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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Photo by Niklas Pivic on Flickr.

  • 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.

  • Bella

    Yesterday I was walking onto my school bus and slipped over something and fell really hard onto the indented floor, I landed on the side of my head close to where my temple is. I saw this flash of white for a split second then got back up. that day at lunch My dad pick me up and brought me home. I’ve been experiencing really bad headaches, pressure on the side of my head and front and dizziness, not sure if I have got a manor concussion or If I should see my doctor soon. My parents aren’t sure either. Please help!

    • James Hubbard, MD, MPH

      Talk to them about getting checked out by a doctor.

  • Riley Whittenberger

    My daughter is a keeper in soccer, in the Fall she got kicked in the chops making a save which gave her a concussion and was out of action from soccer for over a month and out of school by doctors orders for at least a couple of weeks. She had all of the symptoms, headaches, dizziness, couldn’t focus on school work, photophobia, etc. Now just recently during practice she got a knee to the head and to this day it’s just a constant headache, the school nurse checked her out for other possible symptoms of a concussion but nothing, no dizziness, no sensitivity to light, can focus on school work, good balance, pupils were good and so on..Question is can just a constant headache be enough to be called a concussion? We have a doctors appointment and we invested in concussion “prevention” headgear for the future.,

    • James Hubbard, MD, MPH

      Yes, a constant headache can be enough for a concussion. I assume you’ve tried some Tylenol (acetaminophen).

      • Riley Whittenberger

        Wow, I’m surprised that it is, I would have thought that there would have to be more symptoms involved for it to be..Yes Sir, we tried that in the beginning and she said that it didn’t help. If it is, it was to be a very mild case, on a scale of 1-10 she says her headaches are about a 3 or 4..We are going to continue and see her pediatric physician and get her checked as a precaution.. The headgear is forever with soccer now! Unfortunately that’s the crappy part of of being a keeper, sometimes they need to make saves near the feet of a striker…

  • Hayley

    Help!! My friend needs help. In gym this boy threw a soccer ball at the front and back of her head FIVE TIMES. She can’t stand straight, she has nausea, she’s shaking, trouble sleeping, and trouble focusing. I showed her screenshots of the signs/what to do. She has all of 1, most of 2, all of 3 and 4. What should she do?? Is she gonna die

    • James Hubbard, MD, MPH

      She should tell her parents and get checked out.

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  • nubz

    i got hit with a metal lock at school today; it was thrown at me coming at a very fast speed. i have bump on my head and the right side of my brain kills.

  • James Greenwood

    I smacked my head on the corner of my bookshelf about 3 hours ago and I became nauseous but it has subsided some. Should I be worried about a concussion?

  • Mary

    Yesterday, I was putting some boxes away in our storage area. I bent over rather quickly and hit my head on my husbands tool box latch that was on a shelf. I felt a little dazed, and there was a small gash on my head. Since then, I have had a terrible headache, feel extremely “foggy”, dizzy and am very sensitive to light and noise. Is it possible that I have a slight concussion? I didn’t think I hit it that hard.

    • James Hubbard, MD, MPH

      Sounds like you have the symptoms.

  • 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.