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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  • 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.

  • Zozo

    (I am 13 and female) I got hit in the head twice yesterday and it was on purpose and really HARD. I barely remember what happened and I’ve been very sensitive to noises and rarely light. I have been seeing a lot in blur and I lose balances sometimes. The test with the finger and standing with 2 legs I failed. I don’t know what to do please help! (this took me like 10 minutes to write)

    • James Hubbard, MD, MPH

      Tell your parents your symptoms and let them check you.

  • Never again please..

    I experienced a concussion snowboarding. I saw a doctor about 4 days after the incident thinking nothing of it. He said I was clearly suffering from a concussion. I went and rested as I was told to in a dark room.. I couldn’t resist a few hours on my computer in the day against what I was told, but I mostly slept. I was extremely confused for over 18 days, selling a few items which were brand new thinking I had sold second hand items including my own snowboard boots. A few people got a good deal I guess ;) I had lots of pain in the lower neck and up around the back of the head, from whiplash the doctor said. All the symptoms didn’t seem to get any better until about day 18 when all of them, at the same time just started to vanish.. a few days later it was like nothing ever happened. The doctor advised “sleep.. and when you are not sleeping, meditate.” – It was the best advice I could have been given

  • megan

    yesterday i hit my head during a football tournament at it first i feel a lot of pain when i got up i had a headaches when i got home i sleep i woke the morning it feel like the the earth was spinning only if i lay down

  • Chris

    I got hit in the side of the head today by somones hard not badly as in serious it just hurts i have had concussion before not long ago i dont think i have concussion but i suffer from anxiety abit and i hated every minute of it i don’t know if i have concussion im on my own so all the test were fine except the ones with other people i.e tracing finger and light test i just have had a head ache all day i don’t know if i should be concerneed and have concussion or what?

    This took me like 3 minutes to write if that helps ??

    • James Hubbard, MD, MPH

      Chris if you have a concern, have a parent or teacher check you for signs.

    • chris

      I’m 14

  • Chelsea

    I’m very worried about my health. I’m a 15 year old female. I was at a friends house for a sleepover a few days ago and she has many slanted roofs. I hit my head several times, HARD. Not until the day after I started to feel extremely lightheaded, nauseated, having a lot of pressure and stabbing pain in my head and throbbing, and started vomiting quite often. I haven’t vomitted for 2 days now but I’m still quite nauseated. The light headedness and the pressure/pain/throbbing of my head won’t go away, not even with Tylenol or with rest. I’m quite worried. I guess my question is, should I go to the hospital/ER? Do i have a concussion? I’ve been also having trouble remembering some stuff since then, for example, I loose track of what I’m saying only the middle of a sentence. It’s been also hard to focus/concentrate.

    • James Hubbard, MD, MPH

      if you haven’t told your parents, should. And then, perhaps you could call your regular doctor, go to an urgent care clinic, or to the ER.

  • Ila Mcdougal

    I was in the shower and all I remembr is waking up on the floor of the shower. I have a major headache in one spot. Is this a conccussion? If so should I go to the hospital. By the way I’m 13 years old.

    • James Hubbard, MD, MPH

      Check with your parents. But it sounds like you should be seen either in the ER, by your regular doctor, or an urgent care clinic.

  • Curly Whirly

    A child ran to me today and as I bent down to hug him, he jumped up catching me square under the jaw with the top of his head. The initial collision was painful and felt like my jaw went right up into my head. I immediately felt nauseous, but did not lose consciousness. It is now about 8 hours later and I still feel nauseous and have a mild headache. Should I get this looked out further tonight? In the morning? Stay awake?