Returning to work with persistent concussion symptoms
Get ready to talk about duties, hours, screens, breaks and support at work
Maybe your sick leave is running low. Maybe you miss your coworkers and the feeling of being useful. Either way, the hardest part is often the meeting where you explain that you can do your job, just not all of it yet.
Headaches, fatigue, trouble focusing and sensitivity to screens or light can make a normal workday feel huge. They can also make that talk easy to put off.
This guide gives you a duties and adjustments worksheet, a sample schedule, a screen and break plan, and short scripts for your manager, human resources (HR) and care team. Income, benefits, job laws and memory tools at work have their own articles on this site.
What guidelines and studies say about working with symptoms
On average, concussion symptoms clear within about four weeks, according to a Canadian workplace tool, but as many as 30 percent are still dealing with symptoms past that point [1]. If you are in that group, going back to work is still a realistic goal.
Canada’s Living Concussion Guidelines cover adults and get updated as new studies come out. They advise care teams to encourage some form of work, as long as the job does not put you at risk of another injury [2]. They describe a return that builds up both hours and duties over time [2]. They also say delays in going back that are not medically needed should be avoided, because work is linked to overall health [2].
A 2025 guideline for U.S. primary care, from the Action Collaborative on Traumatic Brain Injury (TBI) Care, gives similar advice. It strongly recommends that clinicians advise a step by step return to normal activities, at a pace the person can handle [3]. The guideline points out that plenty of people return to their jobs before every symptom is gone, sometimes with short term changes [3]. It adds that clinicians may provide paperwork, such as a sick leave or light duty note, to clear the way for a gradual return [3].
What workers report
TRACK TBI, a U.S. study, tracked 435 employed people between 18 and 64 after a mild TBI. All had gone to one of 11 trauma centers [4]. At the one year mark, 86 percent of those whose employers had offered help within three months were working, compared with 72 percent of the rest [4]. That help ranged from sick leave and shorter hours to new tasks, assistive technology and coaching [4]. The study shows a link, so it cannot tell us whether the help itself made the difference.
The other side shows up in a Danish interview study of 22 adults two to five years after a mild TBI. Many said shorter hours, adjusted working conditions and support from coworkers had been missing [5]. Some also felt they were sent to rehabilitation too late [5].
Map your job before the meeting
The Living Concussion Guidelines ask care teams to sort out restrictions and adjustments by looking closely at your symptoms and your physical, thinking and emotional limits [2]. A written list of your duties, made before any meeting, gives your care team and your employer something specific to work from. The patient version of the guidelines also suggests keeping track of your symptoms, how much activity you can tolerate and changes in your mood [6].
A restriction is something you should not do yet because it could be unsafe, such as working at heights when your balance is poor [6]. An accommodation, or adjustment, is a change that helps you do the work, such as more breaks or a quieter desk [6].
Comparison compiled by Safety Behind the Wheel Foundation
Examples of symptoms and possible limits at work
| Symptom | Possible limit or change |
|---|---|
| Poor balance | No work at heights |
| Trouble focusing or vision problems | No heavy equipment |
| Headache or nausea with hard effort | Avoid heavy or repeated lifting |
| Light or noise sensitivity | Less screen time, fewer bright or noisy areas |
| Trouble concentrating | One task at a time, at your own pace |
| Irritability or anxiety | Less contact with coworkers or the public |
Adapted from Table 12.1 of the Living Concussion Guidelines, updated April 2024 [7]. Your care team decides which limits apply to you.
Fill in your duties and adjustments worksheet
List your duties in order of how much of your week they take. Next to each one, write how your symptoms affect it right now and one change you would like to try. Put tasks with safety risks, such as driving for work, ladders or machines, on their own lines for your care team to review.
Worksheet from Safety Behind the Wheel Foundation
Duties and adjustments worksheet
| Duty and how often | How symptoms affect it now | Change to ask for | Who can approve it |
|---|---|---|---|
| Example: claims on screen, 5 hours a day | Headache after about 40 minutes | Planned break each hour, some paper files | Manager |
Bring this sheet to your care team before you meet your employer, so any work note matches it. Ideas for changes come from the Living Concussion Guidelines and the Job Accommodation Network [2, 6, 8, 9].
