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

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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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  • Cindy Ferris-Wahlberg

    2 years ago I slipped on ice and went down hitting the back of my head. I had extreme pain for days. I went to my doctor and without even doing anything, said I sprained my neck muscle. My neck didn’t hurt. The back of my head hurt. To this day it still hurts off and on. Last night was the worst. I couldn’t lay on any part of my head without the back of it hurting. Still this morning it hurts just sitting up. What should I do?

  • Pingback: Natural (at home) concussion remedies – The Amateur Herbalist()

  • Leshawn Malcolm

    My grandma fell and hit her head years ago, now she complains of dizziness and heaviness in the head causing her not being able to stand for long hours. About a year ago she was admitted in the hospital as she woke up being unable to walk(still complaining about being dizzy and head feeling extremely burden or heavy) she gets headaches aswell and her blood pressure tends to fluctuate a lot(don’t know if it’s because she’s worrying about her illness) but the doctors here in jamaica says its her nerves which I don’t think is the right diagnosis. Please can a doctor help would really appreciate it

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

      I don’t know how old your grandmother is but dizziness seems to be more of problem the older you get. Anemia (low blood cell count) could be ruled out by a blood test. An MRI could help determine if there’s any masses in the had. If they have checked her thoroughly and not found anything, a common cause is fluctuating blood pressure, or even the medicine for it. Making sure she’s taking her medicine like it should be taken and not missing doses is essential.

  • Susanna

    I was drinking and was a bit tipsy. The floor was slippery so I fell on marble floor in the toilet. I hit on the back of my head hard but I did not lose consciousness or black out. however I have headaches on and off. Do I have a concussion?

  • Heather Akin

    I was slapped really hard in my face it broke my glasses and stabbed my eyebrow now I’m lightheaded and dizzy with a bad headache I have a knot its very soft and mushy very tender when you touch it

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

      Sorry to hear that, Heather. Sound like you have a bad bruise but if the other symptoms continue you should have someone check you.

  • http://www.urbancowgrrl.blogspot.com/ Julia M

    I had a severe concussion twenty years ago in a car accident. I was unconscious and had a seizure apparently. It was a very strange experience because I did not know how badly I was hurt and couldn’t comprehend how serious it was. I didn’t realize until a few days later that I had been hallucinating while being checked out in the ER (I thought it was real). I was in the hospital for a week (with a broken neck too) so being bedridden I obviously was in pain with a lot of fatigue but it was rather indistinguishable as to what which symptom was from. The one that stood out though was that I couldn’t do math for a few weeks – not even simple addition. It wasn’t until it all cleared up that I realized how serious it was. While it was happening it just seemed curious and kind of interesting.

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

      Thanks for sharing, Julia.

  • Alex Green

    So I fell down a flight of stairs. Of course everything hurts and is bruised, but it’s been 24 hours and my head still hurts, and I’m kinda dizzy. Is it really even worth it to go to an MD after this long?

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

      It’s you’re call. One thing I’d look for is if the symptoms are getting less that would be a good sign.

      • Alex Green

        Thanks!

  • Marie

    Yes I have and thank you

  • Marie

    I have a concussion and for about 3 weeks now my eye is half way shut and i cannot open it. I can lift my eyebrow a little but not much. There is no sign of swelling.

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

      Hopefully you’ve told a doctor to have it checked out since it could something going on with the facial nerve.

  • Andrew Daniel

    I was playing football and i got tackled and hit my head on the ground it hurt but just for 1 min i went home and i had some trouble going to sleep but i was nervous. Today i have pain in my right eye.

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

      Sorry to hear that, Andrew. If you’re still having pain have your parents or coach check you out.