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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  • Samantha

    Hi. I was in orchestra rehearsal, and I was getting my cello from the closet. My cello was right next to (practically leaning on) the double bass. All of the sudden, my hand slipped and the double bass started to fall over and it ended up hitting me in the head. I was a bit dazed for a little while but went back to rehearsal. I was asked if I was okay, and I said i was fine. When I got home, I went straight to bed and did not have any energy to get up or do anything. My eyes were having trouble focusing and I was extremely dizzy. It’s been 2 days. What do i do?

    • James Hubbard, MD, MPH

      Have a parent or another responsible adult check you, know what’s going on,, and see if you need to be evaluated further.

      • Samantha

        I know this is sort of TMI, but i threw up a little while ago. I asked my parents and they took me to the ER. I have a really bad concussion. Thank you for the advice

        • James Hubbard, MD, MPH

          You’re welcome. Take care.

  • Valerija

    I know that this is sort of an old thread, but I’m kind of worried about the long-term effects of an untreated mild concussion. I’m positive that I had one about two years ago (I was going down incredibly quickly for one sit up.. and long story short I was sitting too close to the wall. I had the majority of symptoms described) but I never treated it or anything. Anyway, do you know if you can end up with any sort of chronic condition or side effect from this? I get really bad headaches (I can still function, but it gets annoying) about once every month or two, and I’ve recently started to have what seems to be some form of chronic anxiety (panic attacks about every six months, and really bad anxiety over some things, but not every time I encounter such a thing), and do you think any of these could be due to the concussion? When I get these headaches, they last at least 8-12 hours, from breakfast to when I’m in bed at night.

    • James Hubbard, MD, MPH

      You should get an appointment with a neurologist.

  • William Tsuei

    so, I was playing dodgeball an hour ago, but 2-3 hours ago, I jumped on the wall to dodge a ball, but unfortunately couldn’t generate enough force from a single jump to be able to jump back on to the ground and hit my head. I was a bit out of it for a few seconds but I felt fine quickly. I seem a bit tired but I could also equate that to staying up late last night from studying… I have a bit of back and neck pain from the fall though… but no headache.. is it possible I have a concussion?

  • Kt

    What should you do if you can’t get to a Dr.
    Hit in the head been 24 hr dizzy headache Nauseous sensitive to light and sound.

    • James Hubbard, MD, MPH

      Don’t know why you couldn’t get to a doctor at some point if there’s not some some disaster where it’s impossible.. However, if not, someone with you should check you out. As far as resting, etc., that’s in the post. And then there’s this

  • Pingback: What Can Cause An Altered Mental Status

  • Kua Chin Ho

    My friend accidentally tripped me during soccer and I smashed my head really hard on the ground. I had a horrible headache but it now lightenee up. Its been about 2 hours and im a little disoriented. Do I have a concussion?

  • Laureb

    me and my brother were having fun and he trough me on the couch and kept on slapping me and now i feel really really dizzy do I have a cincusion

    • James Hubbard, MD, MPH

      I can’t diagnose people without an exam. If you have concerns, you should have someone check up.

  • nicolas

    Is it possible to get a mild concussion and have none of the symptoms you described above?

    • James Hubbard, MD, MPH

      Maybe so, but you’d have symptoms of some sort. If there’s no brain dysfunction at all, I’m not sure why you’d think concussion since that’s pretty well the definition. Now, rarely, you could have something like some bleeding in the brain that might not initially cause much in symptoms but can become life-threatening. But, if that’s not a concussion. That’s another injury altogether.

      • nicolas

        The reason I was asking was last night I walked into a partially opened door (and hit the thin face that’s usually against the frame when the door is closed). I had heard about getting concussions from similar incidents before and found this site. The only pain I’ve had is pain on my face where it came in contact with the door (right above my eyebrow and on my nose). There are no cuts or bruises, though I expected a bruise. Someone watched me while I did the balance and motor tests you described in “Part 1″ of “Do you have a concussion?” To me, it sounds like I do not have a concussion, but I am not a doctor. What do you think? Also, I’m sorry if this sounds overly thorough. I have a very dear friend who has had problems with this and advised me to be very careful about what I “blow off.” Thank you.

        • James Hubbard, MD, MPH

          Nicholas, I can’t give you specific advice without an exam. However, again, a concussion depends on symptoms. Just because someone gets a lick on the head or a bruise doesn’t equal concussion, bruise or no bruise.

  • Bob

    I was riding a horse and it spooked and I fell off. I hit my head on the ground, nose first. It hurt for a few minutes. I rolled and got right back up, so I don’t think I lost consciousness at all. After getting right back up and walking after the horse, I felt a little dizzy for a second, like you sometimes do after falling and getting right back up. But I seemed fine, so I got back on and kept riding for about another half hour. Afterward, I tripped over something once, and had a bit of a headache, and was overall a bit shaken up. I was tired, but that is probably from lack of sleep. I felt a bit badly, but I don’t think my pupils are dilated. They are usually a bit bigger than other people’s but they look normal. Do I have a concussion, if even just a minor one? And if so, what should I do?

    • James Hubbard, MD, MPH

      Have someone check you out and see how they think you are. By the way, dilated pupils are not a sign of a concussion.

  • J

    I got hit in football on the side of my head… It hurt really bad for like admire after then went away for the rest of the game… However about 2 bourse after the game I started getting this pretty bad headache and felt a little out of it. Now it’s about a day and a half later and I still have a headache however earlier today I was able to play catch and surf. Do I have a concussion?

    • J

      *a minute

      • James Hubbard, MD, MPH

        You should have someone check you out.