Neurologic
Concussion in Adults: Symptoms, Recovery and Therapy
Expert-reviewed guidance on concussion in adults: the danger signs, what recovery looks like, and the therapy that helps when symptoms last.
- Expert Reviewed
- Evidence Based
- Patient Focused
A concussion is a mild traumatic brain injury caused by a bump, blow or jolt to the head, or by a hit to the body that moves the head and brain quickly back and forth.1 Most adults feel better within a couple of weeks.2 The advice is no longer days in a dark room: rest for the first 24 to 48 hours, then increase activity gradually as symptoms allow.3 About 15 to 20% of people still have symptoms a month later.4 For them the guideline sets out treatment symptom by symptom: graded aerobic activity, vestibular rehabilitation for dizziness, treatment of headache and neck pain, and a planned return to work, with referral to an interdisciplinary concussion clinic.5,6
What is a concussion in adults, and what are the symptoms?
A concussion happens when a blow to the head or body moves the head and brain quickly back and forth. That sudden movement can make the brain bounce or twist inside the skull, change its chemistry, and stretch and damage brain cells.1 Doctors call it mild because it is usually not life-threatening; its effects can still be serious.1
You do not have to be knocked out. A mild brain injury does not always cause loss of consciousness, and most people never pass out.9 Some symptoms appear right away; others may not appear for hours or days.2
- Physical: headaches, dizziness or balance problems, nausea or vomiting early on, tiredness, vision problems, and being bothered by light or noise.2
- Thinking and memory: trouble concentrating, feeling slowed down, foggy or groggy, memory problems, and trouble thinking clearly.2
- Mood: anxiety, irritability, sadness, and feeling more emotional than usual.2
- Sleep: sleeping more or less than usual, or trouble falling asleep.2
- Also common: neck pain, ringing in the ears, and numbness or tingling.3
How a concussion is diagnosed. A physician or nurse practitioner makes the diagnosis by ruling out more serious injury to the brain or spine, then checking how you see, walk, think and remember, and often your balance, reflexes and strength.10 A CT scan is not needed to spot a concussion; it is used when bleeding in the brain is a risk.1
Symptoms are easy to miss. The injured person may not recognize or admit the problems, and they can be overlooked by family and by healthcare providers.2 Anyone with a concussion should be seen by a healthcare provider.1
How much should you rest after a concussion?
Rest briefly, then get moving. The adult guideline advises rest and only light activity for the first 24 to 48 hours, then a gradual increase in activity as symptoms allow.3 The CDC gives the same advice: after one or two days of rest, ease back into regular activities even with mild symptoms, and cut back if they get worse.11
Strict rest does not help. A 2023 systematic review of 46 studies, in which most injuries came from sport, found that strict physical rest until every symptom has gone is not effective. Light activity in the first 2 days and prescribed aerobic exercise from days 2 to 14 helped recovery, and in a meta-analysis of seven studies activity and exercise shortened recovery by a mean of 4.64 days.12
A small, short rise in symptoms is expected. Symptoms often go up a little as activity increases. If the rise is more than mild or does not settle, slow the pace rather than stopping.5 The guidance for sport-related concussion puts a number on it: avoid a rise of more than 2 points on your symptom rating, such as a headache going from a 4 to a 7.13
The first day at home. After an emergency visit, have an adult stay with you for the first 12 to 24 hours. You do not need to stay in bed, and light activity around the home is fine, but avoid exercise, lifting weights and heavy work at first, and avoid alcohol until you have recovered.14
Sleep is allowed. Going to sleep is OK; ask your provider whether someone should wake you every 2 or 3 hours for the first 12 hours.14 Keep a fixed bedtime and wake time, sleep in a dark room, and limit screens and loud music before bed.11
How long does concussion recovery take for adults?
Most people feel better within a couple of weeks,2 and the adult guideline tells patients that most recover fully and return to their usual activities within a month.15 With proper care, most people are back at work and their usual activities within a few days or weeks.11
Symptoms change along the way: headaches and nausea are more common early, and a week or two later some people notice they feel more emotional or sleep badly.2
| Time after the injury | What usually happens | What to do |
|---|---|---|
| First 24 to 48 hours | Symptoms are at their worst.11 | Relative rest and light activity, fewer screens, and a watch for the danger signs.3,2 |
| Days 2 to 14 | Most people feel better within a couple of weeks.2 | Build activity step by step, with light aerobic exercise.12 |
| Weeks 2 to 4 | Most adults recover fully within a month.15 | See your doctor if symptoms have not gone within 2 to 3 weeks.11 |
| After 1 month | About 15 to 20% still have symptoms.4 | Referral to an interdisciplinary concussion clinic and targeted therapy.5 |
Recovery may be slower in older adults and in people who have had a concussion or other brain injury before.11 Repeated concussions can mean a longer recovery or more severe symptoms.1
When to go back to the doctor: if symptoms have not gone within 2 to 3 weeks, or get worse once you return to your usual activities.11 The guideline also advises a follow-up with your primary care provider 1 to 2 weeks after the injury.15
Persistent post-concussion symptoms: when recovery takes longer
Symptoms that last more than a month are called prolonged or persistent symptoms, and about 15 to 20% of people have them.4 When symptoms last for months, your provider may talk about post-concussive syndrome.11
One large US study. In a study of 1,154 adults with mild traumatic brain injury treated at level I trauma centers, every one of whom had a head CT, 53% still reported some injury-related limitation in daily life a year later, against 38% of people with orthopedic injuries only.16
What raises the chance of a long recovery: a previous concussion or brain injury, many symptoms early on, a delayed return to work, life stressors, older age, little social support, and being female.4 Depression or anxiety before the injury also count.11
