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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  • Diane Wilkins Potocki

    I fell on concrete on Friday and hit my chin along with other parts if my body. My head feels weird like pressure in it. Feels like I am getting a headache but don’t get one. Mire pressure i am assuming. I was wondering could this be a sign of a concussion and what should i do. I am 59 yrs old.

  • Tam

    I was in a crawl space in the garage and did not realize how far out it went or maybe I even forgot I was under the overhang and went to stand up with full force and hit the back of my head. I sat down for 5 minutes and said owe many times, and kind of cried and said owe my head. Then I asked my husband to help me up as I was not sure if I was hurt or not. I went to lie down for a little but, not long and then pulled it together and went back to painting. I went to work all week. I did firewood outside, twice since then. I still have a bit of discomfort not pain in the back of my head. In the afternoon one day I came home at lunch to have a bath as I felt I needed to wake up. Then again today I was exhausted, barely made it through the day in the afternoon. I don’t have pain, but, I wonder if I have a mild concussion. The night after my hitting my head I woke up at 3 a.m. and felt a bit sick to my stomache it took me about an hour to go back to sleep. That is basically it, I seem active so I don’t want to run to the doctor but in the same sense, I wonder if I have a concussion to which I likely need no treatment just curious :) not worried just wondering if its possible I do.

  • Braxton Hirsbrunner

    Hey. Today I had a football game and got hit in the head pretty hard, but I just shook it off and kept playing. Now I have a huge migraine and have this ringing in my ears and am more moody than usual. Do you think I have a concussion?

    • James Hubbard, MD, MPH

      Braxton, with something like that, someone should check you out. How are you doing now?

  • Amanda

    So today I was at gymnastics and I went to do a backbend and I hit my head pretty hard, I told my mom but she thinks it’s nothing but I have this huge headache and I’m really dizzy.

    • James Hubbard, MD, MPH

      Amanda, sorry, I’ve been out a few days. How are you doing now?

  • worried mom

    my daughter hit her head on the ground yesterday evening. While her sister was driving she just started screaming out of no where and no one could console her. When they got to a friends of ours house they called 911 because she just wouldn’t stop screaming. When I got to her she only knew me. She didn’t know anyone around her. I would ask her about her sister and friends, even her dad and she didn’t know who I was talking about. While in this forgetful state she said she was “talking” to her uncle who passed away 11 years ago and that he was helping her to try to remember. She would just starting spelling names out of people or things and I would confirm to her that she in fact knew those people. After being in the hospital a few hours everything started coming back to her and she started to remember everyone and what happened. Images didn’t show anything and she seems to be fine so far today. She never had a headache or anything. Anyone else experience something like this? I feel so lost and helpless knowing she is going through this.

    • James Hubbard, MD, MPH

      Sorry, I’ve been out a few days. How is your daughter doing?

  • Lisa Winegar Cole

    My 15 yr old daughter was with friends at a lake house. Last night she fell over a mattress on the floor and hit her head on a table in the middle of the night. She didn’t tell us. This morning driving home she very suddenly threw up. She then shared what had happen. She has a knot on the back of her head. She slept all day long and was hard to wake – but she was also up all night with friends and is a teenager… Tonight she admitted she was a bit dizzy and still nauseous. I don’t know it it a tummy bug or a concussion- but she is a competitive dancer and has big things in the next week. I don’t want to get her pulled out of over caution only to find out it is a bruise and stomach bug. But I also don’t want to risk her health. How likely is it a concussion? Once she goes in she will be benched for caution…and she will be so upset with me…

    • James Hubbard, MD, MPH

      If she is having symptoms, she should rest. If you have questions on the specific diagnosis and treatment plan, she should see a doctor. Not only is it best medically, it should lessen her being upset with you if she has to pull out.

  • cassandra

    Just recently had a friend sleep over and my room isn’t all that big and my bed sits on the floor. My friend said she got up to use the restroom and when she came back up she must have moved the TV without realizing it and before I knew it the TV had fallen on my head. I couldn’t move for about an hour and woke my friend up. She got my mother the next day. My mother then told me to shake it off. I’m alive aren’t I? Was that right?

    • James Hubbard, MD, MPH

      Every situation is different.

    • cassandra

      I’m just really tired but now ma won’t let me go to sleep.

  • nicole

    I made the horrible choice to huff dust off like 5 times within a 2 day time period resulting in myself passing out or blacking out, during which I fell at least twice hitting my face and head on not only the ground but also a brick. I have had trouble sleeping, eating, headaches like never before and terrible motion sickness which has never been a problem for me before. My cheek is swollen, can’t tell if it’s broken or not, a black eye, and 2 knots on my forehead. I can’t recall passing out and falling and don’t know if my headaches and nausea are just from being an idiot. Should I go to er?? And if so.. How important is it that they know how this really happened compared to just saying I fell?

    • James Hubbard, MD, MPH

      Go to the ER and please tell them how it happened so they can evaluate you better.

  • Paula Griffiths

    Seems to me that there is not much one can do with a concussion besides rest? I went to a doctor and he said there was nothing I could do.

  • Zozo

    I’ve also been feeling very tired lately.