Do I Have a Concussion? What to Do in the First 24–48 Hours

You hit your head, or perhaps you never actually hit your head at all. You may have been tackled, rear-ended, fallen hard, or experienced enough force that your head moved suddenly and violently.

Now you have a headache and feel a little “off.” You may be dizzy, unusually tired, nauseated, foggy, irritable, or having difficulty concentrating.

The obvious question becomes:

Do I have a concussion, and what should I do now?

The first thing to understand is that a concussion is a brain injury, and it does not always present dramatically. Loss of consciousness is not required for a concussion to occur, and symptoms may not appear immediately. In some cases, they become more noticeable over the next several hours or even days.

Understanding which symptoms to watch for and what steps to take during the first 24 to 48 hours can make an otherwise confusing situation much easier to navigate.

What Is a Concussion?

A concussion is a type of mild traumatic brain injury caused by forces transmitted to the brain.

That force may result from a direct blow to the head, but it can also occur after an impact elsewhere on the body that causes the head to accelerate, decelerate, or rotate rapidly. In other words, you do not necessarily have to hit your head to sustain a concussion.

The sudden movement can temporarily alter how the brain functions. Because a concussion can disrupt multiple aspects of brain and nervous system function, two people can sustain similar injuries yet experience very different patterns of symptoms. One person may primarily experience headaches, while another develops dizziness or nausea. Someone else may struggle with reading, screens, driving, exercise, concentration, sleep, or emotional regulation. This variability is one reason concussion care should be based on the individual rather than on a single symptom, test, or diagnostic score.

Common Signs and Symptoms of Concussion

Concussion symptoms can involve much more than head pain and may include:

• Headache or pressure in the head

• Dizziness

• Nausea

• Balance problems

• Blurred or altered vision

• Sensitivity to light

• Sensitivity to sound

• Brain fog

• Difficulty concentrating

• Memory problems

• Feeling mentally slowed down

• Fatigue

• Changes in sleep

• Irritability or emotional changes

• Neck pain

• Difficulty tolerating physical activity

Symptoms are often most noticeable during the first day or two, although concussion is an evolving injury. Symptoms that initially seem mild may become more apparent several hours after the injury.

First, Make Sure It Is Not an Emergency

A suspected concussion deserves prompt attention, although certain symptoms may indicate a more serious brain injury and require immediate emergency medical evaluation.

Seek emergency care if someone develops any of the following after a head injury:

• A headache that progressively worsens or does not improve

• Repeated vomiting

• Increasing confusion, agitation, or unusual behavior

• Slurred speech

• Weakness, numbness, or significant loss of coordination

• A seizure or convulsion

• Increasing difficulty staying awake or an inability to wake

• One pupil that is noticeably larger than the other

• Loss of consciousness, particularly when accompanied by other concerning symptoms

These are not symptoms that should be monitored at home while waiting for a routine appointment. They warrant urgent medical evaluation.

What Should You Do During the First 24 Hours?

Once a more serious injury has been ruled out, the focus shifts toward protecting the brain while beginning an appropriate recovery process.

Concussion recommendations have changed considerably over time, particularly regarding rest and return to activity.

1. Stop the Activity That Caused the Injury

If a concussion is suspected during sports, the athlete should be removed from play immediately and should not return to the game, practice, or competition that same day. Activities that carry a risk of another head impact should also be avoided until the athlete has been appropriately evaluated and cleared.

This recommendation extends beyond organized athletics. The period immediately following a suspected concussion is not the time to go mountain biking, climb a ladder, participate in a strenuous workout, or engage in another activity in which dizziness, impaired reaction time, or a second injury could place you at additional risk.

2. Get Evaluated

A concussion cannot be reliably diagnosed based on a single symptom.

