Contact sports should be prohibited for this patient with symptoms after sustaining a mild traumatic brain injury, which occurred when head trauma resulted in a transient alteration of neurologic function. The patient exhibited the typical physical symptoms of this type of injury, including headache, dizziness, and nausea. Although the symptoms have largely resolved, he still requires acetaminophen to control headache pain. Prohibiting contact sports is recommended for a patient who is still symptomatic. This restriction should remain in place even when the patient is in an asymptomatic state after taking medication. Not until the patient is asymptomatic without taking any medication should a return to contact sports be considered.

In the presence of normal findings on physical examination, a head CT scan or MRI of the brain is unlikely to provide any useful information and thus has no role. A noncontrast head CT scan is recommended in the setting of acute head injury when skull fracture or intracranial hemorrhage is suspected. Risk factors for these findings include prolonged loss of consciousness, posttraumatic amnesia, focal neurologic deficit(s), vomiting, severe headache, physical evidence of a basilar skull fracture, a Glasgow Coma Scale score less than 15, coagulopathy, or a dangerous mechanism of injury. MRI of the brain may be more sensitive in the detection of small areas of parenchymal damage or hemorrhage in the patient who is seen days or weeks after an injury, but suspicion of such damage would be low in this patient who has shown significant improvement 1 week after the trauma.

Gradual reintroduction of cognitive and normal physical activities is recommended for patients with concussion. Those with significant cognitive symptoms or neuropsychological examination deficits should have restrictions placed on cognitive activity. Immediate resumption of normal levels of cognitive activity (such as full days of classroom work) may delay recovery in some patients. Typically, cognitive rest is recommended for 3 to 7 days, followed by gradual reintroduction of cognitive activity periods. These periods initially should be limited to the threshold of concussion symptom aggravation but, over time, should be lengthened. Given the wide variability of recovery timeframes, management must be individualized. In this patient without any cognitive or significant physical symptoms 1 week after the injury, returning to school is appropriate, and restriction of classroom participation is not required.