

Evidence has shifted hard: strict rest until symptoms resolve is not beneficial for most people. Early, controlled aerobic exercise tends to speed recovery.

• Adolescent RCT: aerobic exercise recovered faster than placebo-like stretching (median 13 vs 17 days). PubMed
• Systematic review/meta-analysis: early prescribed exercise improved recovery by ~4.6 days on average. PubMed

Start with a gentle walk or stationary bike. If symptoms ramp hard, back off. The goal is "a little challenge," not "heroic suffering."

2. Vestibular rehab (if dizziness/vertigo/balance issues)

Vestibular rehabilitation (a type of physio) can help with dizziness, balance problems, and vestibular/ocular symptoms. Evidence is supportive, though studies vary. Meta-analysis

3. Post-traumatic headache / migraine pattern

Headache is the most common persistent symptom after concussion. If headaches are sticking around, ask about a structured plan. The American Headache Society has a clinical white paper on post-traumatic headache that lays out the framework clearly. PubMed

• Medication options to discuss (not for DIY): migraine preventives (e.g., nortriptyline/amitriptyline), migraine abortives (triptans), newer agents (gepants like ubrogepant).
• Non-drug options to ask about: acupuncture, biofeedback, neuromodulation devices (e.g., Cefaly, gammaCore) — these vary in evidence and availability.

When can I return to work/school?

There's a gray zone. You want to re-engage your brain… without punishing it. The consensus approach is stepwise: short blocks of cognitive work + breaks + gradual screen ramp-up. Amsterdam Consensus

A workable template

• Start small: 15–30 minute blocks, then rest.
• Increase by tolerance: add time if symptoms stay mild and don't spike later that day.
• Use accommodations: reduced hours, breaks, dimmer lighting, quiet workspace, speech-to-text, printed materials.
• If you crash the next day: that's data — dial it back.

Supplements — what's worth considering (and what to skip)

Honest framing: the supplement evidence for migraine prevention is stronger than for "speeding concussion recovery." But post-concussion headache often looks like migraine, and some supplements have limited concussion-specific data too.

Magnesium (400–600 mg/day)

• Migraine prevention evidence review (magnesium dicitrate 600 mg often cited). PubMed
• Acute concussion RCT in adolescents: oral magnesium improved symptom scores at 48 hours vs placebo. PubMed

Can cause diarrhea (especially citrate/oxide). If you have kidney disease, talk to a clinician first.

Riboflavin (B2) — 400 mg/day

• Classic migraine RCT (400 mg/day vs placebo). PubMed
• Systematic review/meta-analysis of riboflavin for migraine prophylaxis. PubMed
• Sport-related concussion RCT: riboflavin 400 mg/day associated with shorter recovery time. Contextual review

Melatonin — often 3 mg nightly (clinician-directed)

• Migraine prevention RCT: melatonin 3 mg better than placebo and similar efficacy to amitriptyline 25 mg, with better tolerability. PubMed
• Youth post-concussion syndrome RCT (3 mg and 10 mg doses studied). Full text
• Neuroimaging correlates paper in pediatric PPCS. PubMed

Can cause next-day grogginess. If you drive early mornings, test on a weekend first.

CoQ10 — 300 mg/day

• Migraine RCT (100 mg three times daily) showed benefit vs placebo. Full text
• Systematic review/meta-analysis on CoQ10 migraine prophylaxis. BMJ Open

Omega-3s (EPA + DHA)

Biologically plausible for brain inflammation/cell membrane support, but human concussion outcomes evidence is not settled. Take with realistic expectations.

• Example clinical trial in concussion. PubMed

If you're on blood thinners or have bleeding issues, talk to your clinician first.

Choline / Citicoline (CDP-choline)

Complicated. Smaller studies and some meta-analyses suggest possible benefits, but large high-quality trials in TBI have been mixed. If budget is tight, this is not the first spend.

• Citicoline systematic review & meta-analysis (2017). PubMed

Butterbur (Petasites hybridus) — not recommended anymore

Butterbur used to be recommended for migraine prevention (2012 AAN/AHS guideline), but the American Academy of Neurology stopped recommending it in 2015 due to serious liver toxicity concerns.

• NIH NCCIH summary (AAN stopped recommendation in 2015). NCCIH
• American Headache Society: "Butterbur is no longer a recommended treatment for migraine." AHS

Even if it works for some people, safety + product-quality issues make it a hard pass.