A thorough evaluation considers the mechanism of injury, the patient's symptoms, and neurological function. Depending on the circumstances, an assessment may include:

• Memory and cognition

• Balance and coordination

• Eye movements

• Vestibular function

• Neurological findings

• Cervical spine involvement

• Symptom response to activity

For athletes, standardized concussion assessment tools may also be useful as part of a broader clinical examination. No single computerized test, baseline score, or piece of technology should be used by itself to diagnose a concussion or determine whether an athlete is ready to return to play.

Should You Sleep After a Concussion?

One of the most persistent myths surrounding concussion is the belief that an injured person should not be allowed to sleep.

Sleep itself is not inherently dangerous after a concussion. The more important concern is whether the injured person is showing signs of a potentially more serious brain injury.

Once serious complications have been appropriately ruled out and the person is medically stable, sleep is an important part of recovery. A person who becomes progressively more difficult to wake, increasingly confused, or develops other neurological danger signs requires emergency evaluation rather than simple observation at home.

Should You Sit in a Dark Room All Day?

In most cases, no.

Older concussion recommendations often relied on extremely strict physical and cognitive rest, sometimes referred to as “cocooning.” Current evidence has moved away from that approach.

During the first 24 to 48 hours, relative rest is generally more appropriate. Relative rest means reducing activities that significantly aggravate symptoms while still allowing ordinary, low-demand activities as tolerated. Light physical activity, such as walking, may also be appropriate during this period when it produces no more than mild symptom aggravation.

A useful way to think about early concussion recovery is:

Reduce the load without eliminating normal life altogether.

What About Phones, Television, and Screens?

Reducing screen exposure during the first day or two is often reasonable, particularly when phones, computers, or television increase headache, dizziness, nausea, eye strain, or cognitive fatigue.

This does not necessarily mean every electronic device must be eliminated completely. Instead, symptom response can help guide exposure.

If ten minutes on your phone dramatically increases your headache or dizziness, that response suggests the neurological demand is currently too high. Screen use can then be reduced and gradually reintroduced as tolerance improves.

Can I Exercise After a Concussion?

Exercise recommendations are another area in which concussion management has changed significantly.

Extended complete physical rest is no longer considered the ideal approach for most uncomplicated concussions. During the first 24 to 48 hours, gentle activity such as walking may be appropriate as tolerated. After that initial period, physical activity can generally be increased gradually while symptoms are monitored and activities carrying a risk of another head injury remain restricted.

For some patients, controlled sub-symptom aerobic exercise eventually becomes an important part of treatment.

At NeuroWorks Wellness Center, one tool we may use when clinically appropriate is the Buffalo Concussion Treadmill Test, which helps assess exercise tolerance and can provide valuable information when developing an individualized aerobic exercise program.

This approach differs considerably from telling someone either, “Do not exercise until every symptom disappears,” or, at the opposite extreme, “Just push through it.”

The appropriate amount and intensity of activity depend on the individual patient, the stage of recovery, and the systems contributing to the patient's symptoms.

Can I Go Back to Work or School?

Many people recovering from concussion require temporary modifications rather than complete withdrawal from work or school.

Early difficulties may include:

• Computer work

• Reading

• Bright classrooms

• Fluorescent lighting

• Busy environments

• Long meetings

• Complex mental tasks

• Tests or homework

• Driving

• Physical work

For students, a gradual return to learning is generally preferable to prolonged absence and isolation. Temporary accommodations may include shorter school days, additional breaks, reduced screen exposure, extended assignment deadlines, delayed testing, or temporary restrictions from physically risky activities.

Adults may require similar modifications in the workplace.

The goal is not to avoid stimulation indefinitely. Instead, recovery involves progressively increasing the brain's workload without repeatedly overwhelming the neurological systems that are still recovering.

For athletes in Texas, an important distinction applies to return-to-play clearance.

NeuroWorks Wellness Center can assist with concussion evaluation, diagnosis, recovery, and rehabilitation; however, athletes who require formal return-to-play clearance must obtain that clearance from an appropriately licensed medical doctor or osteopathic physician.

Why Can Two Concussions Feel Completely Different?

The term “concussion” describes the injury, but it does not tell us precisely which systems are contributing to a particular patient's symptoms.

