Concussion without hitting head

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Concussion

Symptoms of a concussion vary depending on both the severity of the injury and the person injured. It’s not true that a loss of consciousness always occurs with a concussion. Some people do experience a loss of consciousness, but others don’t.

It’s important to understand the symptoms you could go through yourself when you’re having a concussion, as well as the signs of someone else having a concussion.

Symptoms you may experience

The signs of a concussion may include:

  • memory problems
  • confusion
  • drowsiness or feeling sluggish
  • dizziness
  • double vision or blurred vision
  • headache
  • nausea or vomiting
  • sensitivity to light or noise
  • balance problems
  • slowed reaction to stimuli

The symptoms may begin immediately, or they may not develop for hours, days, weeks, or even months following your injury.

During the recovery period after a concussion, you may experience the following symptoms:

  • irritability
  • sensitivity to light or noise
  • difficulty concentrating
  • mild headaches

Signs of concussion in a loved one

In some cases, a friend or loved one might be having a concussion, and they don’t know it. The following are some of the signs to look out for:

  • irritability
  • balance issues
  • loss of coordination
  • problems walking
  • seizures
  • draining of blood or clear fluid from the ears or nose
  • unequal pupil size
  • abnormal eye movement
  • lasting confusion
  • slurred speech
  • repeated vomiting
  • brief loss of consciousness after the injury
  • an inability to wake up (also called a coma)

If you or someone you know experiences any of these symptoms after an injury, seek immediate emergency medical treatment or call 911.

Concussion symptoms in babies

Concussion symptoms can vary in babies. These may not be as noticeable at first, since babies don’t exhibit slurred speech, walking difficulties, and other hallmark symptoms that can be exhibited by children and adults.

Some common signs of a concussion in babies include:

  • vomiting
  • drainage from their mouth, ears, or nose
  • irritability
  • drowsiness

Rarely, concussions can cause permanent brain damage. While most babies recover from concussions, it’s important to have them checked out by a doctor. Seek immediate medical help if your baby is unconscious.

Emergency symptoms: When to see a doctor

See a doctor if you suspect that you or someone else has a concussion. If a concussion occurs during sports practice or a game, tell the athletic coach and go to a doctor.

Concussions may be accompanied by injuries to the spine. If you think a person has a neck or back injury, avoid moving them and call an ambulance for help. If you absolutely must move the person, do so very carefully. You should try to keep the person’s neck and back as stationary as possible. This will avoid causing further damage to the spine.

Sports Concussions​​

What Is a Concussion?

A concussion is a mild traumatic brain injury caused by a direct or indirect hit to your head or body.

Your brain sits inside your skull surrounded by fluid. When your head takes a hit — as often happens in contact sports — your brain shifts or shakes around inside the skull.

The impact damages your brain cells, causing chemical and cellular changes in the brain.

Concussion causes and risk factors

The most common cause of a concussion is a hard, direct hit to the head in contact sports. It can also happen from an indirect hit that causes your head to jerk, like when you get whiplash.

Sports that increase an athlete’s risk of head trauma include:

  • Football
  • Hockey
  • Soccer

Younger athletes and females tend to take longer to get better from concussions.

Concussion side effects and complications

Side effects of a concussion cause changes in how the brain functions, such as reduced reaction time. This can increase your chance of getting another concussion if you return to play before seeking treatment.

Repeated concussions can cause problems such as lasting cognitive issues.

No athlete should return to the game until all symptoms are gone and a doctor has cleared him or her to play.

Why choose UPMC for concussion treatment?

Every concussion is unique. There are six clinical types, based on concussion signs and symptoms.

This is why — when it comes to concussion treatment — there isn’t a one-size-fits-all model.

The experts at the UPMC Sports Medicine Concussion Program have been leading concussion treatment for more than a decade.

Our team tailors active concussion recovery programs to meet each person’s:

  • Goals
  • Lifestyle
  • Symptoms

Make an appointment for concussion care

If you — or your coaches, parents, or athletic trainers — suspect you have a concussion, it’s crucial that you:

  • Stop playing your sport right away.
  • See a health professional specially trained in concussion care.

To make an appointment or learn more about concussions, contact the UPMC Sports Medicine Concussion Program at 412-432-3681.

Learn more about concussions

Learn how UPMC Sports Medicine is ReThinking Concussions or see the links below (links open a new browser window):

UPMC’s HealthBeat Blog:

  • Medical Mondays: Concussion
  • Concussions: How Knowledgeable Are Americans?
  • Common Sports Injuries: Football
  • Youth Hockey Injuries Q&A with Dr. Vyas, UPMC Sports Medicine
  • Infographic: A Heads Up on Preventing Sports Injuries

From our Health Library:

  • Concussion Overview
  • Traumatic Brain Injury
  • Head Injury, Age 4 and Older
  • Returning to Play After a Head Injury During a Sporting Event
  • Preventing Children’s Injuries From Sports and Other Activities

Definition

A concussion is an injury to the brain that results in temporary loss of normal brain function. Medically, it is defined as a clinical syndrome characterized by immediate and transient alteration in brain function, including alteration of mental status or level of consciousness, that results from mechanical force or trauma.

