Concussion: What to Expect & Self-Care in the First 48 Hours

The first 48 hours after a concussion are often the hardest part emotionally, even when the injury itself is manageable. You or your child may look fine on the outside while feeling awful inside. This guide covers what to expect in the concussion first 48 hours, how to self-care safely, and when to go to emergency instead of waiting for a clinic appointment.

We are concussion physiotherapists in Subiaco, Perth. We are a day clinic, not a 24-hour emergency service. If you are in doubt after reading the red flags below, call 000 or go to your nearest emergency department.

Symptoms in the first 48 hours

A concussion is a brain injury. Symptoms can start straight away or build over several hours. Common signs in the first day or two include:

• Headache or pressure in the head
• Dizziness, balance problems, or feeling “foggy”
• Nausea or vomiting (occasional vomiting can occur; repeated vomiting is a red flag)
• Light or noise sensitivity
• Blurred vision or trouble focusing
• Slowed thinking, forgetfulness, or difficulty concentrating
• Irritability, anxiety, or low mood
• More sleep than usual, or trouble falling asleep

These symptoms are unsettling. They are also why a structured concussion assessment within the first week matters. We track your pattern, rule out other contributors (such as the neck), and set a plan you can follow instead of guessing. For a plain-language overview of the injury, see what is a concussion.

Red flags: go to emergency, not the physio clinic

Most concussions are managed without hospital admission. A smaller group needs urgent imaging or medical review. Go to emergency (or call 000) if you notice:

• Repeated vomiting
• Headache that is rapidly getting worse
• Seizure or convulsion
• Weakness, numbness, or tingling in the arms or legs
• Slurred speech, severe confusion, or unusual behaviour
• Loss of consciousness at the time of injury or afterwards
• One pupil larger than the other
• Inability to wake the person properly
• Bruising around the eyes or behind the ears (possible skull fracture)
• Neck pain with high-impact mechanism (treat neck injury seriously)

The Healthdirect concussion guide lists warning signs in plain language. Use it as a checklist, not a substitute for professional care when you are worried.

If none of these apply but symptoms are significant, book a concussion physiotherapist promptly. We are not open around the clock; emergency departments are.

Self-care in the first 24 to 48 hours

Think of the first day or two as relative rest, not total shutdown. The goal is to protect the brain from overload while avoiding weeks of isolation that can slow recovery and ramp up anxiety.

Practical steps that help many people:

• Rest when symptoms flare — lie down in a quiet space until things settle, then try light activity again if tolerated.
• Hydrate and eat regularly — skipping meals and dehydration worsen headache and fatigue.
• Limit screens if they trigger symptoms — brightness and scrolling load the brain. Use audio, short messages, or voice calls if needed.
• Short walks indoors — gentle movement is often fine if it does not clearly worsen symptoms.
• Have someone check on you — especially the first night after a significant head knock. They do not need to wake you every hour if you are sleeping normally and red flags are absent.
• Avoid alcohol and recreational drugs — they interfere with recovery and cloud symptom monitoring.
• No contact sport or risk of another head knock — second impact before recovery is dangerous. Full stop until you are cleared through a graduated plan.

If an activity clearly spikes symptoms, pause and try again later at a lower level. That is different from hiding in a dark room for days “just in case.”

Can you sleep with a concussion?

Yes. Sleep helps the brain recover. The old advice to wake someone every hour through the night is outdated for most people once a brief period of observation has passed and red flags are absent.

After a significant head injury, it is reasonable for a responsible adult to stay nearby for the first few hours and confirm the person can be roused, speaks normally, and is not deteriorating. If that check is reassuring and emergency red flags are not present, normal sleep is encouraged.

Seek urgent care instead of “letting them sleep it off” if they cannot be woken easily, vomit repeatedly, have a worsening severe headache, show increasing confusion, or have any red flag from the list above.

Rest, screens, and gentle activity

Complete rest for many days is no longer best practice for most concussions. Brief rest when symptomatic, then a gradual return to light cognitive and physical activity (as long as symptoms do not clearly worsen), is aligned with current sport and clinical guidance, including resources from the Australian Institute of Sport concussion guidelines.

That does not mean “push through” pain or dizziness. It means avoiding both extremes: no heroics, and no cocooning for a week unless your clinician advises it for a specific reason.

We use Complete Concussions protocols at Heads Up to set your exertion ceiling, coordinate neck or vestibular treatment when needed, and link to return to sport or return-to-learn steps. For more on why prolonged rest can backfire, see our article on concussion rehab vs rest.

When to book concussion physiotherapy in Perth

Book an assessment within the first week if:

• Symptoms are affecting school, work, driving, or daily life
• You need a clear plan for sport, work, or study return
• Symptoms are not improving as expected
• You are unsure what activity level is safe

Initial concussion appointments are $139 (in person at Subiaco or via telehealth). No GP referral is required. If symptoms persist beyond the usual window, we coordinate post-concussion syndrome rehabilitation rather than telling you to wait it out.

Meet Jimmy Milligan and the clinic team, or book an appointment online when you are ready for a structured plan.