Persistent symptoms may involve several areas simultaneously.

The cervical spine:An injury capable of causing a concussion can also injure the neck. Cervical dysfunction may contribute to headaches, dizziness, pain, and other symptoms that overlap considerably with concussion.

The vestibular system:Problems involving balance and spatial orientation may produce dizziness, motion sensitivity, nausea, or instability.

The visual system:Eye movement and visual-processing dysfunction can make reading, computer work, grocery shopping, driving, or navigating visually busy environments unexpectedly difficult.

Exercise tolerance and autonomic regulation:Some patients feel relatively normal at rest but develop symptoms quickly when their heart rate increases.

Sleep and recovery factors:Poor sleep can interfere with recovery, while sleep disturbance during the early period following concussion may also be associated with a greater likelihood of persistent symptoms.

For this reason, simply asking, “Do you still have a headache?” does not provide enough information to understand why a patient is continuing to experience symptoms.

What If I Am Still Having Symptoms After a Few Weeks?

Many people improve substantially during the first several weeks following a concussion, but recovery does not occur according to the same timetable for every patient.

When symptoms are not progressively improving, or when headaches, dizziness, neck pain, visual disturbances, exercise intolerance, brain fog, or other problems continue, the appropriate response should not simply be to “keep waiting.”

Persistent or worsening symptoms warrant a more comprehensive, multimodal evaluation. Targeted care may be appropriate when specific systems, including the cervical and vestibular systems, appear to be contributing to ongoing dizziness, headaches, neck pain, balance dysfunction, or other symptoms.

At that point, the more useful question becomes:

What is preventing this particular patient from recovering as expected?

Our Approach at NeuroWorks Wellness Center

At NeuroWorks Wellness Center in Georgetown, Texas, we evaluate concussion and post-concussion presentations from a systems-based perspective.

Our goal is not simply to confirm that symptoms exist. We want to determine what may be driving them.

Depending on the patient, the mechanism of injury, and the stage of recovery, an evaluation may include:

• A detailed concussion and symptom history

• Cervical spine assessment

• Neurological examination

• Balance and coordination testing

• Visual and eye-movement assessment

• Exercise tolerance

• Autonomic function

• Additional factors that may be influencing recovery

When clinically appropriate, our assessment process may also incorporate objective tools such as NeuroInfiniti HRV, EEG, and sEMG assessment as part of the broader clinical picture.

No single test tells the entire story. Instead, the collective findings help us identify which systems may require attention and determine how care should be progressed.

The Most Important Thing to Remember

If you recently experienced a head injury and something does not feel right, do not dismiss your symptoms simply because:

• You never lost consciousness.

• You did not hit your head directly.

• You can still walk and talk normally.

• Your symptoms did not appear immediately.

• Your initial imaging was normal.

• Someone told you to “just rest.”

• Your injury occurred weeks ago.

A concussion is a functional brain injury, and symptoms can evolve over time.

During the first 24 to 48 hours, the priorities are to rule out serious injury, avoid another head impact, use relative rather than prolonged complete rest, and gradually return to safe activity as symptoms allow. When recovery does not progress as expected, a more detailed evaluation becomes particularly valuable.

Still Feeling “Off” After a Concussion?

If you are experiencing persistent headaches, dizziness, brain fog, visual sensitivity, neck pain, exercise intolerance, fatigue, or other symptoms after a concussion, NeuroWorks Wellness Center can help identify the factors that may be contributing to those symptoms.

NeuroWorks Wellness Center is now seeing concussion and post-concussion patients in Georgetown, Texas.

We serve patients throughout Georgetown, Round Rock, North Austin, Cedar Park, and surrounding Central Texas communities.

Contact NeuroWorks Wellness Center to schedule a concussion evaluation and take the next step toward understanding your recovery.

This article is intended for general educational purposes and is not a substitute for individualized medical evaluation. New or worsening neurological symptoms or concussion danger signs require appropriate urgent or emergency medical care.