Causes

Concussions can be caused by direct trauma to the head, such as from falling, getting hit or being in an accident. They can also occur as a result of rapid acceleration-deceleration of the head, such as in whiplash injuries or blast injuries, like in a war zone. Many people assume that concussions involve passing out or a loss of consciousness, but this is not true. In many cases, people with a concussion never lose consciousness. In several cases, external signs of head trauma, such as bleeding, may also be absent.

Symptoms

A concussion can affect memory, judgment, reflexes, speech, balance and muscle coordination. People with concussions often report a brief period of amnesia or forgetfulness, where they cannot remember what happened immediately before or after the injury. They may act confused, dazed or describe “seeing stars.” Paramedics and athletic trainers who suspect a person has suffered a concussion may ask the injured person if they know their name, what month/year it is and where they are.

Even mild concussions should not be taken lightly. Neurosurgeons and other brain injury experts emphasize that although some concussions are less serious than others, there is no such thing as a minor concussion. In most cases, a single concussion should not cause permanent damage. A second concussion soon after the first one does not have to be very strong for its effects to be permanently disabling.

Common Symptoms of Concussion

  • Confusion
  • Headache
  • Vision disturbances (double or blurry vision)
  • Dizziness or imbalance
  • Nausea or vomiting
  • Memory loss
  • Ringing ears
  • Difficulty concentrating
  • Sensitivity to light
  • Loss of smell or taste
  • Trouble falling asleep

If any of these occur after a blow to the head, a health-care professional should be consulted as soon as possible.

When to Seek Medical Care

Most people will recover quickly and completely following a concussion. Some people can have symptoms that last for several weeks before gradually getting better. Seek immediate medical attention if:

  • Headache is worse or does not go away
  • Slurred speech, weakness, numbness or decreased coordination
  • Significant nausea or repeated vomiting
  • Seizures
  • Loss of consciousness
  • Inability to wake up
  • Symptoms have worsened at any time
  • Symptoms have not gone away after 10-14 days
  • History of multiple concussions

Testing and Diagnosis

Brain imaging studies with MRI and CT scans should not be performed routinely in the diagnosis of concussions. They typically do not show any significant changes and, with CT scans, expose individuals to unnecessary radiation. While such tests are more useful for identifying structural defects, an injury from concussion is metabolic and microscopic in nature that often presents normally on neuroimaging.

The doctor asks a variety of questions about how the injury occurred, where on the head and what symptoms are shown. The patient should report any unusual experiences to the health care provider.

Prevalence and Incidence

According to the Centers for Disease Control and Prevention (CDC) surveillance report of traumatic brain injuries, about 2.87 million TBI-related ED visits, hospitalizations and deaths occurred in the United States in 2014. Each year, more than 800,000 children are treated for TBI at emergency departments in the U.S. The highest incidence of TBI occurred in people over the age of 75, children aged 0-4 years and individuals aged 15-24 years.

University of Pittsburgh’s Brain Trauma Research Center reports more than 300,000 sports-related concussions occur annually in the U.S. Additionally, the likelihood of suffering a concussion while playing a contact sport is estimated to be as high as 19% per year of play; in other words, almost all athletes of contact sports suffer from a concussion within five years of participation. It has been reported that more than 62,000 concussions are sustained each year in high school contact sports. Among college football players, 34% have had one concussion and 20% have endured multiple concussions. Estimates show that 4-20% of college and high school football players sustain a brain injury over the course of one season. The risk of concussion in football is three to six times higher in players who have had a previous concussion.

A study conducted by McGill University in Montreal found that 60% of college soccer players reported symptoms of a concussion at least once during the season. The study also reveals that concussion rates in soccer players were comparable to those in football. According to this study, athletes who suffered a concussion were four to six times more likely to suffer a second concussion. Research such as this has led to greater interest in developing protective headgear for soccer participants, but it is not clear that such headgear actually reduces the risk of concussion.

Treatment

Concussion symptoms can affect people in a variety of ways, including vision, balance and even mood. Historically, the standard treatment for concussion was to get plenty of rest. However, newer approaches involve therapy to target specific symptoms. Clinics exist that help determine the most affected system and appropriate therapy for a given symptomology. In addition, a thorough medical examination may be needed before returning to sports or activities with the potential for contact or further head injury.

Complications

Following a concussion, some people may suffer persisting symptoms, such as memory and concentration problems, mood swings, personality changes, headache, fatigue, dizziness, insomnia and excessive drowsiness for several weeks to months. This is known as post-concussive syndrome. Patients with post-concussive syndrome should avoid activities that put them at risk for a repeated concussion. Athletes should not return to play while experiencing these symptoms. Athletes who suffer repeated concussions should consider ending participation in the sport.

Second impact syndrome results from acute and often fatal brain swelling that occurs when a second concussion is sustained before complete recovery from a previous concussion. The impact is thought to cause vascular congestion and increased intracranial pressure, which can occur very rapidly and may be difficult or impossible to control. The risk of second-impact syndrome is higher in sports like boxing, football, ice or roller hockey, soccer, baseball, basketball and skiing. The CDC reports an average of 1.5 deaths per year from sports concussions. In most cases, a concussion, usually undiagnosed, had occurred prior to the final one.

