Signs of Concussion, Testing, & Treatment

Concussion symptoms

Symptoms usually develop immediately after the injury, but there can be a delay of a couple hours. Symptoms fall into four different categories: physical, cognitive (thinking, reasoning, remembering), emotional, and sleep-related. Headache is the most common physical symptom. Confusion and balance problems are also common.

Concussions can be harder to recognize in young children, who may not be able to communicate how they feel. Look for symptoms like fussiness, irritability, a dazed look, unsteady walking, decreased appetite, or vomiting.

Concussion symptoms can overlap with symptoms of more serious brain injuries, like skull fracture, internal bleeding, or brain swelling. So it’s important to look for symptoms that need an immediate evaluation in the ER. These include:

• Loss of consciousness for more than 1 minute
• Extreme confusion
• Neck pain
• Numbness or weakness in the face or limbs
• Slurred speech
• Seizure
• Blood or clear fluid coming from the nose or ear
• More than one episode of vomiting
• Any sudden worsening of symptoms

Dangerous injuries like high-velocity crashes or falls from height are also reasons to go to the ER right away.

Signs and symptoms of a concussion

Physical symptoms

• Headache, which can be made worse by bright lights or loud sounds.
• Dizziness, vertigo, or balance problems
• Nausea and vomiting (if vomiting several times contact a doctor)
• Blurry vision
• Ringing in the ears (tinnitus)

Cognitive symptoms

• Confusion or foggy feeling
• Amnesia. It’s not unusual to forget what caused the injury, or you may have trouble remembering things that happened before or after the injury. It may be difficult to remember new information, and you may ask the same questions over and over again. Amnesia usually gets better within about 24 hours.
• Difficulty concentrating
• Slow responses—both verbal responses to questions and physical or motor responses, like trouble catching a ball

Emotional symptoms

• Mood swings or irritability
• Sadness
• Anxiety

Sleep-related symptoms

• Excessive fatigue
• Insomnia (difficulty falling asleep or staying asleep)

Causes

A concussion can be caused by any injury that hits or shakes (concusses) the head. Sports injuries are common causes in children and young adults, while car accidents and falls from a height are more common in adults. Contact sports like football, soccer, and hockey have a high risk of concussion.

Other blows to the head, like from an assault, can cause concussion. Even whiplash, a sudden back-and-forth movement of the head that can occur in car accidents or sports injuries, can cause a concussion without a direct hit to the head.

But the same type of injury can cause bleeding and serious or fatal brain injury, so it’s very important to be evaluated by a trained medical professional after a head injury.

A concussion damages brain cells, but it’s not clear how this damage leads to specific symptoms like confusion and nausea. Experts do know that the concussed brain experiences decreased energy and blood flow.

What to do next

Since the risks of getting injured again after a concussion can be serious, it’s always best to be seen by a healthcare provider who’s knowledgeable about concussions.

For a very minor head injury with minor symptoms like a mild headache, It’s probably okay to rest at home and follow up with your doctor within 1–2 days.

But if you were knocked out or have amnesia, vision changes, vomiting, balance problems, confusion, numbness, weakness, or other symptoms, you should see a trained medical professional, either a sports trainer (if on the sidelines of a game) or an ER doctor, for a thorough exam and possibly other testing.

In the past, doctors recommended staying awake after a head injury, but if you’ve had a thorough exam by a doctor or trained medical professional, it’s usually safe to sleep. People with concussions who have been cleared by a doctor don’t need to be woken up so someone can check on them.

There is no specific test that shows you have a concussion. The diagnosis is based on neurologic (brain) and cognitive tests to check your reflexes, balance, memory, and coordination.

Concussion can technically be diagnosed without imaging tests like a CT scan or MRI, but these tests may be recommended to rule out a more serious brain or spine injury. People who are unconscious, extremely confused, or showing other unusual symptoms will likely have imaging tests.

Be prepared for a period of observation at the hospital or at home. Observation usually lasts at least 2 hours, but an overnight stay might be recommended if symptoms are severe. Because symptoms can worsen over time, it’s helpful to watch and repeat a physical exam.

Treatment

Your treatment plan will be specific to you and your symptoms, so it’s important to be seen by a doctor who is knowledgeable about concussions. At first you will probably be seen at the ER or a primary care or sports medicine clinic, but you might need follow-up visits with a neurologist. Treatment focuses on rest, but you may be able to take medications to relieve symptoms.

Rest

The main treatment is rest so the brain cells can heal. Rest means resting both your brain and your body.

Avoid anything that raises the heart rate, such as aerobic exercise or strenuous lifting. Don’t return to activities like sports until you’ve been cleared by a doctor. Athletes should not return to playing on the day of the injury.

Cognitive rest is more challenging for most people because it means avoiding reading or using screens, such as phones, computers, and the TV. Children may need to miss school and adults will likely need to miss work to give themselves time to recover.

Medications

There are no medications that treat concussion or speed up your recovery. But there are medications to help symptoms like pain or nausea. Always talk to your doctor before taking anything, as some medications should not be taken right after an injury.

Pain relievers

• Acetaminophen (Tylenol) may be taken for headaches.
• Do not take ibuprofen (Advil, Motrin) or aspirin for at least 48 hours after an injury, as they may increase risk of bleeding in your brain.
• Prescription pain medications and muscle relaxers are generally avoided because they can cause drowsiness or hide signs of a more serious brain injury like severe pain.
• Nausea medication is sometimes given. But your doctor may recommend waiting, because excessive nausea and vomiting can be a sign of a more serious brain injury.

Other at-home treatments

• Applying ice packs to the head or neck
• Spending time in a quiet, cool, and dark room

Returning to everyday activities

Your symptoms should get better with rest within about 3 days. When you no longer have symptoms when resting, your doctor will then recommend a gradual multi-step approach to return to normal activities.

This is usually guided by a concussion specialist or a knowledgeable primary care doctor, who will give you the all-clear to start doing light activities. They will guide you to slowly increase the length and difficulty of physical and mental activities.

You’ll start with light mental activities and exercise—but not any activities that have a risk of a head injury. If you have another head injury before you’ve completely recovered, you may get something called second impact syndrome. Even another mild injury can cause brain swelling and lead to a rapid coma that may be fatal.

You can gradually increase the intensity of your activities as long as you don’t develop symptoms during each activity. If you develop symptoms, stop and rest. Restart the activity if symptoms go away within a few minutes of rest, or try again the next day if the symptoms last a while.

Frequently asked questions