TL;DR: In the first 48 hours after a concussion, rest relatively (not in a dark room), watch for emergency red-flag symptoms, avoid alcohol and a second hit, and don’t push through. Book a physiotherapy assessment within the first 7–10 days — early care speeds recovery.
Direct answer: For the first 24–48 hours after a concussion, take relative rest — reduce screens, work and intense activity, but you don’t need total darkness or to stay awake. Watch for red-flag symptoms (repeated vomiting, worsening headache, confusion, weakness) that mean go to the emergency department now. Avoid alcohol, a second impact, and strenuous exertion. Then book an assessment with a concussion-trained physiotherapist within 7–10 days, because early active rehab shortens recovery.
The first 48 hours: what to actually do
The old advice was a dark, silent room for days. The current evidence says something more nuanced — and more useful.
Do: – Take relative rest. Dial activity back — less screen time, lighter work, no intense exercise — but you don’t have to lie in the dark or avoid all stimulation. A short period of reduced activity, then a gradual return, beats total shutdown. – Let yourself sleep. It used to be common to wake a concussed person every hour. For most people that isn’t necessary — sleep is part of recovery. (The exception is if a doctor has specifically advised monitoring.) – Stay hydrated and eat normally. – Tell someone. Have a person around who knows you’ve had a head injury and can watch for the warning signs below in the first day.
Don’t: – Don’t drink alcohol or use recreational drugs — both cloud the picture and slow recovery. – Don’t risk a second impact. A second concussion before the first heals is genuinely dangerous. Step away from sport, riding, and anything with a fall risk. – Don’t push through symptoms to finish a game, a shift, or a workout. – Don’t take medication without advice. Ask a pharmacist or physician what is appropriate for you — some medications can mask or complicate the picture after a head injury.
Red flags: when the first 48 hours mean the emergency department, not rest
A concussion is a mild brain injury. But a small number of head impacts cause something more serious that needs imaging within hours. Go to the nearest emergency department immediately if, in the hours after the injury, you or the person notices:
- Repeated vomiting (more than once or twice)
- A headache that keeps getting worse
- Seizures or convulsions
- Slurred speech, weakness in an arm or leg, or unequal pupils
- Increasing confusion, agitation, or trouble staying awake
- Clear fluid or blood from the ears or nose
- Loss of consciousness lasting more than a minute
- Worsening neck pain after a fall or collision
These override everything else on this page. When in doubt in the first 48 hours, get checked.
Should I see a doctor or a physiotherapist first?
It depends on the symptoms.
- If there are any red flags above → emergency department or a physician first, for the medical work-up.
- If it’s a straightforward concussion (no red flags, symptoms stable or easing) → a concussion-trained physiotherapist is the right next step, and you can book directly without a referral in BC.
You don’t have to choose one forever — many patients see both. But the assessment that actually drives recovery (retraining the balance, visual, neck and exertion systems a concussion disrupts) is the physiotherapy side. Our concussion management programme runs that assessment at both Vancouver clinics.
Why you shouldn’t just “wait and see” past the first couple of days
Rest for the first 24–48 hours is right. Resting for weeks to see if it sorts itself out is the common, costly mistake.
The evidence is consistent: people assessed and started on active, guided rehabilitation within the first 7 to 10 days recover faster than those who rest passively and wait. The fastest-recovery window is early — and once it closes, lingering symptoms (the dizziness, the screen intolerance, the fog) become harder to shift.
So the rule of thumb is simple: rest two days, then get assessed. For the full symptom picture and what’s normal versus a warning sign, see our concussion symptoms guide.
FAQ
Should I stay awake after a concussion?
For most people, no — you don’t need to be kept awake or woken hourly. Sleep helps recovery. The exception is if a physician has specifically advised monitoring after assessing a higher-risk injury.
Do I need to rest in a dark room?
No. Brief relative rest (reduced screens, work and intense activity) for 24–48 hours is right, but prolonged isolation in a dark room actually slows recovery. A gradual return to gentle activity that doesn’t spike symptoms is the current standard.
How soon should I see a physiotherapist after a concussion?
Within 7–10 days of the injury — sooner if symptoms are worsening. Early assessment and active rehab measurably shorten recovery. No referral is needed in BC.
Can I take pain medication for the headache?
Ask a pharmacist or physician before taking anything — they can tell you what is suitable for you after a head injury. One thing to know regardless: a headache that keeps getting worse is a red flag for the emergency department, and pain relief should never be used to push through it.
What if my concussion was from a car accident?
The same first-48-hours advice applies. Concussion from a motor vehicle accident is covered by ICBC, no referral required, and early concussion-plus-neck physiotherapy is one of the highest-yield treatments in the first 90 days.
About the author: Harminder “Harry” Toor (BScPT, Sports Physio Dip, FCAMT, CGIMS) is a registered physiotherapist and co-owner of Envision Physiotherapy in Vancouver. He is an instructor for Sport Physiotherapy Canada and the Canadian Red Cross, and an Adjunct Professor in the Gross Anatomy Lab at UBC’s Physiotherapy Masters Program. He spent three years as therapist for the Canadian Men’s ski team and was part of the medical team at the 2006 and 2010 Winter Olympics.
Just had a concussion? Rest for the first day or two, watch for the red flags above, then book an assessment — within the first week is ideal. Both Vancouver clinics hold same-week spots for recent concussions: South Granville (604-737-7309), False Creek (604-876-2344). No referral needed; ICBC-covered after a car accident. Concussion management at Envision →
*This article is for educational purposes and does not replace individual medical advice. If you suspect a serious head injury, go to the nearest emergency department immediately.*