As a neurologist and headache specialist, I see a lot of patients who, unfortunately are experiencing symptoms of concussion. The most common question I am asked during our visit is, “When can I return to work/school?” In this fast-paced, high-pressure society, ‘downtime’ is frowned upon. Rushing to return to our normal routine can sometimes cause patients to return prematurely.

Remember, a concussion is more than just “getting your bell rung.” It’s a mild traumatic brain injury that temporarily changes how your brain works. While most people recover fully, the way you manage the days and weeks after your injury has a huge impact on how quickly and how well you heal. As I say to my patients all the time, “This is your only brain. Be patient with it.”

‍

Symptoms of a concussion

Many people are aware that the most common cause of a concussion is hitting your head. However, a sudden jolt to the body that in turn jerks the head back and forth (ie, whiplash) without a direct impact to the head can also result in a concussion. As a general background, you may have a concussion if you experience the following:

- Headache (with or without nausea)

- Dizziness or balance problems

- Sensitivity to light or noise

- Trouble concentrating or remembering things

- Fatigue, irritability, or sleep changes

The average time to return to neurological baseline is 1 to 2 weeks. This means no limitations, no accommodations, 100% how you were prior to the incident. This time period is generally much longer than people expect, and many patients assume they will be “back to normal” in a few days at the most. This is why setting appropriate expectations and timelines is imperative post-acute concussion.

‍

To cocoon or not to cocoon

For the first 24–48 hours, it’s important to give your brain a break. This means avoiding strenuous activities, limiting screen time, and refraining from overexertion at work or school.

But here’s something important: we no longer recommend locking yourself away in a dark room for days. Gentle activity, like a short walk or light reading, can actually help your brain recover, as long as it doesn’t make your symptoms worse.

So, the answer to the great cocoon debate is yes, pull out of most activities and stay home from school, but only for a day or two. The faster you slowly start to re-engage your brain, the better.

‍

Step-wise re-engagement

Going back to work/school should be a gradual process, not all at once. We recommend starting with light activities and limiting them to a few hours at first. Don’t make any commitments while you start to slowly re-engage. You don’t want to feel pressured to overexert yourself.

First, start with light activity at home. Try short periods of reading, answering emails, or light thinking tasks. With every incremental step, stop the activity if symptoms flare.

If the light reading or brief screen time does not worsen symptoms, the next step is a partial return – going back to work or school for shorter days or lighter duties.

I will write a note to students explaining that they may leave after a class or two, so they don’t feel pressured. Even if you feel well at the end of the partial day, it’s important not to extend your time just yet.

Next, moving to a modified work/school schedule involves gradually increasing hours and responsibilities.

And finally, when you’re ready and every step before this has been asymptomatic, you can fully engage and return to work/school without limitation. It’s essential to note that for student-athletes, until they return to school full-time, they are unable to rejoin their after-school activities.

If symptoms worsen at any stage, step back and give yourself more time before progressing.

‍

Accommodations

Certain accommodations may help the transition back to work or school go smoothly, in addition to limited hours. A quiet space away from the noise and distractions of a shared workspace or cafeteria is preferred if available. If materials can be printed instead of being read off a screen, that can also be beneficial. Finally, the postponement of major projects, presentations, or tests will reduce any external pressure to rush through the healing process.

‍

When to seek extra help

Most people improve with time and PATIENCE. However, if symptoms persist for longer than 3 weeks, or if headaches, dizziness, mood changes, or concentration problems are significantly impacting daily life, it’s essential to consult a neurologist.

You may benefit from additional therapies such as vestibular rehab (for balance and dizziness), vision therapy, or strategies to manage headaches and fatigue.

There is no textbook on concussion recovery. Everyone heals differently and needs different support along the way. As I often say to my patients, “The only way to screw this up is by pushing too hard.”

Give your body and brain a little grace, release some of that internal pressure, and let the healing process unfold naturally.

‍

‍

‍

Trusted Resources

• CDC HEADS UP: Concussion Care
• 6th International Consensus on Concussion in Sport (Amsterdam, 2022)

‍