I Just Hit My Head… Now What? Your Step-by-Step Guide for the First 48 Hours
So, you just hit your head. Maybe it was a graceful tumble down the stairs, an unfortunate run-in with your cabinet door, or perhaps you got a little too confident on the pickleball court. Now your brain feels like it’s been tossed into a blender, and you’re left wondering: Do I have a concussion? What happens next? Am I dying?
Relax for a second, you’re probably not dying—but your brain just went through something, and it’s about to demand your full attention whether you like it or not. So let’s talk about those first 48 hours. What can you do to facilitate a full and speedy recovery?
Step 1: identify any warning signs
After a head injury, it's crucial to identify symptoms that signal the need for immediate and or prompt medical attention. These symptoms are categorized into two levels of concern: Red Flags and Orange Flags.
Red Flags: Immediate Medical Attention Required
Red flags are serious symptoms indicating potential severe brain injury. If you or someone else experiences any of these symptoms, it’s not a “wait and see” situation—it’s a get to the ER now situation.(PMID: 37316210)
Glasgow Coma Scale < 13/15 – A lower-than-normal score means serious brain dysfunction.
Tonic Posturing – Rigid, unnatural stiffening of the body, which can signal severe brain trauma.
Severe or Significantly Worsening Headache – Could indicate brain swelling or bleeding.
Skull/Face Deformity – If your head feels different, that could mean a fracture.
Loss of Consciousness – Even briefly, this warrants immediate medical assessment.
Blood or Clear Fluid Exiting from the Ears or Nose – A sign of potential skull fracture or brain injury.
Sudden Difference in Pupil Size – If one pupil is larger than the other, seek medical help immediately.
Seizure or Convulsions – Clear evidence of abnormal brain activity that requires urgent evaluation.
Repetitive Vomiting – More than once is concerning and could indicate brain trauma or increased pressure inside the skull.
Behavioral Changes: Sudden aggression, paranoia, or extreme mood swings = concern.
Amnesia: Memory loss before or after impact could mean serious brain trauma.
Orange Flags: Prompt Medical Evaluation Advised
Orange flags are symptoms that, while not immediately life-threatening, still require prompt medical attention. If you notice any of the following or the physician is in doubt: removal from play and as soon as possible seek further examination by a healthcare professsional. (PMID: 32557913)
Persistent Headache – If the headache sticks around or worsens, get checked out.
Nausea or Vomiting – One episode may not be concerning, but ongoing nausea or vomiting requires attention.
Sensitivity to Light or Noise – If normal lights or sounds suddenly feel unbearable, that’s a sign your brain isn’t happy.
Difficulty Concentrating or Memory Problems – If you feel like your brain is working through molasses, it’s a red flag for brain dysfunction.
Fatigue or Sleep Disturbances – Feeling excessively drowsy or struggling to sleep can signal lingering brain effects.
Neck Pain or Tenderness – Could indicate associated cervical spine injury.
Dizziness – Trouble balancing, lightheadedness, or a spinning sensation means your vestibular system might be affected.
Recognizing these red and orange flags is vital in ensuring appropriate care after a head injury. When in doubt, it's always safer to seek medical evaluation to prevent potential complications.
To learn more about red and orange flags after concussion check out our blog entitled Red Flags in Concussion.
Step 2: What Symptoms to Expect in the First 48 Hours
If you’ve ever had a power surge at home, you know it can knock out your electronics temporarily. Something similar happens within your brain after a concussion. When the brain experiences a traumatic event, it undergoes what’s called a neuro-metabolic cascade—a fancy way of saying that neurons (brain cells) go into overdrive, trying to reset themselves. To learn more check out our blog entitled Concusion Explained: What’s Happening in your Brain?
