Do You Have a Concussion?

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This survival-medicine website provides general information, not individual advice. Most scenarios assume the victim cannot get expert medical help. Please see the disclaimer.

How to Know If You Really Have a Concussion

by James Hubbard, MD, MPH

Almost everyone has hit their head and seen stars. Sometimes it kind of dazes us. We usually rub it and go on with what we’re doing. But sometimes, people get symptoms, and they linger. Then the question becomes, do you have a concussion? And why does it matter to know?

I hope you know you should see a doctor if you ever get knocked out. But what if you just have bad headache? And what should you do if you can’t get to a doctor?

We’re learning more and more how seemingly minor concussions can damage our thinking for as much as a lifetime. No matter the reason for the head trauma, whether it’s sports or a fall or a tree limb, you should know what to watch for and what you should do.

Any sport has its share of concussions—any—from soccer to football to basketball to cheerleading. Concussion can happen at all ages, but a mild concussion in a young person’s still-developing brain has the potential to be more serious than in an adult’s.

Still, that doesn’t mean we older folks shouldn’t worry. For instance, the military has gone into overdrive trying to learn how to prevent concussions and what the best treatment is to diminish long-term effects. And if you follow pro football, you know concussions have become the sport’s most talked-about injury. Many former players are just now reaping the damage from the times they “got their bell rung” and just shook it off. Multiple concussions take their toll.

But, even after one concussion—even what we’d call a mild one—the effects can linger for weeks to months to years, especially if the injury isn’t treated correctly.

Do You Have a Concussion?

Check the Neck

Never forget, if there is a head injury, there could be a serious neck injury. Check the neck thoroughly. Neck injuries cannot ever be ruled out unless the person is alert enough to follow commands and tell you what hurts, what’s numb, etc. See my post and video for stabilizing a neck.

In order to know if you have a concussion, technically termed a “mild traumatic brain injury,” you have to know the signs and symptoms to look for. Most of the following information comes from the CDC’s website section on concussions. The “Heads Up” videos are especially good.

Get to a Doctor

Of course, a thorough, expert medical exam and X-rays—if indicated—are essential after any head or neck trauma, but it becomes a must even if it’s hard to get to a doctor if there is:

  • Any loss of consciousness greater than 30 seconds
  • Weakness or numbness of an arm or leg, hand or foot, fingers or toes
  • Neck tenderness
  • Loss of range of motion in the neck

Signs and symptoms of a concussion come in four general categories. These problems can occur immediately or start hours after the injury.

1. Physical

  • Headache
  • Increased sensitivity to light or sounds
  • Dizziness
  • Trouble with balance
  • Nausea or vomiting
  • Double or blurry vision

Quick exams to check for these signs and symptoms:

    1. Have the person stand, feet together and eyes closed. Be ready to catch if they start falling because of balance problems. If they pass this …
    2. Have them open their eyes and stand on one foot.
    3. Have them walk a straight line.
    4. Have them stretch out a hand, then touch their nose with their index finger. Alternate hands and repeat a few times.

If the person has problems with any of these, think concussion.

2. Thinking

  • Confusion
  • Amnesia (can be trouble remembering things that happen either before or after the injury)
  • Loss of consciousness
  • Feeling foggy
  • Disorientation—trouble knowing what happened, where they are, who they are, or what day it is.
  • Books adTrouble focusing
  • Slurred speech
  • Slowed verbal or physical responses
  • Excessive drowsiness

Quick exams:

    1. Ask them their name, your name, what day it is, and where they are. If they can’t answer all the questions, or if they answer very slowly, they’ve likely had a concussion.
    2. Place your pointer finger about a foot from their face. Have them follow your finger as you move it from side to side, up and down, and diagonally. They should be able to follow it without much lag time.

3. Mood

  • Mood swings
  • Increased irritablility
  • Excessive fatigue that lingers
  • Nervousness/anxiety
  • Depression/sadness

4. Sleep

  • Trouble getting to sleep
  • Sleeping more than usual
  • Sleeping less than usual

See what people are saying about The Survival Doctor e-books.

When a Concussion Becomes an Emergency

Downloadable Chart

The CDC has a chart you can download to follow the status of someone post-concussion. Click here to download the PDF.

Any person with a concussion should be observed for 24–48 hours for any new problems and for initial problems getting worse. If things do get worse, it becomes essential that the person get expert medical help right away since they are going to need further evaluation, along with treatment that just can’t be done in the field.

Danger signs and symptoms include:

  • Increasing headache
  • Slurred speech
  • Repeated vomiting
  • Increasing confusion
  • Seizures
  • Increasing irritability

Exam: Shine a light in one eye, then the other, to check the pupils. They should react and constrict equally. Note the initial exam, repeat every 30 minutes for a couple of hours, then every two hours for the next 24. Watch for changes. It’s much better to do this in a fairly dark place so the eyes will be dilated to start. Try it on a friend to get the hang of it, so you know what a normal exam looks like.

Aha! You Have a Concussion. What to Do.

Other than the above,

1. Rest. It is essential. Any person with a concussion needs to rest physically and mentally until the symptoms have been gone for 24 hours. That means no play and no school. And if you’re in a disaster, someone else needs to take charge if at all possible. It’s not only the danger of poor judgment that makes this important. It’s not even just the fact that getting a second concussion before the first heals is particularly dangerous. It’s that a concussion affects your whole brain. The metabolism changes, the synapses fire improperly. Physical activity can worsen this and also prolong recovery. So can mental activity. You have to rest your thinking. No texting or videogames, no television or reading, and delegate all decision making you can.

