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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  • Coukla

    I was out with friends last night and had too much to drink. I fell in the bathroom and hit my head on the sink on the way down. I was dizzy and had to sit down for an hour w my head between my legs but do not know if it was the alcohol or the head hit. Today it is sore and tender w a lump. But I am not nauseated or dizzy. I just have a normal hangover level headache. Not sure whether or not to wait it out to see if symptoms appear or go to doctor? I am 40 (yes way too old for these antics)

  • kelsey

    so I was walking out the door and somebody was on the other side and the door flew back at me and gave me a bloody side of my forehead before my cheer competition. I had a bad headache and I’m really dizzy and nauseous. do I have a concussion?

    • James Hubbard, MD, MPH

      If the symptoms are still there, have someone check you out.

  • S

    I work at a daycare and at work today a middle schooler kicked a football across the gym, it ricocheted off the wall a few feet behind me, and went straight into the back of my head. When it hit me, I felt my teeth vibrate and I got a little dizzy. I got up off the floor (I was sitting when it happened) and as I walked away, I felt a little nauseous. I was fine after that but got home and started to develop a headache. I took a two hour nap (I realize this might not have been my best choice) and when I woke up my whole body was achy. Advice?

    • James Hubbard, MD, MPH

      If the symptoms haven’t gone by now, you should have someone check you out.

  • Colton

    I remember getting a possible concussion about seven years ago, when I was sixteen. I felt the changes to my mind almost instantly. Didn’t end up going to the doctor until a few months later at which point nothing could be done. To this day I have headaches, cognitive problems, and depression. Now I can only wonder if resting would have prevented all my issues, rather than just shrugging it off and going about life like normal.

    • James Hubbard, MD, MPH

      Thanks for sharing, Colton.

  • Summer1724

    Hi my sister accidentally hit me on the head really hard with her bottle, and now i have constant headaches. I’ve been taking painkillers everyday since then, sometimes it helps sometimes it doesnt. What should i do?

    • James Hubbard, MD, MPH

      Tell your parents and have them check it out.

  • Erica S.

    I feel head first into a cement wall while playing soccer at a church. I didn’t lose consciousness, but there was a lot of blood. I had my husband take me to the ER. They put four staples in and did a ct scan. They said I didn’t have a concussion. So, I been getting really bad headaches the last few days but it’s been almost two weeks since this happened. Ive had the staples out almost a week. Medicines don’t seem to help. Do you think I should go back to the doctor or just wait it out?

    • James Hubbard, MD, MPH

      Go back to the doctor.

  • Sammy

    I hit my head, not very hard, at a basketball game two days ago. It didn’t initially hurt too bad. I got right up. There were only two minutes left in the game, and we were winning big, so coach took me out. The next morning, I woke up with a headache, and it has persisted, even when I take ibuprofen. Light and sound make it worse. i also slept most of the day yesterday. Today I have had mood swings and been irritable, but I haven’t had trouble concentrating and I haven’t felt any other mental deficits. Is it possible I suffered a minor concussion?

    • James Hubbard, MD, MPH

      Sounds like you have the symptoms of one. You should let your parents check you out.

  • Lindsay_Chilly

    I need help. I constantly feel like someone is punching the back of my head/left side whenever I either go from sitting to standing, or from lying down to sitting. This has nothing to do with getting up fast -it can be the most gradual movement and I still get it. Then I get a shooting pain behind my eyes and I can’t look at light. It happens every moment I go from sitting or lying down in the day, it’s not periodic. I’ve had 2 concussions in the past but the more recent one was a year ago. There’s been no head trauma recently (within the past year). I’m worried because it is affecting my memory, I can’t focus on studying (third year university student) and I have midterms but there was no head trauma so I don’t understand what’s going on! I don’t want to just go to the doctor unless there’s legitimately something wrong but when do you draw the line and say it’s your head -go! ?

    • James Hubbard, MD, MPH

      Sounds like your line is pretty clearly drawn. You need to see a doctor, have an exam and some tests, and probably need to see neurologist.

  • Kayla

    A couple of hours ago, my dad came home and found me on the floor. When he touched me , I woke up. I was confused about where I was or what time it was. My toes were numb and my arms and feet are cold. The last thing I remember was standing up and a dog barking. I think I had been on the floor for a few hours at least. I have a minor black eye, headache, bump on head, and I am a bit nauseous. I am also having trouble going to sleep. My dad didn’t want to take me to the doctor. Should I seek medical attention?

    • James Hubbard, MD, MPH

      In other words, you seemed to have passed out and don’t know why? Then, yes, anyone should get checked by a doctor after that, if possible.

  • Josh Lee

    I got kicked in the head with a soccer ball pretty hard, and I have some pressure in my head but not a headache and I can still focus and stuff and I passed all the balance tests except for the one where you closed your eyes and put your feet together but I didn’t fall I just moved around a little. Is that a concussion? Or should I wait for it to get better?

    • James Hubbard, MD, MPH

      With any head injury, always let someone know (parent) so they can keep an eye on you for any subtle changes.