Concussion Myths: Part I

Welcome to Concussion Myths: Part I — because let’s be honest, there will probably be many parts with all of the outdated and misleading information about concussion out there on the interwebs. This series is here to clear up some of the most common myths—starting with those related to treatment.

Myth 1: You have to keep someone awake after a concussion.

You may have heard that you're supposed to frequently wake someone up after they’ve had a concussion to "make sure they're okay." While this advice is well-meaning, it's actually no longer recommended. In reality, sleep is essential for recovery and can help the brain heal after an injury. Waking someone up repeatedly may interrupt this important healing process. With that said, if there are any signs of a declining level of consciousness following a head injury, it’s important to seek immediate medical attention. This could indicate a structural issue in the brain, such as bleeding, that requires urgent evaluation.

Myth 2: The best treatment is "cocooning" in a dark, quiet room.

You may be familiar with the concept of "cocooning"—resting in a dark, quiet room after a concussion—as part of a strategy involving strict physical and cognitive rest after concussion. However, this "cocooning" approach is also no longer recommended. Recent evidence has shown no benefit to prolonged rest, and it may even slow recovery. Current guidelines instead support an initial period of relative rest for 24 to 72 hours, followed by a gradual, step-wise return to activity. This includes controlled aerobic exercise, such as the Buffalo Treadmill Test, tailored to the patient’s symptoms and heart rate. The safety of this approach was first established by Leddy et al. in 2010 (PMID 20051730), and subsequent studies have demonstrated that this early, controlled aerobic activity leads to faster recovery.

Myth 3: There's no treatment for concussion -- you just have to wait it out.

Not true! While many individuals recover after an initial period of rest and gradually resume cognitive and physical activities, some may experience lingering effects. Fortunately, effective treatments are available for what is now referred to as persisting symptoms after concussion (formerly known as post-concussion syndrome). Management typically involves a personalized, multidisciplinary approach. Here are some examples:

• Headaches: lifestyle changes, medications, injections, neuromodulation devices

• Neck pain: physical therapy, medications, massage, acupuncture, injections

• Dizziness and balance issues: vestibular therapy

• Visual disturbances: oculomotor/vision therapy

• Mood symptoms: cognitive behavioral therapy, medications

• Overall symptom management: subsymptom threshold aerobic exercise

Concussions are complex, but thankfully, our understanding of how to treat them is evolving. By letting go of outdated advice and embracing evidence-based approaches, we can better support recovery after concussion. Keep an eye out for Part II, where we’ll tackle even more myths and misconceptions!