What helps. The adult guideline treats prolonged symptoms one at a time, starting with headache, sleep and mood; it asks for a gradual return to normal activity with regular aerobic exercise, treatment of neck pain alongside the other symptoms, and referral to an interdisciplinary concussion clinic after a month. It recommends against hyperbaric oxygen.5
Pacing. Short periods of activity with rest in between, switching between kinds of task, breaks planned into the day, and a timer that stops you before symptoms rise.17
Concussion therapy: what physical, occupational and speech therapy do
Rehabilitation for lasting symptoms is shared between several clinicians. The guideline lists mental health specialists, rehabilitation providers such as occupational therapists and physical therapists, and clinics that specialize in concussion, chosen by your symptoms and exam.17
| Symptom | Who may help | What it involves |
|---|---|---|
| Dizziness, vertigo or poor balance | A physical therapist or other clinician trained in vestibular rehabilitation6 | Vestibular rehabilitation, and a repositioning maneuver for BPPV6 |
| Blurred or double vision, trouble with screens | An ophthalmologist or an optometrist with rehabilitation training; a neuro-ophthalmologist for double vision18,6 | Vision rehabilitation, or reading, prism or tinted glasses18 |
| Neck pain and headache | Your doctor, with a physical therapist for the neck19,20 | A neck and musculoskeletal exam, and neck treatment alongside the other symptoms19,5 |
| Concentration, memory, finding words | An occupational therapist or speech-language pathologist21 | Ways to cope with and work around cognitive problems21 |
| Anxiety or low mood | Your doctor and a mental health specialist such as a psychologist15,17 | Regular checks, and treatment or referral when needed15 |
What a first visit involves. Expect a standard symptom questionnaire and, if you report dizziness, vision or balance problems, a vestibular and eye-movement screen (the VOMS) that is repeated at follow-up visits.6 With symptoms that have lasted, you may also have an exertion test, which shows how different levels of physical activity affect your symptoms.17
How progress is measured. Questionnaires such as the Dizziness Handicap Inventory show how much dizziness limits daily life, and the symptom ratings from the first visit are compared over time.6
Vestibular and eye-movement therapy for dizziness after concussion
Dizziness, vertigo and imbalance are common after a concussion and are often linked to measurable problems in the vestibular system.6 The most common inner-ear cause after a head injury is BPPV: brief spinning set off by changes in head position, such as rolling over in bed or looking up.6 Dizziness can also come from post-concussion migraine and some medicines.18
BPPV is treated with a maneuver, not pills. A positive Dix-Hallpike test is treated with the Epley repositioning maneuver; if BPPV has not cleared after 1 to 3 treatments, the guideline advises referral to an otolaryngologist or a clinician certified in vestibular rehabilitation. Medicines that suppress dizziness and nausea are not supported by current evidence.6
Vestibular rehabilitation is recommended for dizziness that limits daily life. Its exercises bring on symptoms on purpose to desensitize the system, coordinate eye and head movements, and improve balance and walking.6
What the trials show. In 65 adults with mild-to-moderate brain injury and dizziness, eight weeks of group vestibular rehabilitation improved dizziness and high-level mobility at the first follow-up, but the difference had faded two months after treatment ended.22 In 31 people aged 12 to 30 with lasting dizziness, neck pain or headache after a sport concussion, 73% of those given vestibular and neck physical therapy were cleared to return to sport within 8 weeks, against 7% without it.20 In 60 adults with persistent symptoms, adding neck and vestibular therapy to aerobic exercise improved neck and vestibular measures but not symptoms or function more than exercise alone.23
Eye problems. Blurred or double vision, abnormal eye movements, sensitivity to light and screens, and headaches set off by visual tasks are all possible after a concussion, and they usually go away within a couple of weeks.18 For lasting problems with focusing or eye movements, the guideline points to optometrists qualified in rehabilitation, and to a neuro-ophthalmologist for double vision.6
Light and noise sensitivity is treated with graded exposure: more exposure a little at a time, up to the point of mild symptoms but short of a large or lasting flare.6
Is exercise a treatment for concussion?
Yes, at the right dose. For prolonged symptoms, the adult guideline recommends a mix of physical activity by tolerance, including moderate to vigorous aerobic activity.5 In the review behind the 2023 sport consensus, prescribed aerobic exercise in the first two weeks helped recovery and reduced delayed recovery.12
How it is dosed. The aim is to become more active while staying below the level that makes symptoms flare.15 With lasting symptoms, an exertion test shows how much activity your symptoms allow.17
Getting started. Walking, swimming or exercise machines are all reasonable; start slowly and build up, and if exercise brings on a headache, reduce the effort or switch activities.19 Avoid anything with a risk of another head injury, such as contact sports, until you are cleared.11
Headache after a concussion: how long it lasts and what helps
Headache is the most common symptom after a concussion. It can feel like a migraine or a tension-type headache, and in most people it stops within a few days or weeks, though it can last months.19 The international headache classification counts a headache as post-traumatic when it starts within 7 days of the injury, and calls it persistent once it has lasted more than 3 months.24
What helps without medicine: regular sleep, regular meals, drinking water, managing stress, gradual exercise, a cold or hot pack on the neck or head, and a headache diary to take to appointments.19
Pain relievers. After an emergency visit for a concussion, MedlinePlus advises acetaminophen for headache and not aspirin, ibuprofen or naproxen; ask your provider what is safe for you.14 Taking pain relievers more often or for longer than advised can cause a rebound headache, which stops only when that medicine is stopped.19,24
Ask for a full exam. A headache that continues should be assessed with a neurological exam, a neck and musculoskeletal exam, and a vestibular or vision exam.19
When can you go back to work after a concussion?