Imagine a 36 year old insurance claims adjuster who was rear ended on her way home. Eight weeks later, she can work on a screen for about 40 minutes before her head starts to pound. Her worksheet shows that calls are easy, screen work is hard and site visits that involve driving must wait for her care team’s clearance. She goes to her manager with three requests: a break each hour, some files on paper and desk work in place of site visits for now.
Hours and a schedule that grows in stages
The 2025 U.S. guideline describes graded plans of four to six stages, spending a day or more on each [3]. You move up when work causes only a mild, short rise in symptoms. In its terms, that means symptoms go up by no more than 1 or 2 points out of 10 and settle within an hour [3].
The Canadian workplace tool moves from light work activity to part or full days with adjustments, such as short days with breaks [1]. Then the adjustments shrink while the workload grows, until full days without concussion related changes feel manageable [1]. It suggests dropping each adjustment on a trial basis, to check that you no longer need it [1]. The Living Concussion Guidelines patient page gives one sample start: two half days a week, with hours added slowly [6].
A short setback is normal. According to the Living Concussion Guidelines, a brief rise in symptoms is common when you do more, and care teams should tell you so [2]. If symptoms stay worse for more than 24 hours, you have gone past your limit, and a slower, monitored pace makes sense [2].
Comparison compiled by Safety Behind the Wheel Foundation
Sample schedule that adds hours in stages
| Stage | Hours | Work focus | Move on when |
|---|---|---|---|
| 1 | Two half days a week | Catching up, simple tasks | Symptoms rise only a little and settle within an hour |
| 2 | Four or five half days | Usual tasks with planned breaks | Same as above for several days |
| 3 | Some full days | Most duties, screen limits kept | Same as above |
| 4 | Full days | Meetings and deadlines added | Adjustments tested one at a time |
| 5 | Full time | All duties | Your care team agrees |
An example only, built from the Canadian workplace tool stages and the 2025 U.S. guideline [1, 3]. Each stage may last days or weeks. Your care team and employer set the real pace.
Keep a simple work log
A log shows you, your care team and your employer how the plan is going. Fill it in after each workday and bring it to check ins.
Worksheet from Safety Behind the Wheel Foundation
Work tolerance log
| Date and hours worked | Main tasks | Symptoms at start and end (0 to 10) | Back to usual by |
|---|---|---|---|
Based on the guideline advice to track symptoms and activity tolerance [6]. A rise that lasts more than a day is worth raising with your care team [2].
Screens, breaks and your workspace
The Living Concussion Guidelines list less screen use as a possible limit for people bothered by light or noise [7]. According to the Canadian workplace tool, you can bring screens back bit by bit, within what you can tolerate [1]. The patient page lists equipment to help with screen trouble as one kind of adjustment [6].
The Job Accommodation Network (JAN) offers free and confidential advice about workplace changes [8]. For workers with brain injuries who are bothered by light, its current list includes natural light products, lighting other than fluorescent tubes, filters over ceiling lights and cubicle shades [8]. A 2010 JAN guide also suggested a glare guard for computer monitors [9]. Other ideas to discuss include printing long documents, larger text and phone calls in place of some video meetings. Our article on reading and screens after a concussion covers a screen log and settings in more depth.
Breaks that fit your job
One example in the Living Concussion Guidelines is setting a timer so you take breaks at set times [2]. The patient page suggests taking breaks often and stretching out the length of an activity slowly [6]. It also lists a quiet space for breaks during the day [6]. JAN lists periodic rest breaks and a changed break schedule [8]. In jobs where you cannot just walk away, such as a register or a phone line, its 2010 guide suggested arranging coverage for your breaks [9].
A calmer workspace
JAN lists white noise machines, noise canceling headsets and blocks of time with no interruptions [8]. Its 2010 guide also suggested fewer distractions and splitting large assignments into smaller steps [9]. The Living Concussion Guidelines add clearing your desk of everything except what the task needs and asking coworkers for help as part of a team [2].