Head Injury Prevention Tips

Buy and use helmets or protective head gear approved by the American Society for Testing and Materials (ASTM) for specific sports 100% of the time. The ASTM has vigorous standards for testing helmets for many sports; helmets approved by the ASTM bear a sticker stating this. Helmets and head gear come in many sizes and styles, and must properly fit to provide maximum protection against head injuries. In addition to other safety apparel or gear, helmets or head gear should be worn at all times for:

  • Baseball and softball (when batting)
  • Cycling
  • Football
  • Hockey
  • Horseback riding
  • Powered recreational vehicles
  • Skateboards/scooters
  • Skiing
  • Wrestling

Head gear is recommended by many sports safety experts for:

  • Martial arts
  • Pole vaulting
  • Soccer

Sports Tips

  • Supervise younger children at all times, and do not let them use sporting equipment or play sports unsuitable for their age.
  • Do not dive in water less than nine feet deep or in above-ground pools.
  • Follow all rules at water parks and swimming pools.
  • Wear appropriate clothing for the sport.
  • Do not wear any clothing that can interfere with vision.
  • Do not participate in sports when ill or very tired.
  • Obey all traffic signals, and be aware of drivers when cycling or skateboarding.
  • Avoid uneven or unpaved surfaces when cycling or skateboarding.
  • Perform regular safety checks of sports fields, playgrounds and equipment.
  • Discard and replace sporting equipment or protective gear that is damaged.

General Tips

  • Wear a seat belt every time, whether driving or riding in a motor vehicle.
  • Never drive while under the influence of drugs or alcohol, or ride as a passenger with anybody who is under the influence.
  • Keep unloaded firearms in a locked cabinet or safe, and store ammunition in a separate, secure location.
  • Remove hazards in the home that may contribute to falls. Secure rugs and loose electrical cords, put away toys, use safety gates and install window guards. Install grab bars and handrails for the frail or elderly.

Concussions and Head Injuries

The skull protects the brain against penetrating trauma, but does not absorb all the impact of a violent force. The brain is cushioned inside the skull by the surrounding cerebrospinal fluid. Despite this, an abrupt blow to the head, or even a rapid deceleration, can cause the brain to contact the inner side of the skull. There is a potential for tearing of blood vessels, pulling of nerve fibers and bruising of the brain.

Sometimes the blow can result in microscopic damage to the brain cells without obvious structural damage visible on a CT scan. In severe cases, the brain tissue can begin to swell. Since the brain cannot escape the rigid confines of the skull, severe swelling can compress the brain and its blood vessels, limiting the flow of blood. Without adequate blood flow, the brain does not receive the necessary flow of oxygen and glucose. A stroke can occur. Brain swelling after a concussion has the potential to amplify the severity of the injury.

A blow to the head can cause a more serious initial injury to the brain. A contusion is a bruise of the brain tissue involving bleeding and swelling in the brain. A skull fracture occurs when the bone of the skull breaks. A skull fracture by itself may not necessarily be a serious injury. Sometimes, however, the broken skull bones cause bleeding or other damage by cutting into the brain or its coverings.

A hematoma is a blood clot that collects in or around the brain. If active bleeding persists, hematomas can rapidly enlarge. Like brain swelling, the increasing pressure within the rigid confines of the skull (due to an enlarging blood clot) can cause serious neurological problems, and can even be life-threatening. Some hematomas are surgical emergencies. Hematomas that are small can sometimes go undetected initially, but may cause symptoms and require treatment several days or weeks later.

Warning Signs of a Serious Brain Injury

  • Pain: Constant or recurring headache
  • Motor dysfunction: Inability to control or coordinate motor functions or disturbance to balance
  • Sensory: Changes in ability to hear, taste or see; dizziness; hypersensitivity to light or sound
  • Cognitive: Shortened attention span; easily distracted; overstimulated by environment; difficulty staying focused on a task, following directions or understanding information; feeling of disorientation, confusion and other neuropsychological deficiencies
  • Speech: Difficulty finding the “right” word; difficulty expressing words or thoughts; dysarthric speech

Seek immediate medical attention if any of these warning signs occur

Managing Concussions: The NFL Protocol

Because each player and each concussion is unique, there is no set timeframe for recovery and return to participation under the NFL’s current guidelines. The decision to return a player who has a concussion back to practice and games resides with the team physician managing the concussion protocols and is confirmed by an independent neurological consultant (INC), who is consulted specifically for the player’s neurological health.

After a player is diagnosed with a concussion, the protocol calls for a minimum of daily monitoring. The player’s past concussion exposure, medical history and family history are considered, creating a more complete picture of his health. The protocol progresses through a series of steps, moving to the next step only when all activities in the current step are tolerated without recurrence of symptoms. Communication between the player and the medical staff during the protocol is essential.

The first step is rest. During this time, in addition to avoiding physical exertion, the player is to avoid electronics, social media and even team meetings until he returns to his baseline level of signs and symptoms. The next step introduces light aerobic exercise, which takes place under the direct oversight of the team’s medical staff. If aerobics are tolerated, the team physician will reintroduce strength training. The fourth step includes some non-contact football-specific activities, and the fifth step, which is clearance to resume full football activity, comes only after neurocognitive testing remains at baseline and there is no recurrence of signs or symptoms of a concussion.

