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Concussion

Topic Overview

What is a concussion?

A concussion is a type of traumatic brain injury that is caused by a blow to the head or body, a fall, or another injury that jars or shakes the brain inside the skull. Although there may be cuts or bruises on the head or face, there may be no other visible signs of a brain injury.

You don't have to pass out (lose consciousness) to have a concussion. Some people will have obvious symptoms of a concussion, such as passing out or forgetting what happened right before the injury. But other people won't. With rest, most people fully recover from a concussion. Some people recover within a few hours. Other people take a few weeks to recover.

It's important to know that after a concussion the brain is more sensitive to damage. So while you are recovering, be sure to avoid activities that might injure you again.

In rare cases, concussions cause more serious problems. Repeated concussions or a severe concussion may lead to long-lasting problems with movement, learning, or speaking. Because of the small chance of serious problems, it is important to contact a doctor if you or someone you know has symptoms of a concussion.

What causes a concussion?

Your brain is a soft organ that is surrounded by spinal fluid and protected by your hard skull. Normally, the fluid around your brain acts like a cushion that keeps your brain from banging into your skull. But if your head or your body is hit hard, your brain can crash into your skull and be injured.

There are many ways to get a concussion. Some common ways include fights, falls, playground injuries, car crashes, and bike accidents. Concussions can also happen when you take part in any sport or activity such as football, boxing, hockey, soccer, skiing, or snowboarding.

What are the symptoms?

It is not always easy to know if someone has a concussion. You don't have to pass out (lose consciousness) to have a concussion.

Symptoms of a concussion range from mild to severe and can last for hours, days, weeks, or even months. If you notice any symptoms of a concussion, contact your doctor.

Symptoms of a concussion fit into four main categories:

  • Thinking and remembering
    • Not thinking clearly
    • Feeling slowed down
    • Not being able to concentrate
    • Not being able to remember new information
  • Physical
    • Nausea and vomiting
    • Headache
    • Fuzzy or blurry vision
    • Dizziness
    • Sensitivity to light or noise
    • Balance problems
    • Feeling tired or having no energy
  • Emotional and mood
    • Easily upset or angered
    • Sad
    • Nervous or anxious
    • More emotional
  • Sleep
    • Sleeping more than usual
    • Sleeping less than usual
    • Having a hard time falling asleep

Young children can have the same symptoms of a concussion as older children and adults. But sometimes it can be hard to tell if a small child has a concussion. Young children may also have symptoms like:

  • Crying more than usual.
  • Headache that does not go away.
  • Changes in the way they play or act.
  • Changes in the way they nurse, eat, or sleep.
  • Being upset easily or having more temper tantrums.
  • A sad mood.
  • Lack of interest in their usual activities or favorite toys.
  • Loss of new skills, such as toilet training.
  • Loss of balance and trouble walking.
  • Not being able to pay attention.

Concussions in older adults can also be dangerous. This is because concussions in older adults are often missed. If you are caring for an older adult who has had a fall, check him or her for symptoms of a concussion. Signs of a serious problem include a headache that gets worse or increasing confusion or both. See a doctor right away if you notice these signs. If you are caring for an older adult who takes a blood thinner and who has had a fall, take him or her to a doctor right away, even if you don't see any symptoms of a concussion.

Sometimes after a concussion you may feel as if you are not functioning as well as you did before the injury. This is called postconcussive syndrome. New symptoms may develop, or you may continue to be bothered by symptoms from the injury, such as:

  • Changes in your ability to think, concentrate, or remember.
  • Headaches or blurry vision.
  • Changes in your sleep patterns, such as not being able to sleep or sleeping all the time.
  • Changes in your personality such as becoming angry or anxious for no clear reason.
  • Lack of interest in your usual activities.
  • Changes in your sex drive.
  • Dizziness, lightheadedness, or unsteadiness that makes standing or walking difficult.

If you have symptoms of postconcussive syndrome, call your doctor.

