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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  • Lauriane

    A couple weeks ago i was fighting (i do Tkd) and my partner drop kicked me hard in the face, i was ok i got up and continued fighting. Next day my head aches started (and they are still not gone). A couple days later i faught again but i began to get nausious and dizzy to a point i had to sit down and relax (put my head between my legs). Every time i do some sort of physical activity; I have a headache ( but its always there dosent go away) My vision gets wierd, i get off balance and dizzy, the nausea has gone away but at one point it was so bad that i would get nausious on the bus… and i also get sensitive to sound and light. Ive been tiered more than usual too. Should i go see a doctor ? Or should i just take it easy and progressively get back to training like im doing now?

    • James Hubbard, MD, MPH

      Sounds like you should see a doctor. Meantime, consider the recommendations in the last part of the post. If your symptoms are from a concussion and you continue physical and mental activity, the symptoms could linger for a long time.

  • bluna

    Hi Doctor Hubbard,

    My infant daughter and I recently fell out of the bed (I feel asleep while breastfeeding). I feel ill just thinking about it and it makes me cry that this even happened….She hit her head on the carpet (about 2.5 feet) from bed. We took her to emergency and the doctor checked her out saying she is fine, but that maybe she suffered a concussion (she was only 6 weeks old).. She had no apparent symptoms (limited with infant).
    However, I have been terribly worried since then that I have caused her damage. I am constantly looking at her eyes, as since the fall I noticed she sometimes has one ;pupil that dilates slightly larger or than the other. Is this a long term effect?

    I have been to the doctor several times (and to 3 different ones) who tell me they see no difference in her pupils. Is there anyway to know/tell if this pupil difference was present before the fall or if this will last or if it will affect her development?

    Worried mom

    • James Hubbard, MD, MPH

      Bluna, if you’ve been to the doctors and they keep telling you she’s fine and if she’s looking good, acting normal, feeding, etc., you’ve done all you can do. In general many babies hit their head and most get over it without any future problems. If the doctors thought the pupil exam showed any hint of being abnormal, they’d immediately have done other tests.

      • bluna

        Thank you for the reply. I am a first time mom and seem to worry about everything – especially as this happened when she was so so little..
        I also, find that doctors, as you know, are very busy and their quick eye exam does not allow them to see what I see, especially since the pupils seem to vary in size when dilated and dim. Again, thank you for your response, I will try not to over think this anymore.

        • James Hubbard, MD, MPH

          Next time she sees her regular pediatrician, express your concern of the quick exams and that you would like them to take a very good look.

  • Coco

    I hit my head while helping my aunt fix some thingsin the basement! It didnt hurt right after but now im getting headaches!

    • James Hubbard, MD, MPH

      Tell her and have her check you out.

  • Bob

    I accidentally punched my brother in the head by total accident. I did not hit him very hard. I checked his pupils and they dilated perfectly fine. Does this mean that my brother has a concussion or no?

    • James Hubbard, MD, MPH

      You can have a concussion whether or not the pupils are normal.

  • Lindsey

    I hit my head today very hard on top while getting into a golf cart. It caused my teeth to clash together hard. I didn’t get dizzy or blackout, and it actually didn’t really hurt after the shock wore off. I got a little nauseated, but that’s common with me and a phenergan relieved it. But now, it’s 10 hours later and my neck and back of my head feel kind of weird and stiff, like the aftermath of popping your neck when you jerk your head in the wrong way, and I have a headache and throbbing in the top of my head where I hit. I know I can be a bit of an over-reactor, but I don’t know if I could have a concussion. What do you think? I’m a bit nauseated again, but that might be anxiety over not knowing!

    • James Hubbard, MD, MPH

      Anytime you hit your head there’s a chance you can injure your neck also. It can be anything from a mild to severe muscle strain. In rare cases, you can actual fracture it. That’s why, with any head injury, we always check the neck out also.

  • Brian

    Playing soccer, someone kicked the ball into my face. This was yesterday. I still have a headache but no other symptoms, furthermore the pain lessens when I drink water.

    • James Hubbard, MD, MPH

      Thanks for sharing. Hope the post gives you some info you can use and, of course i you have concerns, have a coach or parent check you out.

  • Dalton Rust

    I hit my helad really hard While surfing… I never passed out but I had bad pain and a large bump.. I can’t really say I have exact memory of the whole event either… I feel like I am forgetting some things, and I am tired.. Should I not go scuba diving within the next week? And or surfing?

    • James Hubbard, MD, MPH

      See the section on what to do. And if you have concerns, see a doctor for specific instructions. To me, I’d be extra cautious about scuba diving.

  • HaroldCole

    I have hit my head so many times its ridiculous! A few times I have had a bit of tunnel vision. Is this normal? When I was a kid i hit my head so hard I blacked out. I barely remember the Dr. asking many questions. I couldn’t remember who my parents were, or what year it was, but I could remember the name of the president. Strange feeling.

    • James Hubbard, MD, MPH

      The more concussions you have, the more likely you are to have long-term brain damage as you get older. So be careful.

  • Lauren

    Sorry, my head can’t focus right now. I just tripped on the sidewalk and hit my head. Now I am sweating a lot, and I can’t walk in a straight line, also I had a massive headache. I don’t know if it’s a concussion or not, should I tell a docter

    • James Hubbard, MD, MPH


  • Lauren

    I have a h