When the team physician gives the player final clearance, the player has a final examination by the INC assigned to his team. As part of this examination, the INC will review all reports and tests documented through the player’s recovery. Once the INC confirms the conclusion of the team physician, the player is considered cleared and is eligible for full participation in the next game or practice.

This protocol allows for players to heal at their own individual rates, includes the expertise of both the team physicians and a neurological consultant and specifically includes an assessment of not only the most recent concussion, but also takes into account the medical history of the player.

NCAA Concussion Update

The National Collegiate Athletic Association (NCAA) 2011-2012 Sports Medicine Handbook includes a section called “Concussion or Mild Traumatic Brain Injury (mTBI) in the Athlete,” which notes:

The NCAA defines concussion or mild traumatic brain injury as “a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces.”

The handbook also states, “NCAA member institutions must have a concussion management plan for their student-athletes on file with specific components as described in Bylaw 3.2.4.16 (see Guideline 2i).”

The NCAA Plan

  • Requires that student-athletes receive information about the signs and symptoms of concussions. They also are required to sign a waiver that says they are responsible for reporting injuries to the medical staff.
  • Mandates institutions to provide a process for removing a student-athlete that exhibits signs of a concussion. Student-athletes exhibiting signs of concussions must be evaluated by a medical staff member with experience in the evaluation and management of concussions before they can return to play.
  • Prohibits a student-athlete with concussion symptoms from returning to play on the day of the activity.
  • Requires student-athletes diagnosed with a concussion be cleared by a physician or a physician’s designee before they are permitted to return.

The signs of a concussion, according to the NCAA, are as follows:

  • Amnesia
  • Confusion
  • Headache
  • Loss of consciousness
  • Balance problems
  • Double or fuzzy vision
  • Sensitivity to light or noise
  • Nausea
  • Feeling sluggish
  • Concentration or memory problems
  • Slowed reaction time
  • Feeling unusually irritable

The NCAA handbook includes much more information on concussions starting on page 55. The NCAA also recommends viewing the National Athletic Trainers’ Association’s Heads Up video, which takes a closer look at the types of head injuries incurred and how they happen.

Additional Notes

Sports-related neurosurgical injuries were the focus of the November 2011 issue of the Journal of Neurosurgery. It included the results of a study of 451 patients about the mechanisms and consequences of head injuries referencing an anonymous survey that found that more than 46% of university soccer players experienced a concussion in just one fall season, and almost two-thirds of the same group experienced a concussion over the 12-month period while playing soccer. Another article described a new smartphone app designed for on-the-field concussion testing.

Help Fund Current and Future Research

The Neurosurgery Research and Education Foundation (NREF) is the philanthropic arm of the AANS. The NREF funds research into new and existing neurosurgical treatments, helping neurosurgeons save and improve lives every day.

If you would like to share a story of how your neurosurgeon helped you, please contact the NREF at [email protected] To make a donation that supports neurosurgery research and education, visit www.nref.org.

Author Information

This page has been edited by Nitin Agarwal, MD, Rut Thakkar and Khoi Than, MD, FAANS

The AANS does not endorse any treatments, procedures, products or physicians referenced in these patient fact sheets. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific neurosurgical advice or assistance should consult his or her neurosurgeon, or locate one in your area through the AANS’ Find a Board-certified Neurosurgeon”online tool.

Concussion Recovery 101

It’s always a good idea to check in with your doctor if you think you have a concussion. They can determine how severe your concussion is and give you more specific recovery tips.

In the meantime, try these tips to help you quickly recover from a concussion and get back to your usual activities.

1. Reduce screen time

Bright lights and the eyestrain associated with looking at them can sometimes make concussions symptoms worse, especially headaches. As you recover, try to limit the amount of time you spend looking at your phone, laptop, TV, or other screens.

You can also help to counteract the sleep problems associated with concussions by avoiding screens for two hours before going to sleep.

Learn more about the connection between less screen time and better sleep.

2. Limit exposure to bright lights and loud sounds

After a concussion, you might notice that you’re especially sensitive to bright lights and loud sounds. You may want to try avoiding big crowds and bright fluorescent lighting for a few days while you recover. This will give your body time to heal and prevent light or sound sensitivities from getting worse.

3. Avoid unnecessary movement of your head and neck

Try to avoid anything that causes your head or neck to jostle around. These are the types of motions that can cause a concussion in the first place, and minimizing them gives your brain a chance to recover. While some of these motions might be unavoidable, steer clear of roller coasters and excessive physical activity for a few weeks.

4. Stay hydrated

There’s preliminary evidence that dehydration may increase your risk of concussion. This suggests that staying hydrated is probably a good idea while you recover too. Proper hydration is also important for your overall health, especially while your body is healing.

How much water should you be drinking? Find out.

5. Rest

Resting may be the most important thing you can do while recovering from a concussion. Giving both your mind and body plenty of rest reduces your stress levels and helps your body recover.

Avoid any strenuous exercise for a week or so. If you want to keep exercising, try to keep it light. If you’re a runner, for example, try walking. It’s also best to avoid any heavy lifting for a week.