Most people go back to work within days or weeks, and returning is part of recovery as long as the job does not risk another injury.25,26 Time off is usually no more than 1 to 2 days; ask your provider for written instructions on when it is safe to return.11
Jobs that may need longer off: work at heights, intense physical work, operating machinery or heavy equipment, driving, high-stress or safety-critical tasks, and work that demands sustained attention.27
- Hours: rest breaks, shorter days or a later start, or a gradual re-entry such as two half-days a week to begin.27,25
- Tasks: extra time to finish work, less screen time, less driving, and a temporary move to tasks that do not worsen symptoms.27
- Surroundings: a quiet space for breaks, and sunglasses, earplugs or headphones for light and noise.27,25
- Safety limits: for poor balance, no working at heights.25
If symptoms hold up the return, the guideline recommends compensatory cognitive training combined with supported employment, and other meaningful activity in the meantime, such as part-time work, a course or volunteering.26
When is it safe to drive after a concussion?
Blurred vision, dizziness, fatigue, slowed thinking and headache can all affect driving. The adult guideline advises driving again only when symptoms have settled enough to drive safely, and its advice to clinicians is that a person who still has symptoms should not drive.15
Feeling better may not mean driving normally. In a small simulator study, 14 young adults tested within 48 hours of becoming symptom-free, about 16 days after their concussion, drifted out of their lane more often than matched drivers, especially on curves.28 Ask your provider when you can drive.14
Return to sport after a concussion for adult athletes
Stop playing at once when a concussion is suspected, and do not go back on the same day.29 A second concussion before the first has healed can cause second impact syndrome, rapid brain swelling that can be fatal.13 The injured player should not be left alone and should be watched over the first few hours.29
How long it takes. In adults, most sport concussion symptoms resolve within a month.13 Return to play is stepwise: each step usually takes 24 hours, so the steps take about a week once you are symptom-free at rest and with exercise. If symptoms come back, drop back to the last step without symptoms and try again after 24 hours.29
Daily life before contact. A gradual return to school and social activities comes before contact sport, and you should not be taking medicine that could mask symptoms when you return.29 Accurate diagnosis and return-to-sport decisions matter at every level, amateur to professional.29
Concussion in older adults: falls, blood thinners and recovery
After 65, most concussions come from falls, often at home with no one watching, so a person may not remember hitting their head, or a broken bone may take all the attention.30 Falls are the most common cause of brain injury in older adults,7 and older adults are more likely than any other age group to be hospitalized or die from one.8
Easy to miss. Symptoms overlap with conditions such as dementia,8 so the guideline advises suspecting a concussion after any fall, and considering it when an older person becomes newly confused.30
Blood thinners. Anticoagulants such as warfarin, rivaroxaban and apixaban, and antiplatelet medicines such as clopidogrel and aspirin, can raise the risk of bleeding in the brain after a head injury.8 The guideline recommends brain imaging right away for an older adult on warfarin after a concussion, and the Canadian CT Head Rule to decide for others.30
Recovery. Older age is a risk factor for prolonged symptoms, and older adults respond to the same treatments as younger people.31
The next fall. Balance problems after a concussion can raise the risk of falling and re-injury.18 Fear of falling can make a person less active, and being less active makes them weaker and more likely to fall; falling once doubles the chance of falling again.7
Does Medicare cover physical therapy after a concussion?
Medicare Part B helps pay for medically necessary outpatient physical therapy when your doctor, nurse practitioner, clinical nurse specialist or physician assistant certifies you need it. After the Part B deductible, $283 in 2026, you pay 20% of the Medicare-approved amount.32,33
No yearly cap. Medicare sets no limit on medically necessary outpatient therapy in a year.32 Above $2,480 in 2026 for physical therapy and speech-language pathology combined, and $2,480 for occupational therapy, the clinic adds a KX modifier to confirm the care is medically necessary; claims above $3,000 can be picked for targeted medical review, though not all are.34
Medicare Advantage plans must cover everything Original Medicare covers, but may require in-network clinics, a referral or prior authorization.35 With private insurance, ask your plan whether the clinic is in network and whether visits need approval first.
Common concussion myths, and what the evidence says
“You have to be knocked out.” No. Most people with a mild brain injury never pass out.9
“A normal CT scan means no concussion.” No. A CT scan is not needed to diagnose a concussion; it looks for bleeding in people at risk of it.1
“Rest in a dark room until every symptom is gone.” No. Strict rest until symptoms resolve is not effective; rest for a day or two, then return to activity gradually.12,3
“Never let someone with a concussion sleep.” Going to sleep is OK; ask your provider whether someone should check on you during the first 12 hours.14
“No symptoms means safe to drive or play.” Not always. Driving errors have been measured after symptoms had gone,28 and return to sport is stepwise, never the same day.29
“Symptoms after a month mean permanent damage.” No. The guideline tells people with symptoms after a month that most achieve symptom resolution with a symptom-based approach.5
Concussion rehabilitation goals, with examples
Work a full day at my desk without a headache · Drive to work again · Shop in a busy store without dizziness · Read for an hour · Run a 5K again
Reduce symptoms · Improve vestibular function
How do you find concussion therapy near you?
Ask your doctor for a referral if symptoms are not improving after 1 to 2 weeks, and about an interdisciplinary concussion clinic if they last beyond a month.17,5 For dizziness and balance, look for a clinician with specialized training in vestibular rehabilitation; for concentration, memory or finding words, an occupational therapist or speech-language pathologist.6,21
Find a therapy clinic near you
Verified clinics near you. What the badge means.
Conditions related to concussion in adults
Conditions and pages that commonly come up alongside a concussion.
Traumatic brain injury
Rehabilitation after a more severe brain injury, in the hospital and after discharge.
Learn more →Vestibular disorders
BPPV, vestibular neuritis and the other causes of dizziness, and how each is treated.
