How to treat the consequences of mild traumatic brain injury

Information for doctors

What is the procedure for mild traumatic brain injury treatment?

1. Provide a consultation on the concussion and set expectations for complete recovery.
2. Manage acute headaches by administering acetaminophen every six hours for 48 hours. If needed, transition to nonsteroidal anti-inflammatory drugs (NSAIDs) afterward.
3. Delay prescribing NSAIDs until 48 hours after the concussion. Avoid administering tramadol, acetaminophen combined with caffeine and butalbital, or opioids.
4. Review the patient’s current medications and dietary supplements.
5. Recommend 24 hours of complete bed rest in the barracks.
6. Reevaluate the patient’s condition with a general practitioner after 24 hours.

Information for patients

1st day after injury

• Maintain good sleep hygiene — stay in a dark, quiet, well-ventilated (cool) room. Rest for 24 hours. Your fellow service members should not disturb you. No one should make noise, watch video streams, play games, or smoke in the room.
• Use your bed only for sleeping! Your brain should not associate it with reading, using a smartphone, or other activities.
• Limit your intake of energy drinks or other beverages high in caffeine. These stimulate your brain, which needs rest.
• Reduce your use of smartphones, tablets, and computers. Excessive sensory stimulation — such as bright lights, loud noises, frequent color changes, screen flickering, and blue light — can overload your brain.

2nd day after injury: Relative rest

• Avoid triggering symptoms. Rest to support recovery. Minimize exposure to light and noise (see Day 1).
• Limit your use of electronic devices with screens to prevent symptom aggravation.
• Stay at home or at your home station. If needed, ask fellow service members to go to the store or post office for you.
• There are no dietary restrictions — eat and drink as you normally would, except for energy drinks.
• Engage in daily activities that do not worsen symptoms, such as taking a shower, having conversations with fellow service members, or reading.
• Avoid sudden or significant changes in head position.
• Refrain from physical activity, including morning exercise.

3rd day after injury: Activity limited by symptoms

• Begin moderate physical activity, such as walking on level ground and doing light everyday chores.
• Stay in a calm and familiar environment with minimal stimuli.
• Avoid sudden or significant changes in head position.
• Do not engage in exercises that involve additional weight.
• Resume typical activities, such as standard computer work, reading for pleasure, and socializing with fellow service members.
• Perform tasks that help restore brain function, such as assembling jigsaw puzzles, building model kits, folding origami, drawing, rewriting song lyrics or poems, or reciting them.

4th day after injury: Light activities

• Gradually reintroduce activities related to your military specialization while increasing sensory stimulation (e.g., noise and light).
• Return to duty with a limited scope of tasks to prevent triggering significant symptoms (e.g., cleaning weapons, reporting on the radio, assisting fellow service members).
• You may engage in exercises that involve head movement and other physical activities without additional weight.
• Do not lift more than 9 kg.  
• Take on unfamiliar tasks or complex usual tasks, such as planning for the coming days, reading specialized literature, or listening to lectures on topics of interest.
• Continue brain function recovery exercises, gradually increasing their complexity.

5th day after injury: Gradual return to activity

• Spend time in an environment with sensory stimulation while engaging in activities to a tolerable extent.
• Attempt exercises that involve significant or sudden changes in head position, such as bending, squatting, sit-ups, and twists.

Before fully returning to duty, you must be able to:

• Perform exercises with the same duration and intensity required for duty.
• Function in a normal daily environment without avoiding sensory stimulation.
• Handle complex tasks or multitask effectively, as well as manage physical activity and environments with multiple triggers (e.g., noise, bright light, and uneven terrain).

Seek medical attention if you experience:

• Persistent or worsening headaches that interfere with daily activities or new sleep problems within four days of the injury;
• Ongoing nausea or vomiting;
• Development of stammering or other speech difficulties;
• Panic attacks;
• Sudden hearing loss or ear pain;
• Worsening vision or other visual impairments, such as blurriness, visual field distortion, vision loss in one eye, or differences in pupil size.

If you experience any of these symptoms, contact your doctor immediately.

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