6. Eat more protein

A 2015 study found that branched-chain amino acids, which are the building blocks of proteins, may improve some of the cognitive symptoms of a concussion. As you recover, try to eat plenty of protein. Meats, beans, nuts, and fish are all great sources of branched-chain amino acids.

Looking for more options? Here are 20 high-protein foods to help you recover.

7. Eat foods rich in omega-3s

Omega-3 fatty acids have also been linked to improving both cognition and the recovery of neurons in concussions sustained by mice in a lab setting. They’re also good for overall health, so there’s plenty of benefit to incorporating them in your diet.

Foods rich in omega-3s include fatty fish, such as salmon, walnuts, flax seeds, soy, and chia seeds. You can also take fish oil supplements, available on Amazon, to increase your omega-3 intake.

8. Eat foods with lots of antioxidants

Some research suggests that antioxidants may improve memory and overall neural functioning. They haven’t been linked specifically to recovery after a concussion, however.

To get more antioxidants, try eating these 12 foods.

9. Be patient

Try to resist the urge to jump right back into your usual daily activities. This can be especially hard if your symptoms come and go. However, taking it easy for a week will help you get back to your everyday life faster.

Try to use this time to catch up on sleep and reduce your overall stress.

10. Follow all your doctor’s orders

Your doctor will likely give you some additional recovery tips. These might include waking yourself up regularly during the first night or taking some time off work.

If headaches are a component of your concussion, your doctor may prescribe medications to treat them.

They can also tell you about signs to watch for and guide you on when it might be a good idea to head to the ER.

Question: I have a 17-year-old who is into all sports — from traditional to extreme, he does it all. He plays hockey, snowboards, skateboards, BMX bike rides and wakeboards. He has had several serious spills, with his head taking the brunt of the falls, but I don’t know if he has actually had a concussion. He is going snowboarding for March break. What advice can I give him about concussions?

Answer: Your son has lots of company. Many people don’t understand the risk of concussion — or just how debilitating this injury can be. Unfortunately, some find out the hard way.

Here’s my first piece of advice for your son, and anyone involved in sports: Don’t underestimate concussion. This common form of brain injury temporarily disrupts mental function. If not treated, it can have nasty, long-term consequences. People with untreated concussion may suffer from headaches and fatigue — sometimes for years. They aren’t as sharp as they should be mentally and they can’t focus.

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We don’t yet understand concussion completely, and exact figures are hard to come by. It tends to be underreported because it’s an “invisible injury,” that is, it can’t be seen with the naked eye, or even on an X-ray. One thing we know — it’s common. My colleagues and I recently surveyed a group of university football players and found almost half of them reported symptoms of concussion during the previous year.

Contrary to popular belief, concussion is not always the result of a blow to the head. A hard tackle, a body check, a bad fall on the slopes, are enough to concuss someone. You don’t actually have to hit your head — you just have to be shaken up.

To understand this, imagine shaking a bowl of Jell-O so hard that it wobbles and slaps against the sides of the bowl. Now imagine the Jell-O is the brain, and the bowl — with rough, ridged edges — is the skull. Can you imagine how a delicate and complex organ like the brain can be injured, even without a direct blow to the head?

Here’s another common myth: “You have to be knocked out to have a concussion.” Not true! I’ve treated many people who have been concussed without losing consciousness. They tell me they just felt stunned or dazed after their injury. Athletes in contact sports talk about a “bell-ringer,” to describe the sensation after a heavy hit. That’s concussion.

If your son takes a bad fall, advise him to get off the hill right away if he feels woozy or dazed, or sees lights or stars, like in a cartoon. Confusion is another sign to watch for. Right after a concussion, people may not have their wits about them. For instance, in sports like hockey, they might not know the score of the game, or recall which team they’re on. Sometimes, symptoms get worse during the next 24 hours. As a rule of thumb, be suspicious.

If your son even suspects he has been concussed, urge him to get to a doctor, the sooner, the better. It’s vital to treat concussion early, especially in school-age people. Otherwise, they can lose a semester or even a whole academic year.

Right after a concussion, people are at much higher risk for further injury. They’re not able to react or think quickly. Also, the brain is very sensitive after an injury. Reinjuring the brain while concussed can lead to really serious health problems — far more serious than either of the two injuries alone could cause. In head injuries, one plus one equals four.

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Treatment for concussion is simple — physical and mental rest. Physical rest means don’t train, don’t run, don’t bike, and don’t shovel snow — just rest for a few days, until symptoms settle down. Mental rest means don’t go to classes and don’t do homework. This can be really tough for young people who have exams or projects coming up. Dedicated students sometimes tell me “I can’t rest now.” My response is, “Either take a week off now or be prepared to take a couple of months later on.”

Most people quickly realize they’re not up to mental effort after a concussion. If they try to study or work, they accomplish virtually nothing. Once symptoms have subsided, they can gradually resume active life. In cases of so-called simple concussion, the most common and least serious form of the injury, the person should feel well in a day or two, do a little more each day, and be back to normal in a week or so. The key is to take things step by step. Otherwise, recovery will be a long, slow process.

With early diagnosis and proper care, symptoms resolve quickly in most cases.