How is a concussion diagnosed?

Any person who may have had a concussion needs to see a doctor. If a doctor thinks that you have a concussion, he or she will ask questions about the injury. Your doctor may ask you questions that test your ability to pay attention and your learning and memory. Your doctor may also try to find out how quickly you can solve problems. He or she may also show you objects and then hide them and ask you to recall what they are. Then the doctor will check your strength, balance, coordination, reflexes, and sensation.

Neuropsychological tests have become more widely used after a concussion. These tests are only one of many ways that your doctor can find out how well you are thinking and remembering after a concussion. These tests can also show if you have any changes in emotions or mood after a concussion.

Usually doctors will not order imaging tests such as a CT scan or an MRI unless there are signs of a severe injury, like a skull fracture or brain bleed. This is because damage to the brain from a concussion can't be seen in these tests. And imaging tests have other risks from sedation or exposure to radiation.

How is it treated?

Right away

After being seen by a doctor, some people have to stay in the hospital to be watched. Others can go home safely. If you go home, follow your doctor's instructions. He or she will tell you if you need someone to watch you closely for the next 24 hours or longer.

Call 911 or seek emergency care right away if you are watching a person after a concussion and the person has:

  • A headache that gets worse or does not go away.
  • Weakness, numbness, or decreased coordination.
  • Repeated vomiting or nausea.
  • Slurred speech.
  • Extreme drowsiness or you cannot wake them.
  • One pupil that is larger than the other.
  • Convulsions or seizures.
  • A problem recognizing people or places.
  • Increasing confusion, restlessness, or agitation.
  • Loss of consciousness.

Warning signs in children are the same as those listed above for adults. Take your child to the emergency department if he or she has any of the warnings signs listed above or:

  • Will not stop crying.
  • Will not nurse or eat.

In the days or weeks after

Recovery from a concussion takes time. Most people feel better within 1 to 3 months. How soon or long it takes to feel better varies from person to person. But some things may slow down your or your child's recovery. These may include:

  • Having had a concussion or another head injury before.
  • Having any neurologic or mental health conditions, like epilepsy or depression.
  • Having a learning disability.

Stressful things at home, school, or with friends may also increase the time it takes to feel better.

Rest is the best way to recover from a concussion. You need to rest the body and brain. Most experts agree that physical and mental rest for 1 to 2 days after the injury is best. Pay close attention to symptoms as you or your child gradually returns to a regular routine. Avoid any activity that makes symptoms worse or causes new symptoms.

Here are some tips to help you or your child get better.

At home:

  • Make sure you or your child gets plenty of sleep at night. It may help to keep the room quiet, dark or dimly lit, and cool. Go to bed and get up at the same time each day, and limit foods and drinks with caffeine.
  • Limit housework, homework, and screen time.
  • Avoid alcohol and illegal drugs.
  • Do not take any other medicines unless your doctor says it is okay.
  • Avoid activities that could lead to another head injury.
  • Ask your doctor when it's okay to drive a car, ride a bike, or operate machinery.
  • Use ice or a cold pack on any swelling for 10 to 20 minutes at a time. Put a thin cloth between the ice and the skin.
  • Follow your doctor's instructions for a gradual return to activity and sports.

Talk to your doctor before you take or give your child prescription or over-the-counter medicines like Tylenol. Pain medicines can make headaches more likely.

Concussion and school

After a concussion, you or your child may need to take time off from school. Follow your doctor's instructions on how to gradually return to your normal activities.

These tips for parents may help.

