Good days and difficult days during concussion recovery: how to track the bigger picture
Use a weekly tracking sheet and learn which trends to raise with your care team
Imagine a 47 year old school custodian whose bicycle was clipped by a pickup making a right turn three months ago. On Tuesday he walked to the park, read the paper for an hour and felt close to normal. On Thursday his headache hit 7 out of 10 and he could not stand the sound of the TV. He wonders which day tells the truth about his recovery.
Neither day can answer that alone. Symptoms after a concussion often swing up and down, and the direction of recovery shows up over weeks. Our article on coping with a difficult recovery day covers how to get through a hard day itself. This one is about keeping simple records that show the bigger picture.
You will find a weekly tracking sheet, a way to rate everyday activities, and a list of trends that call for a clinician.
Why symptoms swing from day to day
One small pilot study followed 10 young people from a concussion clinic, with an average age of about 20. They rated their symptoms on a phone five times a day for 20 days [1]. Patterns over time, such as daily cycles, explained about a quarter of the ups and downs on average [1]. That share ranged from none at all to 82%, depending on the person [1]. The authors suggested that some symptoms may follow daily rhythms of alertness and activity [1].
A 2025 study looked at adults with symptoms that had lasted. Nineteen people logged their symptoms in a phone app every day for four weeks [2]. People who gave the same answer on a standard symptom questionnaire often had very different day to day swings [2]. The authors argued that a single total score oversimplifies what people live with [2].
What can push a day up or down
Activity is one trigger you can see. The CDC notes that symptoms can flare when you go back to your regular activities, and it advises cutting back on an activity that makes them worse [3]. Sleep, stress and pain are worth noting too, since they often travel with concussion symptoms.
Canada’s adult concussion guideline offers a useful test. Lingering symptoms should not stop you from doing daily tasks, and they should not keep dragging down how you function the next day [4]. So the question to ask after a hard day is whether you bounced back by the following day, or whether it took longer.
What recovery usually looks like over months
Guidance written in 2025 for U.S. primary care says most people get back to their usual level of function within about a month of a mild TBI [5]. Some take longer, and long term studies show what that path tends to look like.
Findings from trauma centers
TRACK TBI is a large U.S. study of people treated at level I trauma centers, the hospitals that handle the most serious injuries. It enrolled 1,154 people with a mild TBI between 2014 and 2018, plus 299 people with other injuries such as broken bones [6]. At the two week mark, 87% of those with mild TBI said the injury still limited their daily life in some way [6]. A year out, the figure was 53%, versus 38% in the group with other injuries [6].
Those numbers come from people sick enough to go to a major trauma center, so they may not match everyone. The authors said the results point to a need for more organized follow up care after mild TBI [6].
Four common paths
A 2025 study followed 185 people with mild TBI at two weeks, then at three, six and twelve months [7]. The researchers found four groups [7]:
- 54% started with low symptoms that kept falling.
- 19.5% started with moderate symptoms that fell.
- 20.5% started with high symptoms that fell.
- 5.9% had very high symptoms that stayed high.
So in three of the four groups, symptoms came down over the year, including many people who started out struggling. People in the two highest groups also had more catastrophizing, which means expecting the worst, along with more avoidance of activity and more depression [7]. The authors suggested that treatment aimed at those problems may help recovery [7].
Why your memory is a shaky yardstick
When a care team asks how you have been, you answer from memory, and memory has limits. The 2025 app study noted that questionnaires that ask you to look back can be bent by memory and miss daily swings [2]. In that study, the look back questionnaire explained at most 35% of the differences in people’s daily averages [2].
Remembering how you felt before the crash is even harder. One study asked 836 people with mild TBI to rate their symptoms from before the injury, at four separate times [8]. Almost half, 45%, gave answers that did not match from one time to the next [8]. The authors concluded that comparing complaints before and after an injury is difficult [8].
Compare yourself with your own records
One widely used form, the Rivermead Post Concussion Symptoms Questionnaire, lists 16 symptoms. It asks you to rate each one over the last 24 hours, compared with before the accident, on a scale from 0 to 4 [9]. Your care team may use it, and it is a fair tool for them. For your own tracking, compare yourself with what you wrote down three or four weeks ago.