Tell your son to enjoy himself but to keep in mind the risks associated with concussion because, if left untreated, it can make life miserable for months or even years. Professional athletes take concussion very seriously. So should the rest of us.

Dr. Karen Johnston is a neurosurgeon and director of the Concussion Clinic at the Toronto Rehabilitation Institute. Her specialty is brain injury, and her main area of research is concussion in athletes. She has served as a medical consultant to numerous professional sports teams.

Ask The Doctor appears every other Tuesday. E-mail questions to [email protected]

Symptoms of a Concussion: What They Are, How Long They Last, and When to Get Help

Concussion symptoms can be confusing. They don’t always show up right away, they can come and go, and they don’t always go away without extra therapy. We treat concussion patients every day and answer these questions for our patients regularly. That’s why we’ve put together a guide to concussion symptoms, including:

  • The long term and short term effects of a concussion on the brain

  • When symptoms of a concussion usually appear

  • How long symptoms typically last

  • Why symptoms of a concussion might be delayed

  • What symptoms could appear in adults, teenagers, or children and toddlers

  • Which symptoms could be from post-concussion syndrome

  • When you should see a doctor.

In case you’re in a hurry, we’ve also put together this signs and symptoms of a concussion checklist:

If you have any of those symptoms, combined with a known head injury, you could have a concussion. Hopefully, the content below will answer a few of the many questions you have.

Note: Have your concussion symptoms lingered for weeks, months, or even years? On average, our patients improve by 75% after treatment at our center specializing in post-concussion therapy. To see if you are eligible for treatment, sign up for a free consultation.

Effects of a Concussion on the Brain

A concussion is the same thing as a mild traumatic brain injury (mTBI). You don’t have to receive a blow to the head to get a concussion: A concussion may occur whenever you receive a “bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging brain cells.” (Centers for Disease Control and Prevention). For example, if your car stops suddenly, your brain might be jarred enough to hit your skull. If it does, that jostling is enough to cause concussion symptoms.

Short-Term Effects of a Concussion on the Brain

In severe traumatic brain injuries, you might incur physical damage to the skull and brain. But a concussion, by definition, means you have not suffered severe physical damage. If you have a concussion, you suffer from the effects of a mild TBI: damage to brain cells (popularly called “bruising”) and inflammation.

Inflammation is the body’s natural response to an injury. Blood and other fluids rush to the site of the injury so that the body can effect repairs. Brain swelling can result from this process. According to the American Association of Neurological Surgeons, “brain swelling after a concussion has the potential to amplify the severity of the injury.”

Normally, your brain calls for increased blood flow to deliver oxygen when and where it’s needed. For example, if you’re reading a book, then the parts of your brain governing sight and reading comprehension would call for increased blood flow. That gives your brain the energy it needs to help you perform those tasks.

Any cognitive activity requires coordination between cells from various regions of the brain. If inflammation and cell damage prevent blood resupply signalling, the normal neural pathways can’t function properly. Other areas of the brain have to work harder to help you complete the same task.

In other words, communication between neurons along the original pathways is disrupted because they don’t get enough oxygen (among other things). As a result, you may experience any number of the symptoms listed in the checklist (or in the sections below).

In an ideal recovery, the brain will resume using the most efficient pathways to deliver oxygen and information. But that doesn’t always happen.

Long-Term Effects of a Concussion on the Brain

Sometimes, the brain doesn’t return to using the most efficient pathways. Instead, it may continue using the less efficient pathways formed during rest and recovery. That change may or may not result in symptoms.

Usually (but not always), one concussion isn’t enough for lasting symptoms. In most cases, the number of pathways affected are not enough for you to notice a difference in your day-to-day life.

It’s more common for people who experience a second concussion — or even multiple concussions — to have long-term symptoms that do not resolve without therapy. That’s because the more concussions you have, the more opportunities your brain has to solidify suboptimal (less good) ways of sending information and getting oxygen. Those changes can be responsible for everything from headaches to mood changes to forgetfulness.

Think about suboptimal signalling pathways in your brain like the different routes you can take to commute home from work. Some roads have more traffic than others. If you have to route around an accident, you’ll take longer to get home. And if you get stuck in traffic, who knows how long it will take. In those situations, you end up tired and frustrated because what should be an easy trip home, isn’t.

During healthy brain function, communication “traffic” would be equally distributed along existing roads. Suboptimal pathways are like getting stuck in a traffic jam or having to take the long way around. Those cells are unable to call for enough oxygen to do their jobs, so other cells have to do it. The more that happens, the more tired your brain becomes and the more opportunity there is for your symptoms to emerge. This situation can occur from just one concussion or from many; severity depends on the individual patient.

Once those suboptimal pathways are set in place, it can be difficult to retrain them without expert assistance. But with a combination of physical therapy, cognitive therapy, diet, and calming activities like meditation, most people do reset most of those pathways.

When Do Symptoms of a Concussion Appear?

When it comes to symptoms, everyone is different. Most people have symptoms immediately. Those symptoms might go away and come back, or new symptoms could appear a few days later. Below are the answers to a few commonly asked questions about when concussion symptoms appear and disappear.

How Long Should Symptoms of a Concussion Last?