  • Children may be able to return to school when they're able to focus for 30 to 45 minutes at a time.
  • Tell teachers, administrators, school counselors, and nurses what symptoms your child has or could develop. Sign a release form so the school can coordinate care with your child's doctor.
  • Discuss the need for your child's brain to rest and recover. For example, depending on symptoms, your child may need to:
    • Start back to school with shorter days.
    • Take 15-minute breaks after every 30 minutes of classwork.
    • Have more time for assignments, postpone tests, or have another student take notes.
    • Avoid bright lights. (You can suggest dimmed lighting or that the child wear sunglasses.)
    • Avoid noisy places, like the gym or cafeteria.
  • Check in with school staff often. Discuss how your child is doing, academically and emotionally. A concussion can make kids grouchy and emotional. And needing extra help or extra rest can be hard for some kids.
  • If your child doesn't recover within 3 to 4 weeks, talk with your doctor and the school staff. They may recommend a 504 plan. It's a plan for kids who need ongoing adjustments at school.

Concussion and sports

A person who might have a concussion needs to immediately stop any kind of activity or sport. Being active again too soon increases the person's risk of having a more serious brain injury. Doctors and concussion specialists suggest steps to follow for returning to sports after a concussion. Use these steps as a guide. In most places, your doctor must give you written permission for children and teens to begin the steps and return to sports.

In some cases, you and your doctor may need to discuss the benefits and risks of continuing to play contact sports. There are many things that may affect this decision. For example:

  • How many concussions or other head injuries have you or your child had in the past?
  • Is it taking you or your child longer to recover from a concussion?
  • Do your or your child's symptoms get worse with each added concussion?
  • Are concussions occurring more often? Or with less force?

This may not be an easy conversation or decision to make. But it's important to think about your or your child's goals for the future and what role sports play.

How can you prevent a concussion?

Reduce your chances of getting a concussion:

  • Wear a seat belt every time you drive or ride in a car or other motor vehicle.
  • Never drive when you are under the influence of drugs or alcohol.
  • Make your home safer to prevent falls.

Wear a helmet for any activity that can cause a fall or impact to the head or neck. Examples include bike riding, football, baseball, ATV riding, skateboarding, skiing, snowboarding, inline skating, and horseback riding. Helmets help protect your skull from injury. But brain damage can occur even when a helmet is worn.

Reduce your child's chances of getting a concussion:

References

Other Works Consulted

  • American College of Emergency Physicians (ACEP) and Centers for Disease Control and Prevention (CDC) (2008). Clinical policy: Neuroimaging and decisionmaking in adult mild traumatic brain injury in the acute setting. Annals of Emergency Medicine, 52(6): 714–748.
  • American College of Sports Medicine (2006). Concussion (mild traumatic brain injury) and the team physician: A consensus statement. Medicine and Science in Sports and Exercise, 39(2): 395–399.
  • Giza CC, et al. (2013). Summary of evidence-based guideline update: Evaluation and management of concussion in sports: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology, 80(24): 2250–2257. Also available online: http://www.neurology.org/content/80/24/2250.full.
  • Halstead ME, et al. (2010). Sport-related concussion in children and adolescents. Pediatrics, 126(3): 597–615.
  • Halstead ME, et al. (2013). Returning to learning following a concussion. Pediatrics,132(5): 948–957.
  • McCrory P, et al. (2013). Consensus statement on concussion in sport: The 4th International Conference on Concussion in Sport held in Zurich, November 2012. British Journal of Sports Medicine, 47(5): 250–258. Also available online: http://bjsm.bmj.com/content/47/5/250.full.
  • Meehan WP, Bachur RG (2009). Sport-related concussion. Pediatrics, 123(1): 114–123.
  • Smith BW (2010). Head injuries. In SJ Anderson, SS Harris, eds., Care of the Young Athlete, 2nd. ed., pp. 185–191. Elk Grove Village, IL: American Academy of Pediatrics.

Credits

Current as ofMarch 28, 2019

Author: Healthwise Staff
Medical Review: Anne C. Poinier MD - Internal Medicine
E. Gregory Thompson MD - Internal Medicine
Adam Husney MD - Family Medicine
Kathleen Romito MD - Family Medicine
Martin J. Gabica MD - Family Medicine
William H. Blahd Jr. MD, FACEP - Emergency Medicine


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