Learn more →Falls and balance
Why falls happen in later life, and the exercise that reduces them.
Learn more →Concussion in children
Return to learn before return to sport, for children and teens.
Learn more →- Adult neurologic therapy
- Adult therapy: where to start
- Cognitive-communication disorders
- All adult therapy
Frequently Asked Questions
Can a concussion cause dizziness or vertigo?
Yes. Dizziness and balance problems are common concussion symptoms.2 The most common inner-ear cause after a head injury is BPPV, brief spinning with changes in head position, which is treated with a repositioning maneuver.6
How long does dizziness last after a concussion?
Most people feel better within a couple of weeks.2 If balance problems, nausea or dizziness last longer than that, the guideline suggests specialist testing, and vestibular rehabilitation is recommended when dizziness limits daily life.18,6
Does physical therapy help concussion symptoms?
For symptoms that last, the guideline recommends vestibular rehabilitation for limiting dizziness and treating neck pain alongside the other symptoms.6,5 In one trial, 73% of young people given vestibular and neck physical therapy were cleared to return to sport within 8 weeks, against 7% without it.20
Can an occupational therapist help after a concussion?
Yes. For trouble concentrating, remembering or planning, the guideline names occupational therapists and speech-language pathologists among the specialists who teach ways to work around these problems,21 and it advises an assessment for accommodations before a return to work.17
Is it OK to sleep after a concussion?
Yes. Going to sleep is OK; ask your provider whether someone should wake you every 2 or 3 hours for the first 12 hours.14 Regular sleep at fixed times helps recovery.11
Do I need a CT scan after a concussion?
Not to diagnose it: a CT scan is used when there is a risk of bleeding in the brain.1 Older adults taking warfarin should have brain imaging right away after a concussion.30
Sources
- Centers for Disease Control and Prevention. About Mild TBI and Concussion. Checked October 29, 2026.
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Caused by “A bump, blow, or jolt to the head, or By a hit to the body that causes the head and brain to move quickly back and forth”, which can cause “The brain to bounce around or twist in the skull”, “Chemical changes in the brain” and “Stretching and damaging brain cells”; “Healthcare providers may describe these injuries as mild because they are usually not life-threatening. Even so, the effects of a mild TBI or concussion can be serious”; “A scan of your brain (such as a CT scan) is not needed to spot a mild TBI or concussion, but may sometimes be used for patients at risk for bleeding on the brain”; “People with a mild TBI or concussion need to be seen by a healthcare provider”; “A person with a history of multiple or repeated mild TBIs or concussions may experience a longer recovery or more severe symptoms”. - Centers for Disease Control and Prevention. Symptoms of Mild TBI and Concussion. Checked October 29, 2026.
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Some symptoms “may appear right away, while others may not appear for hours or days after the injury”; “most people with a mild TBI or concussion feel better within a couple of weeks”. Physical symptoms: “Bothered by light or noise”, “Dizziness or balance problems”, “Feeling tired, no energy”, “Headaches”, “Nausea or vomiting (early on)”, “Vision problems”; thinking: “Attention or concentration problems”, “Feeling slowed down”, “Foggy or groggy”, memory problems, “Trouble thinking clearly”; social or emotional: anxiety, irritability, “Feeling more emotional”, sadness; sleep: more or less than usual, trouble falling asleep. “you may have headaches and feel sick to your stomach earlier on. A week or two after your injury you may notice you feel more emotional than usual or have trouble sleeping”; “A person may not recognize or admit that they are having problems”; problems “may be overlooked by the person ..., their family members, or their healthcare provider”. Danger signs in adults, for which others “should call 9-1-1 or take you to an emergency department right away”: “a headache that gets worse and does not go away”; “weakness, numbness, decreased coordination, convulsions, or seizures”; “Vomit repeatedly”; “slurred speech or unusual behavior”; “one pupil ... larger than the other”; “Cannot recognize people or places, get confused, restless, or agitated”; “Lose consciousness, look very drowsy or cannot be woken up”. - Living Concussion Guidelines (Ottawa Hospital Research Institute). Guideline for Concussion & Prolonged Symptoms for Adults 18 Years of Age or Older: Initial Management of Concussion (patient version). Last updated July 2025. Checked October 29, 2026.
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“It is important to rest and only do light activities during the first 24-48 hours after your injury. After this, you should start to gradually increase your activity levels as your symptoms allow”; “Limit your use of electronic devices”; listed symptoms include “Neck pain”, “Ringing in the ears” and “Numbness and tingling”; driving: “do not start to drive again until these symptoms are low enough to allow you to drive safely”. - Living Concussion Guidelines (Ottawa Hospital Research Institute). Guideline for Concussion & Prolonged Symptoms for Adults 18 Years of Age or Older: Diagnosis of Prolonged Symptoms (patient version). Last updated July 2025. Checked October 29, 2026.
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“Most patients recover from a concussion within the first few weeks after the injury, but 15-20% of patients will still have symptoms beyond one month. These are called 'prolonged symptoms'”; “Sometimes the word ‘persistent’ is used instead of ‘prolonged’”; factors that can influence recovery: “Having a history of concussion or other brain injuries”, “Having a high number of symptoms early in recovery”, “Delayed return to work”, “Life stressors”, “Older age”, “Lack of social support”, “Female gender”. - Living Concussion Guidelines (Ottawa Hospital Research Institute). Guideline for Concussion & Prolonged Symptoms for Adults 18 Years of Age or Older: Management of Prolonged Symptoms. The healthcare provider section (April 2023). Checked October 29, 2026.
