Top 5 Most Effective Evidence-Based Treatment Options for Concussion

Updated: April 2024

Historically, healthcare providers told patients with concussion symptoms due to mild traumatic brain injury to rest, rest, rest. And, when complete rest didn’t work, healthcare providers told them to rest some more.

The research on concussions and post-concussion syndrome is evolving at an exponential rate, and we realize that not only does prolonged mental rest not work, but it can also make your post-concussion symptoms worse.

Sadly, many healthcare providers are not keeping up with the explosion in post-concussion syndrome research and are still not up to speed on how to treat a concussion. They continue telling their patients that the only treatment for a head injury is mental rest. If you have fallen victim to this, you don’t need more rest; you need a second opinion.

While relative rest is still important during the early stages following injury, that timeline is getting shorter (i.e., 48 hours of relative rest), with strict, prolonged rest starting to worsen patient symptoms over time. So, although you may have been told to rest at the emergency room, if it’s been more than ten days of symptoms, it’s time to switch it up and start finding better concussion-supportive therapy before your symptoms worsen. (1)

If not rest, then what?

The Top 5 Most Effective Evidence-Based Treatment Options for Concussion & Post-Concussion Syndrome:

In this article, we are exploring the best concussion therapies to treat your mild traumatic brain injury – especially those suffering from persistent symptoms. Concussion recovery involves more than just treating the brain – a good concussion specialist will look at all the reasons why persistent concussion symptoms occur and take into account your previous concussion history, your physical & cognitive symptoms, your vestibular system, mood changes, and mental health disorders, and implement a concussion treatment plan that should include the following elements as part of their post-concussion treatment 5 step program:

Let’s explore why each one of these areas is so vital to concussion recovery and helping symptoms resolve for patients suffering from post-concussion syndrome.

1. Exercise Therapy

Following a traumatic brain injury, animal (and many human) studies have demonstrated an alteration in blood flow to the brain. (2) Recent post-concussion research has found that these blood flow changes may persist for some time following injury due to ongoing dysfunction in the Autonomic Nervous System (ANS). (3,4,5,6) The ANS consists of two differing sides: the sympathetic nervous system and the parasympathetic nervous system.

Sympathetic And Parasympathetic Nervous System

The Sympathetic Nervous System (SNS)

The SNS is also known as the “Fight, Flight, or Freeze” system. This side of the ANS is responsible for increasing our heart rate, dilating our blood vessels to pump blood to our muscles, releasing adrenaline, dilating our pupils, and preparing for action.

The Parasympathetic Nervous System (PNS)

The PNS, on the other hand, is our “Rest & Digest” system. This side of the ANS is responsible for lowering our heart rate, increasing our saliva production and digestion, activating our metabolism, and helping us feel relaxed and calm.

These two systems can be thought of as a teeter-totter. When one is up, the other is down—but not necessarily “on vs. off.” They fluctuate in relative dominance throughout our days and play synergistic roles in our individual actions (e.g., micturition or “peeing” requires both SNS and PNS activity). Overall, our autonomic nervous system works to maintain harmony and balance.

Brain injury creates an imbalance in the ANS, with most suffering from a shift toward a high “sympathetic tone” – this means that we get stuck in a bias toward a “fight or flight” state. Our heart rate tends to be more elevated than usual and doesn’t respond well to increased demands; blood flow to our brain is not as well-regulated; our digestion may slow down, leading to stomach pains, food sensitivities, and increased inflammation; our anxiety levels rise, we may get lightheaded more easily, and we may suffer symptoms with slight increases in everyday activities.

The good news is that research is improving at testing for and treating this problem very quickly, provided you know what you’re doing!

The solution for this problem goes against conventional thought: exercise! (7)

Image from PMID: 38188504

Pioneered by the University of Buffalo researchers, numerous studies have demonstrated complete resolution of signs and symptoms and improved brain blood flow (as measured on fMRI) through a specific graded exercise program alone. (8)

More recent evidence suggests that exercise helps speed recovery after a concussion—as early as within the same week of the injury! (1) 

This type of testing and exercise prescription is usually carried out by a physical therapist, occupational therapists, athletic trainers, or chiropractors. It is essential to see a healthcare provider who knows exactly what they are doing with this protocol and has received advanced training in the treatment of head injury and post-concussion syndrome. Testing with a trained healthcare provider must be done first to establish set points and your specific program.

2. Manual Therapy & Neck Rehab

With every concussion, there is also a whiplash element of the initial injury.

Studies have demonstrated that the acceleration required to cause a concussion is between 70 and 120 G’s (where G = force of gravity = 9.8m/s2). Whiplash, on the other hand, has been shown to occur at only 4.5 G’s. (9,10,11)

It is, therefore, conceivably impossible for a concussion to occur without also causing a sprain or strain injury to your neck! This is a repeatable finding in the research; these injuries are happening together. (12,13) 

What becomes even more confusing is that the signs and symptoms of whiplash and neck dysfunction are the same as concussion symptoms! Headaches, problems with cognitive tasks, emotional issues & mood swings, balance problems and dizziness, eye movement control problems, and brain blood flow abnormalities have all been shown to occur in post-concussive syndrome as well as whiplash and neck pain patients.(14,15,16,17)

Unfortunately, there is no way to tell if the symptoms are coming from your neck or your concussion except with testing (some specific tests that we won’t go into here). Most of the head injury patients in this category don’t even report any neck pain, which makes this all the more confusing for the average medical provider.