How long symptoms stick around depends on the severity of the concussion. It can also vary from person to person. Interestingly, mental confusion at the time of the injury is the best predictor of long-lasting symptoms (meaning, if you experience confusion when injured, you’re more likely to have symptoms that don’t go away quickly).

In general, symptoms of a concussion should resolve in two weeks. Some people have symptoms for longer — up to three months. If symptoms don’t resolve after three months. Concussive symptoms typically resolve in 7 to 10 days (sports-related concussions) or within 3 months (non-athletes) (Epps and Allen, 2017). If symptoms don’t resolve after three months, they probably won’t go away without therapy. In the article “Early Clinical Predictors of 5-Year Outcome After Concussive Blast Traumatic Brain Injury” which was published in the May 2017 issue of JAMA Neurology, it states that many concussive patients experience evolution of symptoms five years after mTBI, not resolution of symptoms. 72% of patients had worsening global disability after five years. This clearly evidences that chronic concussion symptoms are likely to progress over time, rather than resolve. Recovery time isn’t correlated with injury source. Someone who has a concussion from a car accident, for example, is likely to need the same recovery time as someone with a sports concussion.

The above guidelines hold true for roughly 80% of the population (although this number fluctuates in any given study). The remaining 20% take longer to recover than most people — or might not see their symptoms go away at all.

In general, if your symptoms haven’t gone away after two weeks, it’s time to look for treatment alternatives. (If that sounds like you, we offer a free consultation to patients who would like to determine their eligibility for post-concussion treatment).

Can Symptoms of a Concussion Come and Go?

Yes, symptoms of a concussion can come and go. Some patients feel great after their initial recovery. Then a few days or weeks later, those symptoms return with ferocity. Why?

It may be that your brain is still using suboptimal pathways to relay information and oxygen. When your symptoms are gone, that means your brain is still doing a pretty good job of compensating. But when symptoms return, it’s often because some other stressor — an illness, emotional trauma, extra stress at work — is too difficult for the brain to handle.

Can Symptoms of a Concussion Be Delayed?

Yes, symptoms of a concussion can be delayed (although it’s fairly rare). Some patients don’t feel any negative effects from their concussion. Or, they might have a few symptoms that resolve (like headaches), followed by new symptoms (like overwhelm or anger).

Remember those suboptimal pathways? The changes might not be severe enough for you to notice… at first. But sometimes it’s the start of a downward spiral. In these cases, when a certain section of the brain doesn’t receive enough oxygen, its ability to signal for more oxygen is negatively impacted. Over time, the reduced oxygen and signalling make each other worse.

Eventually, that negative loop makes the deficiency present symptoms. For example, you might have had no problems with vision immediately after your concussion. But a few months later, you might discover that your peripheral vision is disappearing. That negative cycle of oxygen insufficiency and reduced signalling is why.

Symptoms of a Concussion in Adults

We’ve categorized adult concussions symptoms by when they typically appear. Symptoms in the “Immediate or Early” column are often observed earlier than not. The symptoms in the second column, “Early or Delayed,” may appear early, but are often noticed later in recovery.

Immediate or Early

Early or Delayed

  • Amnesia (about the traumatic event)

  • Anxiety

  • Brief loss of consciousness

  • Blurred vision

  • Confusion

  • Car sickness or nausea with motion

  • Dazed appearance

  • Change in (or loss of) taste or smell

  • Delayed response to questions

  • Depression

  • Dizziness or “seeing stars”

  • Difficulty concentrating

  • Fatigue

  • Difficulty finding things

  • Feeling of pressure in the head

  • Difficulty reading

  • ‘Foggy’ feeling or thinking

  • Easy to distract

  • Headache

  • Feeling of overwhelm

  • Loss of balance

  • Getting lost

  • Nausea

  • Irritability

  • Persistent neck pain

  • Low energy or motivation

  • Ringing ears

  • Occasional heartbeat irregularities

  • Slurred speech

  • Sensitivity to light and noise

  • Temporary loss of consciousness

  • Short-term memory problems

  • Tired eyes

  • Sleep disturbances

  • Vomiting

  • Slowness to decide, think, speak, or act

  • Tired for seemingly no reason

  • Various other mood/personality changes

The above are symptoms that, in and of themselves, do not necessarily constitute an emergency. If you’re having balance problems, make sure you’re in a safe environment and that you have a loved one with you, if possible, to keep you safe until they resolve.

Memory loss is uncommon outside of brief amnesia associated with the event that caused the concussion. If you experience more than mild short-term memory loss, consult with a medical professional.

Symptoms that are more dangerous (but which still do not necessarily constitute an emergency) are weakness or decreased coordination, repeated vomiting or nausea, and slurred speech. Sometimes, concussions cause startling, more severe symptoms. If you experience any of the following symptoms, get medical attention immediately.

Go to the Emergency Room If You:

  • Are increasingly confused, restless, or agitated

  • Can’t recognize certain people or places

  • Exhibit strongly unusual behavior (like impulsive or dangerous decision-making, making odd or illogical statements, drunken appearance, etc.)

  • Have convulsions or seizures

  • Have one pupil that is larger than the other

  • Look excessively drowsy or do not awaken

  • Lose consciousness.

These symptoms are serious and should be treated by a medical professional immediately.