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“a proportion of individuals (15% or greater) may continue to have prolonged symptoms”; 5.1: people with symptoms after 1 month “should be informed and reassured that a symptom-based approach will facilitate recovery and that the majority of patients achieve symptom resolution”; 5.2: “first focus on managing headache, sleep and mood symptoms”; 5.3b: “transient symptom worsening with increased activity is common. If symptom worsening is more than mild or prolonged then a monitored, slower progression in return to normal activity should be implemented”; 5.4: activities should include “Moderate to vigorous aerobic physical activities” and “Light routine physical activities”; 5.5: prolonged symptoms for more than one month “should be considered for referral to interdisciplinary concussion services/clinics”; 5.6: “Neck pain and other bodily pain significantly interfering with patient functioning should be appropriately investigated and treated concurrently with other concussion-related symptoms”; 5.8: “It is not recommended to use Hyperbaric Oxygen”. - Living Concussion Guidelines (Ottawa Hospital Research Institute). Guideline for Concussion & Prolonged Symptoms for Adults 18 Years of Age or Older: Vestibular (Balance/Dizziness) & Vision Dysfunction. The healthcare provider section (May 2023). Checked October 29, 2026.
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“Persistent vertigo, dizziness, imbalance and visual disturbance are common symptoms of patients with concussion and are often associated with objective impairments of the vestibular system”; “While historically, medications have been used to suppress vestibular symptoms, including nausea, current evidence does not support this approach”; “The most common cause of post-traumatic peripheral vestibular dysfunction is benign paroxysmal positional vertigo (BPPV)”, with vertigo “with sudden changes in position, often including rolling over in bed or looking up”; the Dizziness Handicap Inventory “can help to assess the functional impact of dizziness”; vestibular rehabilitation “is typically provided by a ... healthcare professional with specialized training and involves various movement-based regimens to bring on vestibular symptoms and desensitize the vestibular system, coordinate eye and head movements, and improve functional balance and mobility”; patients with diplopia and/or impaired vision “should be referred to a neuro-ophthalmologist”; impairments of accommodation, version or vergence “may benefit from rehabilitative techniques rendered by qualified optometrists”. 10.1: when vestibular, vision, balance and coordination symptoms are endorsed, “they should be screened for and monitored at follow-up appointments using the VOMS”; 10.2: if still functionally limiting beyond 1 month, “Referral to a healthcare professional with specialized training in the vision or vestibular system is recommended”; 10.4: a positive Dix-Hallpike is treated with the Epley/canalith repositioning maneuver; “If BPPV does not resolve within 1-3 treatments, consider referral to an otolaryngologist or healthcare professional certified in vestibular rehabilitation”; 10.5: “Vestibular rehabilitation therapy is recommended for patients experiencing functionally limiting dizziness”; 10.6: for noise, light and other sensory sensitivities, “a graduated exposure program is recommended”, pushing “to the point that does not result in a significant or prolonged exacerbation of symptoms”. - Centers for Disease Control and Prevention. Facts About Older Adult Falls. Checked October 29, 2026.
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“more than one out of four older people falls each year”; “Falling once doubles your chances of falling again”; “Falls are the most common cause of traumatic brain injuries for older adults”; head injuries “can be very serious, especially if the person is taking certain medicines (like blood thinners). An older person who falls and hits their head should see their doctor right away”; fear of falling “may cause a person to cut down on their everyday activities. When a person is less active, they become weaker and this increases their chances of falling”. - Centers for Disease Control and Prevention. Facts About TBI. Checked October 29, 2026.
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“Falls lead to nearly half of the TBI-related hospitalizations”; “Older adults are more likely to be hospitalized and die from a TBI compared to all other age groups”; TBIs “may be missed or misdiagnosed in older adults because symptoms of TBI overlap with other medical conditions that are more common among older adults, such as dementia”; blood thinners: “Anticoagulants like warfarin (Coumadin), rivaroxaban (Xarelto), and apixaban (Eliquis)” and “Antiplatelet medications like clopidogrel (Plavix), ticagrelor (Brilinta), and acetylsalicylic acid (Aspirin)”; “These medicines may increase the risk for bleeding in the brain following a TBI”. - MedlinePlus Medical Encyclopedia, National Library of Medicine. Traumatic brain injury. “Mild TBIs do not always lead to loss of consciousness. Most people never pass out”; “Head injuries that cause a TBI often occur with an injury to the neck and spine. Take special care when moving people who have had a head injury”. Checked October 29, 2026.
- Living Concussion Guidelines (Ottawa Hospital Research Institute). Guideline for Concussion & Prolonged Symptoms for Adults 18 Years of Age or Older: Diagnosis of Concussion (patient version). Checked October 29, 2026.
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“A physician or nurse practitioner are qualified to diagnose a concussion. They do so by ruling out more severe types of injury to the brain or spine”; they assess “your abilities to see, walk, think, and remember” and may examine “your balance, reflexes, and muscle strength”. - Centers for Disease Control and Prevention. What to Do After a Mild TBI or Concussion. Checked October 29, 2026.
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“With proper care, most people can return to work, school, and many other activities within a few days or weeks”; talk with your provider if symptoms “Do not go away within 2 to 3 weeks, or Get worse after you return to your regular activities”; post-concussive syndrome “is believed to occur most commonly among people with: A history of multiple mild TBI or concussions, or Prior health conditions, such as depression and anxiety”; “Resting is good the first few days ... as this is when symptoms are more severe”; “You may need to take a short time off from work or school, although usually no more than 1 to 2 days”; “After one or two days of rest, it's important to ease back into your regular activities even if you still have some mild symptoms. If your symptoms get worse, you should cut back on that activity”; “Ask your health care provider for written instructions about when you can safely return to work, school, or other activities, such as driving a car”; “Recovery may be slower among: older adults, young children, and people who have had a concussion or other TBI in the past”; “Avoid activities that can put you at risk for another injury to your head and brain, such as playing sports”; “Limit screen time and loud music before bed, sleep in a dark room, and keep to a fixed bedtime and wake-up schedule”. - Leddy JJ, Burma JS, Toomey CM, et al. Rest and exercise early after sport-related concussion: a systematic review and meta-analysis. British Journal of Sports Medicine. 2023;57(12):762–770. doi:10.1136/bjsports-2022-106676 (PMID 37316185). A systematic review for the 2022 Amsterdam consensus on concussion in sport: 46 studies in which most injuries came from sport. Checked October 29, 2026.
