Living Concussion Guideline for Adults (ONF)
Adults with concussion or mild TBI, including symptoms that last longer than expected. Written for primary care and rehabilitation clinicians. Its 3rd edition was funded by the Ontario Neurotrauma Foundation; it is now kept online as a "living" guideline, and each section is revised as new evidence is published.
Guideline for Concussion & Prolonged Symptoms for Adults 18 Years of Age or Older
Key recommendations
- Tell patients that most people recover fully within about a month, and give the information in writing as well as in person.
- After a brief rest of 24–48 hours, return gradually to everyday activity — including work or school — as symptoms allow. A mild, short-lived rise in symptoms is common; if it is more than mild or lasts, slow the pace.
- Consider referral to interdisciplinary concussion services when symptoms last more than one month.
- Manage headache, sleep and mood first, because symptoms affect one another, and treat neck or other pain that limits function at the same time.
- Offer vestibular rehabilitation when dizziness limits daily life; refer to a clinician trained in vision or vestibular care when these symptoms still limit function after a month.
- For thinking and memory problems that persist and limit function, consider a specialized cognitive assessment (such as neuropsychological testing) and rehabilitation with a specialized program or regulated provider.
- Plan return to work and school individually, with accommodations; for prolonged symptoms, combine compensatory cognitive training with workplace supports.
- Do not use hyperbaric oxygen to treat post-concussion symptoms.
How it shows up in our care
Go Clinic follows this guideline from the first visit: clear information on day one, a brief rest and then a gradual return to activity, work and school — and, when symptoms last beyond about a month, the interdisciplinary assessment it describes, from a team that already knows the case.
About this guideline
The guideline is organized by topic: diagnosis; initial management; sport-related concussion; assessment and management of prolonged symptoms; post-traumatic headache; sleep-wake disturbances; mental health; cognitive difficulties; vestibular and vision problems; fatigue; return to activity, work and school; and older adults.
Each recommendation shows its level of evidence and the date it was last updated. A patient version and a separate pediatric guideline are published on the same site.
What it says about the conditions we treat
Most adults recover fully within about a month. After a brief rest of 24–48 hours, everyday activity should resume gradually as symptoms allow.
Patients whose symptoms last more than one month should be considered for referral to interdisciplinary concussion services. Headache, sleep and mood are managed first, because symptoms affect one another.
Headache is managed early, together with sleep and mood, because symptoms affect one another. The guideline has a dedicated post-traumatic headache section.
Vestibular rehabilitation is recommended when dizziness limits daily life (Level A evidence). BPPV is confirmed with positional testing and treated with a repositioning maneuver.
For cognitive problems that persist past 4 weeks and limit function, consider a specialized assessment such as neuropsychological testing, and refer for rehabilitation with a specialized program or regulated provider. Work or school accommodations should be reviewed and extended as needed.
Neck or other pain that significantly limits function should be investigated and treated at the same time as concussion symptoms.
This summary is paraphrased for general information — see the source for its exact wording and full recommendations. Go Clinic is not affiliated with, and has not been reviewed or endorsed by, Ontario Neurotrauma Foundation. Last updated October 2026. This page is not medical advice; Go Clinic's telehealth services are not for emergencies — call 911 or go to the nearest emergency room.
Care that follows the evidence.
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