Symptoms of a Concussion in Teenagers

The list of concussion symptoms for teenagers is the same as the symptoms in adults listed above. However, parents often ask us how to tell the difference between teen angst and concussion symptoms.

Here’s our rule of thumb: If the behavior or complaints you observe in your teen are at all unusual for them, assume it’s the concussion. While some symptoms like irritability, depression, or anxiety may come from other sources, it’s entirely possible that they’re stemming from a previous concussion. Trust your instincts and when in doubt, pursue treatment options for a concussion.

It may be that they won’t feel better until they receive adequate medical care.

Symptoms of a Concussion in Children and Toddlers

Many everyday activities put young children at risk for concussions. Try as you might, it’s not possible to prevent every situation that could result in head trauma. But it’s harder to know if they have a concussion, since toddlers can’t always tell you exactly what’s wrong. They’re still learning how to understand and express what they feel. That makes it harder to tell if your child has a concussion.

Clues to Symptoms

Children may behave in ways that help you know if they’re experiencing a concussion. They might:

  • Anger easily

  • Appear dazed

  • Cry more than usual

  • Change their behavior patterns for food and sleep

  • Lose their balance more frequently or seem unsteady

  • Seem unusually tired

  • Seem uninterested in favorite toys or activities

  • Touch their head a lot to indicate it hurts.

Definitely Go to the Emergency Room If:

  • You know they bumped their head or experienced shaking or jolting, and

    • They have any of the emergency room-worthy symptoms listed for adults

    • They just won’t stop crying

    • They refuse nourishment

Ultimately, if there’s any question as to whether your child is suffering from a concussion, it’s always better to have your child’s doctor check them over than to assume nothing is wrong.

Symptoms of Post-Concussion Syndrome

Many people who experience symptoms after their concussion should have healed have something called post-concussion syndrome. Unfortunately, rest is not adequate health care to fix brain damage incurred via this syndrome. Instead, intensive physical and cognitive therapy is needed to help the injured brain rebuild its pathways.

While any of the symptoms listed as “Early or Delayed” apply, here are a few of the most common symptoms experienced by our patients.

Headaches That Worsen With a Specific Condition

Common triggers for post-concussion headaches include physical exercise, trying to think, exposure to light, and attempting to work.

Depression, Anger, Anxiety, or Other Personality Changes

Post-concussion patients are hit with a “double-whammy.” Not only can concussion symptoms cause mood changes like depression or irritability, but these conditions are often worsened by the belief that they won’t get adequate help. In a recent study, students who have experienced a concussion have a higher risk of self-harm, depressive symptoms, attempted suicide, injury from attempted suicide, and overall poorer mental health outcomes (Yang et al. 2019) Many are also accused of faking their symptoms. Emotional symptoms as a result of concussion are real and they can be treated. We’ve got a post about personality changes after a concussion that dives deeper into this topic.

Note: Many of our patients were told that their condition is untreatable. That’s not true. Post-concussion syndrome is not a condition that many doctors treat, but it is often treatable. There is hope. To learn if you’re eligible for treatment, schedule a free consultation with our staff.

Overwhelm

The feeling of being overwhelmed is often triggered by light and noise. Patients may struggle with common activities like going to the grocery store or to a party because their brains can no longer filter out all the background noise in today’s society. They may also feel overwhelmed during or after work.

Vision Changes

Visiting an optometrist won’t fix vision issues caused by a concussion. Some patients find that their vision blurs after trying to read or use the computer. Others can’t read fine print. And some find that their peripheral vision disappears (or they have the opposite problem — peripheral vision that picks up too much).

Decreased Cognitive Performance

Patients often experience things like brain fog, trouble shutting off their brains for the night, difficulty focusing or following conversations, and short-term memory issues. Even difficulty remembering where you put your keys could stem from post-concussion syndrome.

When Should You See a Doctor?

If you experience trauma to the brain, watch out for the emergency symptoms listed above. If any of those symptoms emerge, you need to visit a hospital immediately.

But if your symptoms are normal for a concussion and you’re not showing danger signs, should you see a healthcare professional? That depends. If you’re of the “better safe than sorry” temperament, it’s not a bad idea to schedule an appointment and follow-ups if recommended.

If you do decide to see a physician, avoid your general practitioner’s office — unless you need them to refer you for an MRI (this is only helpful if structural damage is suspected). Otherwise, opt for a sports medicine practitioner. Since sports injuries frequently include concussions, sports doctors are more likely to stay current on recent developments in treating concussions and can give you better advice than just recommending bed rest.

If you prefer to wait, give yourself two weeks for symptoms to resolve. If you play contact sports, don’t resume practice until you’re fully healed. If the signs of a concussion are still present after two weeks, it’s time to get a professional involved. Post-concussion syndrome, in most cases, will not fully resolve on its own. Targeted physical and cognitive therapy can make a huge difference in outcomes: Even post-concussion syndrome doesn’t have to be permanent brain damage.

Note: Have your concussion symptoms lingered for weeks, months, or even years? Our patients’ symptoms improve by 75% on average after treatment at our center specializing in post-concussion therapy. To see if you are eligible for treatment, schedule a free consultation with our staff.

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