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“In a meta-analysis of seven studies, PA and prescribed exercise improved recovery by a mean of -4.64 days (95% CI -6.69, -2.59)”; “early return to light PA (initial 2 days), prescribed aerobic exercise treatment (days 2-14) and reduced screen use (initial 2 days) safely facilitate recovery. Early prescribed aerobic exercise also reduces delayed recovery”; “Strict physical rest until symptom resolution is not effective”. - Living Concussion Guidelines (Ottawa Hospital Research Institute). Guideline for Concussion & Prolonged Symptoms for Adults 18 Years of Age or Older: Sport-Related Concussion (patient version). Last updated July 2025. Checked October 29, 2026.
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“In adults, most of the sport concussion symptoms resolve within 1 month”; “It is critical to stop playing your sport immediately after having a suspected concussion. If you continue to play, you will increase your risk for ‘second impact syndrome.’ ... This can lead to rapid brain swelling and can be fatal”; “you do not want more than a 2-point increase in symptom burden rating compared to your pre-activity symptom rating (i.e., avoid going from a level 4 headache pre-activity to having a level of 7 or 8 headache)”. - MedlinePlus Medical Encyclopedia, National Library of Medicine. Concussion in adults - discharge. Reviewed May 4, 2026. Checked October 29, 2026.
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“You may use acetaminophen (Tylenol) for a headache. Do not use aspirin, ibuprofen (Motrin or Advil), naproxen (Naprosyn or Aleve), or other non-steroidal anti-inflammatory medicines”; “You do not need to stay in bed. Light activity around the home is okay. But avoid exercise, lifting weights, or other heavy activity”; “Have an adult stay with you for the first 12 to 24 hours after you are home from the emergency room”; “Going to sleep is OK. Ask your provider whether, for at least the first 12 hours, someone should wake you up every 2 or 3 hours”; “Do not drink alcohol or use drugs until you have fully recovered”; “Your provider should tell you when you can ... Drive a car”. - Living Concussion Guidelines (Ottawa Hospital Research Institute). Guideline for Concussion & Prolonged Symptoms for Adults 18 Years of Age or Older: Initial Management. The healthcare provider section. Checked October 29, 2026.
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“it is advised that a person who remains symptomatic post concussion should not drive”; “after a brief period of rest during the acute phase (24–48 hours) post-injury, patients can be encouraged to become gradually and progressively more active while staying below their cognitive and physical symptom-exacerbation thresholds”; recommendation 2.2: “the majority of patients typically experience full recovery and return to usual activities within one month”; 2.4: routinely monitor for and manage depression and anxiety, with referral to a mental health specialist if needed; 2.5: medical follow-up “within 1 to 2 weeks of concussion”; 2.6: “symptoms such as blurred vision, dizziness, fatigue, impaired cognition, and headache may impact their ability to drive. Patients should only resume driving following concussion when their symptoms subside sufficiently to permit safe driving” (August 2022). - Nelson LD, Temkin NR, Dikmen S, et al. Recovery after mild traumatic brain injury in patients presenting to US level I trauma centers: a Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study. JAMA Neurology. 2019;76(9):1049–1059. doi:10.1001/jamaneurol.2019.1313 (PMID 31157856). Checked October 29, 2026.
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A cohort of 1,154 people with mild TBI (mean age 40.9) at 11 US level I trauma centers, all with a clinical head CT, and 299 with orthopedic injuries. “At 12 months, the percentage of mTBI participants reporting functional limitations was 53% (95% CI, 49%-56%) vs 38% (95% CI, 30%-45%) for OTCs”. - Living Concussion Guidelines (Ottawa Hospital Research Institute). Guideline for Concussion & Prolonged Symptoms for Adults 18 Years of Age or Older: Management of Prolonged Symptoms (patient version). Last updated July 2025. Checked October 29, 2026.
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“You will need to have a physical exam and maybe an exertion test. An exertion test is used to to find out how different levels of physical activity affect your symptoms”; “After 1-2 weeks, if your symptoms are not improving, your primary healthcare provider should refer you to other healthcare providers as needed”; referrals may include “Mental health specialists (e.g. psychologist)”, “Rehabilitation providers (e.g., occupational therapists, physiotherapists, chiropractors)”, “A clinic that specializes in concussion” and “Assessments to find out if you need accommodations when you return to work or school”; pacing: “Start with shorter periods of structured exercise/activity, with rest in between”, “Switch between different types of activities”, “Schedule rest breaks”, “Use a timer to help you stop doing an activity before your symptoms start or get worse”. - Living Concussion Guidelines (Ottawa Hospital Research Institute). Guideline for Concussion & Prolonged Symptoms for Adults 18 Years of Age or Older: Vestibular and Vision Problems (patient version). Last updated July 2025. Checked October 29, 2026.