Comparison compiled by Safety Behind the Wheel Foundation
What different time frames can tell you
| Time frame | What it shows | What it can miss |
|---|---|---|
| One day | How today went | Whether today was typical |
| One week average | Your usual level right now | Slow change across months |
| Month to month | The direction of recovery | A sudden new symptom |
| Questionnaire at a visit | A standard score for your team | Swings between visits |
| Memory of before the crash | A rough starting point | Accuracy, since recall shifts |
Sources: Rauwenhoff and colleagues [2]; Rabinowitz and Fisher [1]; Voormolen and colleagues [8]; Rivermead form [9].
Your weekly tracking sheet
Tracking works best when it is quick. Aim for about two minutes a day, at the same time each evening. Pick the one to three symptoms that bother you most, and rate each from 0 (none) to 10 (worst). Add your hours of sleep and a short note about the day.
The 2025 app study compared people’s average, highest and last day scores from their final week of records [2]. You can use the same three numbers. Together they show your usual level, your worst moment and where you ended the week.
Worksheet from Safety Behind the Wheel Foundation
Weekly tracking sheet
| Day | Main symptom (0 to 10) | Hours of sleep | What I did and notes |
|---|---|---|---|
| Monday | |||
| Tuesday | |||
| Wednesday | |||
| Thursday | |||
| Friday | |||
| Saturday | |||
| Sunday | |||
| Week average | |||
| Worst day |
Make one copy for each symptom you track. Based on daily symptom logging in Rauwenhoff and colleagues [2] and the CDC’s advice to watch how activity affects symptoms [3].
How to work out a weekly average
Add up the seven daily numbers and divide by 7. If the custodian’s headache scores were 4, 3, 5, 7, 4, 3 and 2, the total is 28, so his average is 4. The Thursday 7 stands out, but his usual week sits around 4. If his average was 5 a month ago, he is moving in the right direction.
Your weekly summary
Once a week, take five minutes and write a few lines.
Checklist from Safety Behind the Wheel Foundation
- This week’s average for each symptom, next to last week’s.
- The worst day, and what happened the day before.
- How many days you were back to your usual level by the next morning.
- Any new symptom, and the date it started.
- Any change in mood, sleep or pain that lasted most of the week.
- One thing that went better than a month ago.
Keep the summaries together in one folder or phone note. After four weeks, line them up side by side and bring them to your next appointment.
Tracking what you can do
Symptom scores leave out how much you can get done in a day. Rehabilitation teams use a simple tool called the Patient Specific Functional Scale. You choose activities that matter to you, then rate each from 0, meaning you cannot do it, to 10, meaning you can do it as well as before [10]. It takes less than four minutes [10].
The Shirley Ryan AbilityLab summary of the scale lists studies in neck and back pain, knee and other joint problems, limb loss and multiple sclerosis. It lists none in brain injury or concussion [10]. In people with neck problems, a change of about 2 points was the smallest that was likely real [10]. That finding comes from neck problems, not concussion, but it hints that a 1 point change in your own ratings may be normal wobble. Ask your care team how much change matters for you.
Canada’s guideline gives everyday examples of activities to build up gradually, such as walking, reading and cleaning the home [4]. Pick three to five activities like these that matter in your life.
Worksheet from Safety Behind the Wheel Foundation
My everyday activity ratings
| Activity | Week 1 (0 to 10) | Week 4 (0 to 10) | Week 8 (0 to 10) |
|---|---|---|---|
0 means you cannot do the activity; 10 means you can do it as well as before the injury. Based on the Patient Specific Functional Scale [10].
An example
The custodian picks three activities. Reading the paper goes from 3 in week one to 5 in week four and 6 in week eight. Grocery shopping stays at 2, then climbs to 4. Riding his bike around the block starts at 0 and reaches 3 with the go ahead from his care team. His headache still has bad days, but the ratings show real gains he could easily overlook.
When a trend needs a clinician
Your records can also tell you when to call. The CDC advises telling your provider when you do not think you are improving, when symptoms are getting worse, or when they do not go away [3]. The same goes for symptoms that worsen after you return to your normal routine [3].
Guidelines give a few more markers. Canada’s guideline treats symptoms lasting more than a month as prolonged. It says your care team should record them on a standard symptom scale at follow up visits until they improve or level off [4]. It also notes that specialized assessment may be appropriate for people still having symptoms at one month [4]. The 2025 U.S. guideline says a formal thinking skills assessment may be offered when thinking problems last longer than a month [5]. That applies when the problems are disabling or are not getting better with treatment [5].