The symptoms can last from a few hours to many months. After they’ve gone away for 24 hours …

2. Gradually start back the mental and physical activities. If the headache or other symptoms return, you need to do less activity for 24 more hours.

I know this can be very, very inconvenient. But if you don’t do it right, symptoms will linger. In fact you may never get back to normal.

However, the good news is the vast majority of people with concussions do return to normal brain function, usually within 24–48 hours, especially if it’s their first concussion.

What about you? Have you known anyone who had a concussion? How did they do?

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  • Lando

    I woke up and decided to put my head down on the corner of the desk next to me. there is an inch opening above my eyebrow and it hurts and im bleeding. Can i go back to sleep

  • angel

    I hit the side of my head on a sidewalk skating today but I was barely about to take off when the accident happened, I felt a minor headache soon afterwards, I remember what I did right before the incedent too but I dont know how I fell FROM the sidewalk to the street but I guess the good thing is that I didn’t hit the back of my head but my shoulder hurts. My question is, if I hit the side of my head and have good memory, almost no headache, have I had a cuncussion?

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Angel, you’ll have to decide that for yourself. Look at the symptoms in the post. If you have concerns, have someone check you.

  • ODAHLIN

    I was playing basketball and fell, while falling another girl fell and landed on my head. I have had on and off headaches. I am also noticing I am get more irratated around things like when people ask slot of simple questions or even when a cat was walking around me. Doi I have a concussion?

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Have a parent, coach, trainer, or nurse check you out.

  • Anne Straith

    Yesterday I hit my head on my trampoline and it hurt for a minute but then it went away and now I only have a very small headache in the back of my head,its hardly noticeable but its there, about the same place it hit the tramp. should I be worried?

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Anne, all I can tell you is to read the post, see if you have any symptoms (you didn’t mention any) and decide for yourself. Or have someone reliable look at the area. What you describe sounds like a bruise, but I couldn’t tell you without looking at it.

  • Nichole G.

    My uncle hit her head on the bathroom door pretty hard today. And now hes very dizzy and sad and he’s hallucinating really bad. And he’s afraid to go to bed. But everyone’s sleeping so he has no ride to the hospital. What should I do?

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      If your uncle is suddenly hallucinating, wake someone up and take him to the hospital, or someone should call 911.

  • Nikki

    Last night I was playing soccer and I collided shoulder to shoulder with a guy who was considerably bigger than me. It kind of was like being clothes-lined, and I landed really hard on my back. I know I hit my head, but I’m not sure if it was when I hit him or when I landed. I had to lie there for a minute to re-orient myself and think about what had happened, but I never lost consciousness. I haven’t had a headache, just lower back and shoulder pain, but today I just can’t “wake up” and I’m dizzy and not very focused. I’m fairly sure that if I have a concussion it’s a mild one, but was just wondering approximately how long I should rest for before you’d recommend playing again. I have 4 games this week and would hate to miss any but definitely want to make sure I’m better first, as I’ve had 3 concussions in the past. I live in a rural area, so I’d rather avoid having to drive all the way to the doctor’s, I’d appreciate any suggestions immensely!

  • Sarah

    i got punched in the back of the head a few hours ago and now i have a dull pain in my neck and the back of my head. my balance is fine and im good mentally i just got tired all of a sudden could this be a concussion. every time i move my head the back of my neck aches.

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      From your description, it sounds like you strain some neck muscles.

  • Savannah

    Yesterday i was at work ( construction ) i got bored and started to play with a metal level. I wacked myself in the back of the head pretty hard i was dazed for a second but did not fall over or lose conciousness. Later on i got a headache and though that was pretty normal considering the circumstances and didnt think much of it. The headache presisted through the night and now all of today. Extra strength advil did not help and neither has sleeping. I am also very nausious but havent thrown up. Along with the headache my ears are ringing. As a side note, there is a little bump at the spot where i hit my head but no blood cut etc. Sound like a concussion?

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Possibly. Sounds like you should get checked out if it’s not improving.

  • wolfke74

    I hit my head last week Tuesday on a very low hang rain pipe, I hit it quite hard. I had a painful bump on my head but nothing further special. Then on Saturday the headache was creeping in, now it is Thursday and the headaches are getting worse, even my neck on the right side is getting more stiff and painful and my shoulders also are hurting a lot. Now as I was getting my kids to be, I had to lie down on there bad, a very bad headache hit me and went through my neck, to my back, I could hardly get up. I had to force myself to get up. I am not really nausea, just a little bit and have bit of ringing in the ears. I am wondering if I should let it check out.

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      If you have a rapidly progressing headache, you should have it checked out right away.
      If it’s only in the neck and back, it could be muscle strain, but still should be checked out soon.

  • Kelly Carnes

    Just an hour ago I was at Walmart and decided to walk out where the carts are placed. I knew it was low and had to duck but I didn’t duck long enough and hit the top of my head. As soon as I got home I got an ice pack on it and then a couple of pain meds. I stayed sitting up but decided to lay down even if I don’t sleep. Not really dizzy just sleepy.