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Balance and dizziness problems “are very common after a concussion” and “can increase the risk of falling and re-injury”; “Dizziness may also be caused from post-concussion migraines and certain medications”; vision problems include “Blurred or double vision”, “Abnormal eye movements”, “Sensitivity to light, computer, or TV screens” and “Headaches related to or triggered by visual activities”; you may need to see “an ophthalmologist or an optometrist with specialized rehabilitation training”; “Vision problems usually go away on their own in a couple of weeks”; treatment may be “vision rehabilitation or ... special glasses such as reading glasses, prism glasses, or tinted glasses”; “If you still have loss of balance, nausea, or dizziness after a couple of weeks you may need to have some testing done by another specialist”. - Living Concussion Guidelines (Ottawa Hospital Research Institute). Guideline for Concussion & Prolonged Symptoms for Adults 18 Years of Age or Older: Post-Traumatic Headache (patient version). Last updated July 2025. Checked October 29, 2026.
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“Headache is the most common symptom after a concussion”; “Some headaches feel like a migraine, others feel like a tension-type headache. In most people, headaches stop after a few days or weeks. Sometimes they can last for months or longer”; prevention: regular sleep, regular meals, drinking water, avoiding stress, and regular exercise, starting slowly (“you might go for walks, go swimming, or use exercise machines. If exercise triggers a headache, reduce your effort or try a different activity”); without medication: “Apply a cold or hot pack to your neck or head”, a headache diary; exams include “A neurological exam”, “A cervical spine (neck) exam and musculoskeletal exam” and “A vestibular or vision exam”; “If you use an analgesic for longer than or more than you are supposed to, it may trigger a ‘rebound headache’. The only way to treat a rebound headache is to stop taking the analgesic that caused it”. - Schneider KJ, Meeuwisse WH, Nettel-Aguirre A, et al. Cervicovestibular rehabilitation in sport-related concussion: a randomised controlled trial. British Journal of Sports Medicine. 2014;48(17):1294–1298. doi:10.1136/bjsports-2013-093267 (PMID 24855132). Checked October 29, 2026.
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Randomized trial of 31 people aged 12 to 30 with “persistent symptoms of dizziness, neck pain and/or headaches following a sport-related concussion”, treated weekly by a physiotherapist. “In the treatment group, 73% (11/15) of the participants were medically cleared within 8 weeks of initiation of treatment, compared with 7% (1/14) in the control group”. - Living Concussion Guidelines (Ottawa Hospital Research Institute). Guideline for Concussion & Prolonged Symptoms for Adults 18 Years of Age or Older: Cognitive Problems (patient version). Checked October 29, 2026.
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Problems can include “Finding it hard to concentrate”, “Difficulty having conversations (e.g., finding words to express yourself, following a conversation)” and “Finding it hard to plan, to start, or to complete tasks”; treatment “might include working with rehabilitation specialists such as an Occupational Therapist (OT) or Speech Language Pathologist (SLP)”, which “can help you learn ways to cope with your cognitive problems and work around them”. - Kleffelgaard I, Soberg HL, Tamber AL, et al. The effects of vestibular rehabilitation on dizziness and balance problems in patients after traumatic brain injury: a randomized controlled trial. Clinical Rehabilitation. 2019;33(1):74–84. doi:10.1177/0269215518791274 (PMID 30056743). Checked October 29, 2026.
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Single-blind randomized trial of 65 people with mild-to-moderate TBI (mean age 39.4) and dizziness or balance problems: eight weeks of group-based vestibular rehabilitation against usual care. Benefits on the Dizziness Handicap Inventory and high-level mobility at the first follow-up; “At the second follow-up, no significant between-group differences were found”; “The intervention appeared to speed up recovery ... However, the benefits had dissipated two months after the end of the intervention”. - Langevin P, Frémont P, Fait P, et al. Cervicovestibular rehabilitation in adults with mild traumatic brain injury: a randomized clinical trial. Journal of Neurotrauma. 2022;39(7–8):487–496. doi:10.1089/neu.2021.0508 (PMID 35102743). Checked October 29, 2026.
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Single-blind randomized trial of 60 adults with persistent symptoms after mild TBI: a 6-week symptom-limited aerobic exercise program alone, or with cervicovestibular rehabilitation. The combination “was not superior to a SLAE program alone in term of symptoms and functional level improvement but resulted in improved physical cervical and vestibular function”. - Headache Classification Committee of the International Headache Society. ICHD-3, 5. Headache attributed to trauma or injury to the head and/or neck. Checked October 29, 2026.
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“During the first 3 months from onset they are considered acute; if they continue beyond that period they are designated persistent”; “most often these resemble 2. Tension-type headache or 1. Migraine”; headache “must be reported to have developed within 7 days following trauma or injury”; “The overuse of abortive headache medications may contribute to the persistence of headache after head injury through the development of 8.2 Medication-overuse headache”. - Living Concussion Guidelines (Ottawa Hospital Research Institute). Guideline for Concussion & Prolonged Symptoms for Adults 18 Years of Age or Older: Return-to-activity: Work Considerations (patient version). Last updated July 2025. Checked October 29, 2026.
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“Most people can return to work within days or weeks after the injury”; “Returning to work is an important part of your recovery process and is recommended if it does not pose the risk of re-injury”; a restriction for poor balance: “no working at heights”; accommodations: “Flexible work hours (such as starting later or ending earlier)”, “Gradual work re-entry (such as starting at 2 half-days per week and increasing hours gradually)”, “Allowing more time to finish tasks”, “A quiet space available for breaks throughout the day”, “Temporary change of job”. - Living Concussion Guidelines (Ottawa Hospital Research Institute). Guideline for Concussion & Prolonged Symptoms for Adults 18 Years of Age or Older: Return-to-Activity / Work / School Considerations. The healthcare provider section. Checked October 29, 2026.
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12.2b: “transient symptom worsening with increased activity is common”; 12.3: “Encourage patients to return to some form of work, so long as work does not place the person at risk of reinjury” (August 2022); 12.4: “For patients experiencing prolonged symptoms, compensatory cognitive training with supportive employment interventions is recommended to help patients return to employment” (February 2024); 12.5: when symptoms are a barrier to pre-injury employment, “Other employment (full-time or part-time), educational activities, community roles ... (e.g. volunteer work) may be considered”. - Centers for Disease Control and Prevention. TBI in the Workplace Facts. Checked October 29, 2026.
