Is It Safe to Drink Coffee After a Concussion? What Experts Say

A Double-Edged Sword: Caffeine’s Neuroprotective vs. Neurotoxic Role

More recent work—like the study Caffeine: A Neuroprotectant and Neurotoxin in Traumatic Brain Injury (TBI)—adds nuance. Researchers describe caffeine as “dose- and context-dependent,” capable of both helping and hurting the concussed brain.

In small, controlled amounts, caffeine may offer short-term benefits like temporarily boosts attention and alertness. It can also dampen inflammation through adenosine receptor antagonism.

However, the same stimulant can quickly become a liability if consumed in excess or too soon. It can heighten anxiety, worsens sleep disturbances, and may impair emotional regulation and cognitive clarity​.

This dual nature calls for careful clinical decision-making. Rather than viewing caffeine as wholly harmful or helpful, recovery teams should consider when and how it’s introduced, especially in athletes or patients already prone to anxiety or insomnia post-concussion.

Clinical Guidance: What the Experts Recommend

In a detailed review published in Practical Neurology, clinical neurologists outline best practices for concussion management. Their recommendation is clear: caffeine-containing substances should be avoided during the initial recovery phase. Why?

1. Neurological Rest: Caffeine interferes with neurological rest by increasing cortical arousal, which may delay the return to normal autonomic and cognitive function.
   
   
2. Sleep Disruption: Sleep is essential for neuroplasticity and recovery. Caffeine, especially in the afternoon or evening, reduces both total sleep time and sleep quality.
   
   
3. Dehydration Risk: As a diuretic, caffeine may contribute to mild dehydration—a common but often overlooked factor that can aggravate post-concussion headaches and fatigue​.

Their advice echoes what many sports neurologists and rehabilitation specialists emphasize: the post-concussive brain benefits most from stability—not stimulation.

The Adolescent Consideration: Sleep and Emotional Recovery

Pediatric and adolescent populations represent a unique clinical group, particularly sensitive to external influences like caffeine. A University of South Carolina dissertation examining adolescent caffeine use after mTBI found troubling associations. 

Adolescents who regularly consumed caffeine reported more somatic symptoms (headaches, nausea). Poorer sleep quality and increased emotional distress were noted among caffeine users compared to non-users.

The data suggested caffeine may act as an amplifier of existing post-concussion symptoms in younger populations​

While causation can't be firmly concluded, the correlation supports a conservative stance—especially for high school athletes where academic and athletic demands compound post-injury vulnerability. Athletic trainers working in school settings should educate students and families on these risks while collaborating with physicians to monitor recovery milestones.

A Case for Individualized Use: When Caffeine Might Help Later

In contrast to early-phase caution, some evidence supports selective, symptom-guided use of caffeine during the later stages of concussion recovery—particularly in patients who struggle with residual fatigue or cognitive fog.

A 2021 study published in Sports Health explored how stimulants, including caffeine, might benefit patients with persistent concussion symptoms (PCS). The study noted:

• Mild stimulant use improved attention and mood in select individuals
• Benefits were more likely when sleep disturbances were addressed
• Caffeine’s role was less therapeutic and more symptomatic, offering short bursts of improved mental energy​

This aligns with clinical experience in vestibular rehabilitation, where reintroducing certain stimuli—visual motion, cardiovascular activity, and yes, even caffeine—can be titrated into the protocol once acute symptoms have resolved. However, this reintroduction should be supervised and deliberate.

Real-World Applications: What Athletic Trainers and Clinicians Should Know

Athletic trainers and physical therapists are often the first line of education for athletes recovering from concussion. When questions about coffee consumption arise, here’s how experts are guiding conversations:

For physical therapists specializing in concussion rehabilitation, this decision should always be part of a broader clinical strategy—not a standalone judgment. Symptom monitoring tools, hydration status, and cognitive load all factor into determining readiness for reintroduction.

While the allure of caffeine—especially coffee—is understandable, its use after concussion must be managed carefully. The best available evidence suggests that caffeine can worsen outcomes if consumed too early, too often, or in high doses. Yet it also has a place in carefully selected cases later in recovery, where fatigue and low cognitive stamina persist.

For now, the safest and most evidence-supported recommendation is to avoid caffeine during the first several days following a concussion. After that, its use should be guided by clinical progress, symptom stability, and individual tolerance. Whether you’re a physical therapist, athletic trainer, or team physician, this issue offers another opportunity to educate, monitor, and advocate for the best possible outcomes in concussion care.

References

1. Sharma, R., & Gupta, R. (2003). Effect of Caffeine on Closed Head Injury in Rats. Indian Journal of Experimental Biology. PubMed
2. Preprints.org. (2024). Caffeine: A Neuroprotectant and Neurotoxin in Traumatic Brain Injury. Download PDF
3. Prichep, L. S., et al. (2012). Sports Concussion and the Clinical Neurologist, Part III. Practical Neurology. PDF
4. Gaus, A. L. (2020). Adolescent Caffeine Consumption Post-mTBI. University of South Carolina. ETD 7497
5. Lumba-Brown, A., et al. (2021). Stimulant Use in Persistent Concussion Symptoms. Sports Health: A Multidisciplinary Approach. DOI