New symptoms after the first month
The VA/DoD guideline for mild TBI, written for veterans and service members, covers symptoms that are brand new more than a month (30 days) after the injury. In that case it suggests a check aimed at the new symptom, to rule out other possible sources [11]. A new symptom late in recovery deserves a call, and your log can show exactly when it began.
Mood changes
Mood belongs on your tracking sheet as well. The 2025 guideline lists mood symptoms such as depression, anxiety and posttraumatic stress among the things clinicians may screen for [5]. The National Institute of Mental Health says that severe symptoms lasting two weeks or more call for professional help [12]. Examples include feeling sad, tearful or hopeless, trouble focusing or making simple choices, and changes in appetite or sleep [12]. Some of these overlap with concussion symptoms, which is one more reason to let your care team sort them out.
Signs a trend needs a clinician
Checklist from Safety Behind the Wheel Foundation
- Your weekly average has not improved for three or four weeks in a row.
- Your weekly average is climbing.
- Hard days now take more than a day to bounce back from.
- A new symptom started more than a month after the injury.
- Your activity ratings are dropping.
- Low mood, hopelessness or worry has lasted most days for two weeks.
- You are still having symptoms a month after the injury and have not had a follow up visit.
Comparison compiled by Safety Behind the Wheel Foundation
Trends to watch and what to do
| What your records show | What to do |
|---|---|
| Slow, uneven improvement | Keep tracking; share it at your next visit |
| No improvement over several weeks | Call your care team before your next visit |
| Symptoms getting worse | Call your care team soon |
| A new symptom after the first month | Ask for a check of other causes |
| Low mood most days for two weeks | Ask for a mental health assessment |
| Thoughts of self harm | Call or text 988 now |
| Any danger sign | Call 911 |
Sources: CDC [3, 13]; Living Concussion Guidelines [4]; VA/DoD guideline [11]; NIMH [12]; 988 Lifeline [14].
Danger signs: call 911
Treat any of the following, after a knock to the head, as an emergency. Phone 911 or head to the nearest hospital emergency room quickly [13]:
- A headache that keeps building and does not fade.
- Weakness, numbness, poor coordination, convulsions or seizures.
- Throwing up over and over.
- Slurred speech or unusual behavior.
- Pupils of different sizes, with one black center bigger than the other.
- Confusion, restlessness or agitation, or trouble knowing familiar faces and places.
- Passing out, being very drowsy, or being hard or impossible to wake.
If you are thinking about harming yourself
Long recoveries can wear people down, and help is available.
- The Suicide and Crisis Lifeline answers at 988, by phone call or text message. Its website, 988lifeline.org, has a chat option [12].
- Veterans who dial 988 can press 1 to be routed to the Veterans Crisis Line. Texting 838255 works too [14].
- For a Spanish speaking counselor, dial 988 and press 2 [14].
- If a life is at risk this minute, call 911 [12].
Questions to ask your care team
Question checklist from Safety Behind the Wheel Foundation
- Which symptoms should I track, and how often?
- Is there a symptom questionnaire you would like me to complete, and how often?
- How much change in my weekly average would you see as real progress?
- My records show this pattern. Does it fit what you expect at this stage?
- Which trends should make me call before my next visit?
- Could sleep, pain, mood or a medicine explain my harder days?
- If I am not improving, what is the next step, and is a referral needed?
- Which everyday activities should I try to build up next?
Frequently asked questions
How long should I keep tracking?
Track at least until your symptoms improve or level off, which is when Canada’s guideline says standard symptom checks at visits can stop [4]. Try to collect at least four weeks of records before you judge a trend, so good and bad days have time to even out.
Will tracking make me focus on my symptoms too much?
Keep it brief so it stays a tool. In the 2025 trajectory study, people in the higher symptom groups also tended to expect the worst and avoid activity [7]. Keep your daily entry short, include one thing that went well, and tell your care team if tracking makes you more anxious.
What if my numbers look worse but I feel better?
Look at your activity ratings. If you are doing more, a small rise in symptoms may reflect that. The CDC advises cutting back on an activity that makes symptoms worse [3], so share both sets of numbers with your care team and decide together.
The bottom line
Recommendation from Safety Behind the Wheel Foundation
Good and bad days are a normal part of concussion recovery, and neither one alone tells you where you are headed. Most people improve over months, including many who start with heavy symptoms. Track a few symptoms and a few activities, look at weekly averages, and compare yourself with your own records from a month ago.
Bring your summaries to every visit. Call your care team if your trend is flat for weeks, getting worse, or includes a new symptom or low mood. Call or text 988 for thoughts of self harm, and call 911 for any danger sign.