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“Some people with a TBI can return to work within a couple of days of their injury ... Others may need weeks, months, or longer”; workers may need more time off if a job requires “Working from heights”, “Intense physical activity”, “Attention or concentration”, “Driving”, “Operating machinery or heavy equipment”, “High-stress or safety risks”; changes a provider may recommend: “Rest breaks, shortened work schedule, or a later start time”, “Temporary transfer to a position with tasks that don't worsen symptoms”, “Access to sunglasses, earplugs, or headphones if bothered by light or noise”, “Reduced driving or physical activity”, “Extended time to complete tasks”, “Reduced screen time”. - Schmidt JD, Hoffman NL, Ranchet M, et al. Driving after concussion: is it safe to drive after symptoms resolve?. Journal of Neurotrauma. 2017;34(8):1571–1578. doi:10.1089/neu.2016.4668 (PMID 27959745). Checked October 29, 2026.
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Simulator study of 14 people with concussion (mean age 20.2) and 14 matched controls; the concussed group drove “within 48 h of becoming asymptomatic (15.9 ± 9.0 days post-concussion)” and “committed more frequent lane excursions”; “Despite being asymptomatic, concussed participants exhibited poorer vehicle control, especially when navigating curves”. - Living Concussion Guidelines (Ottawa Hospital Research Institute). Guideline for Concussion & Prolonged Symptoms for Adults 18 Years of Age or Older: Sport-Related Concussion. The healthcare provider section (April 2017, adapted from the Concussion in Sport Group consensus). Checked October 29, 2026.
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“Accurate diagnosis, management, and return-to-sport decisions are essential at all levels of participation (i.e., amateur to professional)”; 3.2: “The player should not be left alone following the injury, and serial monitoring for increasing symptoms or signs of deterioration is essential over the initial few hours”; “A player with suspected SRC should not be allowed to return-to-play on the day of injury”; 3.4: “a sensible approach involves the gradual return to school and social activities (prior to contact sports) as tolerated”; 3.8: return to play “follows a stepwise process ... Generally, each step should take 24 hours so that an athlete would take approximately 1 week to proceed through the full rehabilitation protocol once they are asymptomatic at rest and with provocative exercise. If any post-concussion symptoms occur while in the stepwise program, then the patient should drop back to the previous asymptomatic level and try to progress again after a further 24-hour period of rest”; 3.9: athletes “should not be taking any pharmacological agents/medications that may mask or modify the symptoms”. - Living Concussion Guidelines (Ottawa Hospital Research Institute). Guideline for Concussion & Prolonged Symptoms for Adults 18 Years of Age or Older: Older Adults. The healthcare provider section (July 2025). Checked October 29, 2026.
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“The majority of concussions sustained in this age group are due to falls which are often not witnessed as the most likely place for falls to occur is at home. This can make diagnosis more difficult if the patient cannot remember hitting their head or if they present with a more prominent injury which demands more immediate attention (e.g. a broken bone)”; “Older age is a risk factor for prolonged concussion symptoms”; 13.1: “Concussion should be suspected for all older persons presenting with a fall”; 13.2: for new onset cognitive impairment, “concussion should be considered within the differential diagnosis”; 13.3: the need for immediate neuroimaging “should be determined according to the Canadian CT Head Rule”; 13.4: “Older persons taking vitamin K antagonist anticoagulants (e.g., warfarin) should undergo neuroimaging immediately after a concussion”. - Living Concussion Guidelines (Ottawa Hospital Research Institute). Guideline for Concussion & Prolonged Symptoms for Adults 18 Years of Age or Older: Concussion in Older Adults (patient version). Last updated July 2025. Checked October 29, 2026.
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“Older people respond to the same types of treatments as younger people do for all concussion symptoms”; “Being of older age is a risk factor for having prolonged symptoms”. - Centers for Medicare & Medicaid Services. Physical therapy services. Medicare.gov. Checked October 29, 2026.
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“Medicare Part B (Medical Insurance) helps pay for medically necessary outpatient physical therapy”; “Your doctor or other health care provider (including a nurse practitioner, clinical nurse specialist, or physician assistant) must certify that you need it”; “After the Part B deductible, you pay 20% of the Medicare-approved amount”; “There's no limit on how much Medicare pays for your medically necessary outpatient therapy services in one calendar year”. - Centers for Medicare & Medicaid Services. Medicare costs. Medicare.gov. Part B deductible in 2026: “$283 before Original Medicare starts to pay. You pay this deductible once each year”. Checked October 29, 2026.
- Centers for Medicare & Medicaid Services. Therapy services. CMS.gov. Checked October 29, 2026.
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“Claims for services over the KX modifier threshold amounts without the KX modifier are denied. For CY 2026 this KX modifier threshold amount is: $2,480 for PT and SLP services combined, and $2,480 for OT services”; the targeted medical review threshold is $3,000, and “not all claims exceeding the MR threshold amount are subject to review”. - Centers for Medicare & Medicaid Services. Compare Original Medicare and Medicare Advantage. Medicare.gov. Checked October 29, 2026.
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Medicare Advantage: “Plans must cover all medically necessary services that Original Medicare covers”; “You may need to use doctors and other providers who are in the plan's network”; “You may need to get a referral to see a specialist”; “You may need to get approval (prior authorization) from your plan before it covers certain services or supplies”.
Medical disclaimer. This page is for general educational purposes and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider about your individual situation. Never start, stop, or change a dose without medical guidance. Seek emergency assessment for any head injury with the symptoms listed above.