So, if you are still having post-concussion symptoms, even if you don’t have neck pain, you may be suffering from symptoms that are coming from your neck, which are easily treated with physical therapy consisting of manual therapy and rehabilitative exercises.

3. Diet/Nutritional Changes

During the recovery process following an injury to any tissue, there is inflammation; post-concussion patients are no exception, with several studies demonstrating increased inflammatory markers following brain injury. (18,19)

Concussion results in metabolic dysfunction (read: energy deficit) in the initial stages, which is why strict rest used to be prescribed as part of the immediate medical care to help the brain recover. The thought was – anything that burns energy, such as thinking or physical activity, could worsen symptoms. As mentioned above, however, rest is no longer considered an effective post-concussion treatment.

The majority of studies examining this metabolic disruption show a recovery between 22 and 45 days after injury. (20,21) In other words, beyond a 3-6 week period, there is little metabolic explanation for your symptoms, provided you didn’t suffer a second concussion during that time window.

Treatment options for both metabolic dysfunction and neuro-inflammation include simple dietary changes such as avoiding pro-inflammatory foods (refined sugars, white bread, pasta, artificial sweeteners, etc) and replacing them with healthier options such as fruits and vegetables, freshly caught fish (salmon, mackerel, herring), and good fats (coconut oil, flax seed, almonds). These changes may offset an ongoing inflammatory response and reduce your concussion symptoms. (22)

Although still in its infancy, there is increasing support for various supplements such as Omega-3 fatty acids, creatine, curcumin, magnesium glycinate, and melatonin. (23,24,25,26,27,28,29,30,31) Please speak with your concussion specialist before starting on any supplements, as there can occasionally be adverse effects and/or interactions with other medications that you may be taking.

Another option would be to speak to your doctor about a short course of anti-inflammatory medications. Note that we say “short course” as, over a prolonged period, these medications are not an effective treatment option.

4. Vestibular and Visual Rehab

Dizziness and balance problems are some of the most common ongoing concussion symptoms associated with post-concussion syndrome. This may be due to several overlapping issues such as problems with the balance centers of your brain (vestibular system), your visual system, and/or problems with the muscle and joint sensors of your neck. (17)

Problems with the visual system may also be one of the causes of ongoing cognitive complaints such as trouble with concentration and/or memory. If you find yourself reading a passage and then having to re-read it several times before you understand what it is saying, you might have a problem with how your eyes are moving or working together. If so, this may require vision therapy (also known as neuro-optometric rehabilitation) as opposed to occupational therapy or cognitive therapy.

These categories are placed together because it is often difficult to tell where persistent symptoms of dizziness and visual issues are coming from. Sometimes, these issues require physical therapy or chiropractic care (mostly vestibular therapy and manual therapy/rehabilitation of the neck), and sometimes, you require neuro-optometric rehabilitation or vision therapy from a neuro-optometrist.

Testing for each of these areas requires extensive knowledge of each of the systems and how they may interact. If you have not had extensive testing of these systems as part of your head injury care, then you are in the wrong place!

A proper rehabilitation program can be set up following a thorough assessment of these areas and a thorough neurological examination. The research on rehabilitation for these areas is extensive with numerous studies showing the resolution of dizziness and visual abnormalities, with a fairly short course of treatment. (32,33)

5. Education and Reassurance (due to Psychological Comorbidities)

It has been well established that patients with a pre-existing history of depression and/or anxiety tend to have an increased risk of post-concussion syndrome. (34,35) Not only that, the symptoms of these and other mental health conditions can result in, or mimic, the same symptoms of concussion (dizziness, mental confusion, concentration problems, sadness, emotional outbursts, and mood swings). (36,37,38) Many of these issues can begin before or after the head injury, which may be due to the brain injury itself, or a direct result of being mismanaged by an uninformed healthcare provider. (39,40) In other words, being told to sit in a dark room, avoid all social contact, not go to work or school, and not do any physical activity for months on end may be causing the very anxiety, depression, and triggering symptoms that you are attempting to eliminate.

Studies examining the overlay of mental health conditions and post-concussion symptoms are endless (so much so that I won’t even begin to start referencing them), and mental health will always be a big part of concussion management. In many cases, patients often feel much better just learning about their condition and learning that it is 100% treatable, given the right approach. The Ontario Neurotrauma Foundation recently demonstrated that one of the best evidence-based treatment options for preventing long-term symptoms was patient education and reassurance! (41) Just by helping the patient to be better informed about their condition and the effective treatment options available for post-concussion syndrome allows concussion patients to be empowered to seek out effective post-concussion treatment.

Hopefully, reading this article has made you feel better about your condition. In more serious cases, you may need to see a psychologist, psychiatrist, or other mental health professional such as a social worker. If you feel that you are depressed or hopeless, please talk to your doctor or seek the help of a mental health professional!

There is help out there! The trick is finding the right clinic, practitioner, or team that can help you. Click here for our interactive map to find a concussion specialist clinic near you!

Additional Resources:

• Infographic: 5 Effective Concussion Treatments