For the purposes of today’s blog just know that your brain is now burning through glucose at a much higher rate, but due to the injury, it has trouble replenishing these resources. On top of that blood flow to the brain may be reduced, starving the injured area of the oxygen and nutrients it desperately needs for repair. This is why concussion symptoms like brain fog, dizziness, and fatigue are so common—the brain is literally running on fumes. Post-impact, your brain might throw a little tantrum. Here's what you might experience:
Headache – Your brain's way of saying, "That wasn't fun."
Dizziness – Feeling like you're on a merry-go-round that won't stop.
Nausea – Your stomach might protest the recent upheaval.
Sensitivity to light and noise – Suddenly, your cozy living room feels like a rave.
Brain Fog – Thoughts moving slower than Monday morning traffic.
Difficulty Concentrating – Focusing on anything feels akin to herding cats
Sleep - Your brain is in full repair mode, which means you might feel like you could sleep for days.
Irritability - If you suddenly feel like everyone around you is unbearable, blame your brain, not your personality.
Visual Issues - Your brain controls eye movement, and when it takes a hit, your vision can get temporarily scrambled.
Step 3: Can You Sleep After a Concussion?
Short answer: Yes, sleep.
Longer answer: The archaic advice of keeping concussion patients awake is as outdated as dial-up internet. Sleep is a vital component of recovery. In general, you do not need to be awakened during the night unless you are experiencing any of the red flags mentioned prior. If any of these apply, a trusted person should check in periodically to ensure your condition has not worsened. (PMID: 38853235)
To learn more about sleep immediately following a concussion check out our blog entitled Can You Sleep after a Concussion?
Step 4: Common Mistakes People Make in the First 48 Hours
Avoid these missteps to ensure a smoother recovery:
"Toughing It Out" – This isn't the time to channel your inner action hero. Rest is paramount.
Screen Time – Your brain currently views screens as arch-nemeses. Give devices a break.
Ignoring Worsening Symptoms – If things go south, don't adopt a wait-and-see approach. Seek help.
Popping Ibuprofen or Aspirin – These can increase bleeding risks. If you need pain relief, use acetaminophen (Tylenol).
Consuming Alcohol or Caffeine – Alcohol can inflame your brain, and caffeine will trick you into thinking you’re fine when you’re not. Both are off the menu.
To learn more about common mistakes made following a concussion check out our blog entitled Avoid these Mistakes after a Concussion
Step 5: How to Support Brain Recovery in the First 48 Hours
Now, assuming you’ve cleared the red flags, the next thing I want you to do is engage in ‘relative rest.’ And no, that doesn’t mean lying in bed waiting for the universe to magically fix you. You’re going to continue most of your daily activities—but at a reduced intensity. (PMID: 37316210)
Here’s what that looks like:
Reduce screen time - your brain does not need a Netflix binge right now.
Hydrate - your brain is mostly water—help it out.
Eat nutrient-dense foods - this is not the time for gas station nachos.
No alcohol or caffeine - trust me, your brain will thank you.
Light physical activity - a gentle walk is great—as long as it doesn’t spike your symptoms.
For a more detailed account of screen time, dietary strategies, supplementation, or the use of exercise after concussion check out our blogs entititled:
Dietary Strategies for Concussion Recovery
The Return to Play Protocol
Final Thoughts
The first 48 hours after a concussion set the stage for your recovery. Get this part right, and you’re giving your brain the best chance to heal quickly and fully. Get it wrong, and you could be looking at a much longer, more frustrating recovery process.
Here’s the bottom line:
Know the Red Flags—if something seems off, don’t ignore it.
Let your Brain Rest—but not too much. A little movement is good, total isolation is not.
Skip the Screens—it’s a simple change that could cut your recovery time in half.
If you’re looking for a more detailed breakdown of what to do (and what not to do) after a concussion, download my free Concussion Recovery Guide—it walks you through the essential steps to avoid common mistakes and heal faster.
And if you’re still unsure about what to do next, let’s talk. I offer a free phone consultation to help you figure out the next steps in your recovery. Whether you need guidance on what’s normal, what’s not, or how to get back to feeling like yourself faster, I’m here to help. Click the button below to schedule your free call today.