Scripts for your manager, HR and care team
Under the Americans with Disabilities Act (ADA), you can ask for a change at work in everyday language, without naming the law [10]. In guidance from 2002 that is still posted, the Equal Employment Opportunity Commission (EEOC) says a request need not be written down [10]. That guidance came before a 2008 law that widened who counts as having a disability [10]. Writing your request down afterward still gives you a record. After a request, you and your employer are expected to talk through what you need and what would work, in an informal back and forth [10].
When the reason for your request is not plain to see, your employer can ask for reasonable medical paperwork about your condition [10]. In most cases, though, it cannot ask for your complete medical records [10]. If more than one option would work, your preference should count the most, but the employer has the final say [10]. A modified or part time schedule can count as a reasonable accommodation [10]. Whether the ADA covers you depends on your employer and your situation. Our article on working with post concussion syndrome explains the ADA, family and medical leave, and income options. Check your own employer’s policy and your state’s labor or civil rights agency, and talk with the EEOC or an employment lawyer if you have questions.
At the weekly check in
JAN’s current brain injury page lists written instructions and weekly or monthly meetings about workplace issues [8]. Its 2010 guide also suggested a way to judge whether each change is working [9]. Bring your work log, one thing that went well and one thing to adjust. Ask your manager to confirm agreed changes in a short email.
When the plan stalls
The Living Concussion Guidelines advise a monitored, slower return when symptoms rise a lot or stay up [2]. Their return to work flowchart includes a referral for a vocational evaluation when work keeps bringing symptoms back [11]. That review looks at you, the demands of your job, your work setting, the supports around you and what helps or blocks your return [11].
For people with prolonged symptoms, the guidelines recommend compensatory cognitive training combined with supported employment [2]. That means learning practical ways to manage symptoms while you get ongoing support on the job. A Norwegian trial tested this approach in 116 adults aged 18 to 60 with mild to moderate TBI [12]. All were still at least half on sick leave 8 to 12 weeks after the injury [12]. At three months, 81 percent of the program group had returned to steady work, compared with 60 percent of those with usual care [12]. By 12 months, most people in both groups were back at work (90 and 84 percent), a gap small enough to be due to chance [12]. The authors say the results need to be repeated [12].
A 2025 systematic review pulled together studies of adults returning to work after concussion [13]. Treatments it named as possibly effective include talk therapy, vestibular and vision rehabilitation, exercise, cognitive training, strategies to work around symptoms and vocational support [13]. Vestibular means your inner ear balance system. Programs that helped often included action planning and problem solving [13]. The worksheet and log in this guide use both.
If your old job is not possible for now, the guidelines suggest other meaningful roles, such as part time work in another job, a course or volunteering [2, 11].
When to get emergency care
A rough day at work is common, but some symptoms need help right away. Get emergency help by calling 911, or ask someone to drive you to an emergency room, if any of these happen [14]:
- Headache pain that builds and builds instead of fading
- New weakness or numbness, unsteady movements, convulsions or a seizure
- Vomiting several times
- Speech that comes out slurred, or acting in ways that are not like you
- One pupil, the dark center of the eye, wider than the other
- Not knowing familiar faces or places, or seeming mixed up, agitated or restless
- Blacking out, unusual sleepiness, or being impossible to rouse
Questions to bring to your return to work meeting
Question checklist from Safety Behind the Wheel Foundation
- Who will be my main contact for the return plan, and how often will we check in?
- Can I start with shorter days and add hours in stages, with a set date to review?
- Which of my duties can wait, be shared or be done another way for now?
- Could I take planned breaks, and is there a quiet place to use?
- Can some screen work move to paper or the phone, and can my monitor or lighting be changed?
- What should I do if my symptoms flare during a shift?
- Who will see my medical information, and where will it be kept?
- If a change is not working, how do we adjust it?
Frequently asked questions
Do I need a note from my care team?
It often helps. Under the 2025 U.S. guideline, a clinician may write paperwork that supports a gradual return [3]. The Living Concussion Guidelines say care teams should share your limits and abilities with your employer, with your consent [2]. Ask for a note that lists current limits and a review date, without your full history.
What if my employer says there is no light duty?
Ask about other options, such as different hours, working from home part of the time or moving some tasks. The Living Concussion Guidelines note there is no single plan that fits everyone [2]. If talks stall, ask your care team about a vocational evaluation [11].