Sources and further reading
- 1Rabinowitz AR, Fisher AJ. Person-specific methods for characterizing the course and temporal dynamics of concussion symptomatology: a pilot study. Scientific Reports. 2020;10:1248. pmc.ncbi.nlm.nih.gov/articles/PMC6985195
- 2Rauwenhoff J, Storvig G, Lenaert B, et al. The association between daily registrations of persistent post-concussion symptoms using an mHealth app and the retrospective Rivermead Post-Concussion Symptoms Questionnaire. Neurotrauma Reports. 2025;6(1):756-767. cris.maastrichtuniversity.nl/…/the-association-between-daily-registrations-of-persistent-post-co
- 3Centers for Disease Control and Prevention. What to do after a mild TBI or concussion. Updated September 15, 2025. cdc.gov/…/response/index.html
- 4Living Concussion Guidelines. Guideline for concussion and prolonged symptoms for adults: Section 4, diagnosis and assessment of prolonged symptoms. Ottawa Hospital Research Institute. Updated April 2023. concussionsontario.org/…/diagnosis-assessment-of-prolonged-symptoms
- 5Silverberg ND, Lee K, Mikolić A, et al. Action Collaborative on Traumatic Brain Injury Care: adapted clinical practice guideline. Annals of Family Medicine. 2025;23(6):552-569. annfammed.org/content/23/6/552
- 6Nelson LD, Temkin NR, Dikmen S, et al. Recovery after mild traumatic brain injury in patients presenting to US level I trauma centers: a Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study. JAMA Neurology. 2019;76(9):1049-1059. scholar.usuhs.edu/…/recovery-after-mild-traumatic-brain-injury-in-patients-presenting
- 7King S, Winkens I, Wijenberg M, et al. Recovery trajectories of patients with mild traumatic brain injury. Journal of Neurotrauma. 2025;42(15-16):1345-1358. cris.maastrichtuniversity.nl/…/recovery-trajectories-of-patients-with-mild-traumatic-brain-injur
- 8Voormolen D, Cnossen MC, Spikman JM, et al. Rating of pre-injury symptoms over time in patients with mild traumatic brain injury: the good-old-days bias revisited. Brain Injury. 2020;34(8):1001-1009. repub.eur.nl/pub/128131
- 9Rivermead Post-Concussion Symptoms Questionnaire (form, based on King N, Crawford S, Wenden F, Moss N, Wade D. Journal of Neurology. 1995;242:587-592). WSIB Ontario. Dated June 2008. wsib.ca/…/mtbi_rivermead.pdf
- 10Shirley Ryan AbilityLab. Rehabilitation measures: Patient Specific Functional Scale. Last updated April 2013; instrument details updated 2019. sralab.org/…/patient-specific-functional-scale
- 11U.S. Department of Veterans Affairs, U.S. Department of Defense. VA/DoD clinical practice guideline for the management and rehabilitation of post-acute mild traumatic brain injury: provider summary. Version 3.0. 2021. healthquality.va.gov/…/VADoDmTBICPGProviderSummaryFinal508.pdf
- 12National Institute of Mental Health. My mental health: do I need help? Revised 2025. nimh.nih.gov/…/my-mental-health-do-i-need-help
- 13Centers for Disease Control and Prevention. Symptoms of mild TBI and concussion. Updated September 15, 2025. cdc.gov/…/signs-symptoms/index.html
- 14988 Suicide and Crisis Lifeline. Get help. Accessed October 2026. 988lifeline.org/get-help
This article reflects the safety priorities of brain injury recovery and safe driving education. It provides general information only and is not medical or mental health advice. Research on recovery keeps growing, so check official sources for current guidance and review your own records with your care team or another qualified professional. Reviewed October 2026.
Special thanks to our contributors
We appreciate the professionals, experts, and community members who share their knowledge and perspectives to help make this resource better. Your insights are always welcome and appreciated.
Have professional expertise, firsthand experience, or a perspective that could make this resource better?
We welcome your input. Your knowledge and experience can help us make this resource more useful, accurate, and meaningful to the people who rely on it.
Thank you. Your contribution is on its way.
We’re grateful you took the time to share your knowledge with us. Our team reviews every contribution with care. If it helps improve this resource, we’ll update the page and recognize you the way you chose.
Keep learning
Safe Driving Resource Center
Guides, self-checks and articles for drivers, parents of new drivers, and families recovering after a crash.