The bottom line
Recommendation from Safety Behind the Wheel Foundation
Going back to work with lingering concussion symptoms is often possible with a gradual plan and temporary changes [2, 3]. Prepare before you talk: list your duties, track your symptoms, and bring specific requests about hours, screens and breaks.
Keep your plan in writing, check in weekly and slow down when symptoms stay up. Job rights and leave rules differ by employer and state. Check with HR, your employer’s policy or your state agency, and talk with your care team or a qualified professional before big decisions.
Sources and further reading
- 1BC Injury Research and Prevention Unit. Concussion Awareness Training Tool: Concussion Resources for Workers and Workplaces (version 8, June 2024), including the Return to Work tool (version 2, updated September 2023) and Concussion Information Sheet. concussionsontario.org/…/CATT%20Concussion%20Resources%20for%20Workers%20%26%20Workplaces%20V8.pdf
- 2Living Concussion Guidelines. Guideline for Concussion and Prolonged Symptoms for Adults over 18 Years of Age, Section 12: Return to activity, work and school considerations. Ottawa Hospital Research Institute. Recommendations updated August 2022 and February 2024. concussionsontario.org/…/return-to-activity_work_school_considerations
- 3Silverberg 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. doi.org/10.1370/afm.250352
- 4Gaudette É, Seabury SA, Temkin N, et al. Employment and economic outcomes of participants with mild traumatic brain injury in the TRACK-TBI study. JAMA Network Open. 2022;5(6):e2219444. pmc.ncbi.nlm.nih.gov/articles/PMC9244609
- 5Graff HJ, Deleu NW, Christiansen P, Rytter HM. Facilitators of and barriers to return to work after mild traumatic brain injury: a thematic analysis. Neuropsychological Rehabilitation. 2021;31(9):1349-1373. doi.org/10.1080/09602011.2020.1778489
- 6Living Concussion Guidelines, patient version. Return to activity: work considerations. Last updated July 2025. concussionsontario.org/…/return-to-activity%3A_work_considerations
- 7Living Concussion Guidelines. Table 12.1: Identifying workplace restrictions and limitations. Last updated April 2024. concussionsontario.org/…/Restrictions%20and%20limitations.pdf
- 8Job Accommodation Network. Brain Injury: accommodation ideas. Accessed October 2026. askjan.org/disabilities/Brain-Injury.cfm
- 9Job Accommodation Network. Employees with Brain Injuries. Accommodation and Compliance Series. U.S. Department of Labor, Office of Disability Employment Policy. Updated March 22, 2010. govinfo.gov/…/GOVPUB-L41-PURL-gpo9207.pdf
- 10U.S. Equal Employment Opportunity Commission. Enforcement Guidance on Reasonable Accommodation and Undue Hardship under the ADA. October 17, 2002. eeoc.gov/…/enforcement-guidance-reasonable-accommodation-and-undue-hardship-under-ada
- 11Living Concussion Guidelines. Return to Work Considerations Algorithm. Updated May 2024. concussionsontario.org/…/Return%20to%20Work%20Algorithm%202024%20%28revised%2014-May-2024%29.pdf
- 12Fure SCR, Howe EI, Andelic N, et al. Cognitive and vocational rehabilitation after mild-to-moderate traumatic brain injury: a randomised controlled trial. Annals of Physical and Rehabilitation Medicine. 2021;64(5):101538. doi.org/10.1016/j.rehab.2021.101538
- 13Ethier-Gagnon M, Lithopoulos A, Pattison M, et al. Interventions to help adults with concussion return to work: a systematic review. PM&R. 2025;17(7):830-849. pubmed.ncbi.nlm.nih.gov/40152151
- 14Centers for Disease Control and Prevention. Symptoms of Mild TBI and Concussion. Updated September 15, 2025. cdc.gov/…/signs-symptoms/index.html
This article reflects the safety priorities of concussion recovery, safe return to work and road safety education. It offers general education, not medical or legal advice. Workplace rights, leave and employer policies differ by state and by employer, so check official sources and your employer’s own policy, and talk with your care team or a qualified professional about your situation. Reviewed October 2026.
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