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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  • drummajordyl

    While stunting on my cheer team, another girl and I hit heads pretty hard. Our athletic trainer had me take this test that each of us took at the beginning of the season. It showed that my reaction time and memory were way worse than before.I am really sensitive to light and sound. I’ve also had a bad headache for the last 48 hours. Thanks to cheer leading I have a concussion, keeping me away from both marching band and cheer.

    • James Hubbard, MD, MPH

      Hope you’re well so. Take care

  • Sam

    I play hockey I didn’t really get hit but I got clipped (tripped) and I didn’t hit my head but I spun around and I was like a ragdoll…the only thing is that I am not dizzy or throwing up and I can’t tell about the head ache…I had an head ache before I got tripped…but it got worse after the trip… Do I have a concussion?

    • James Hubbard, MD, MPH

      If you’re still having symptoms you should be checked out by a coach, trainer, etc.

  • Chris

    I got hit in my head hard at football last night and I don’t have any neck or head pain and I only have 1 symptom which is drowsyness. Do i have a concussion?

    • James Hubbard, MD, MPH

      You should have a parent, coach, nurse etc. check you out before you go back to contact.

  • Mia King

    Hey so in gym today we were playing floor hockey. Me and a guy collided hard. He is taller than me and all muscle. I was thrown back and i hit my head on the gym floor. My elbow also hit the ground hard. His hockey stick hit my neck. I was taken out and told to sit down with ice. My head still hurts a little and my elbow i think has a pinched nerve. When i was hit i got blurry eyes for a second and i was dizzy for a second. It been about 3-4 hours since it happened. Do i need to go get checked out?

    • James Hubbard, MD, MPH

      Yes, by a teacher, coach, nurse, parent.

  • Andrew

    Got hit in head with a 90mph fastball. It hit the side of my helmet and i was able to get up a min later. Ive had minor dizziness and headaches along with a ringing in my ear where i got hit. Im not nauseous nor have i vomitted. I got hit about 9 hours ago. Minor concussion?

    • James Hubbard, MD, MPH

      You have to make that call. I can only give you the general information. Although, If would tell someone like a coach and parent and have them check you.

  • kampff

    today my daughter was playing a soccer match and she got a kick to her forehead while saving the ball. she felt dizzy at first and then drowsy and wanted to go asleep. she still has a bad headache 7 hours later . do i need to get her checked or would i be best waiting and watching her. we did use ice packs earlier

    • James Hubbard, MD, MPH

      In my post you’ll see that a headache that’s getting worse is a sign to be seen right away. If it’s not and relieved by over-the-counter medicines that’s a more encouraging sign. At some point she needs checked, at least by a nurse, trainer, or some other healthcare provider.

  • Tom

    Hello Doctor,

    A little over a month ago I had a fall which was pretty bad and resulted in me fracturing my two upper front teeth. The cartilage of my nose was also bent out of shape (minor break?). I was evaluated by a nurse at the emergency department who simply advised me to consult with my dentist, I think we both failed to realise how bad the injuries were at that time. I sought dental care and am currently being treated, my dentist actually referred me back to the hospitals maxillo-facial unit as she was worried that I may have fractured my hard palate (there was significant swelling/soft tissue trauma). I was seen by two specialists there who were able to rule out a serious fracture after a pretty thorough examination; they diagnosed alveolar fracture and said I would heal up in time.

    I am wondering if one could experience symptoms of concussion as a result of an injury such as this? I ask as I am currently experiencing some brain fog/problems with cognition, dizzy/light-headed moments, nausea and some very fleeting moments of mild disorientation. I have been shaken up pretty badly by what has happened to me over the last few weeks, so I’m not ruling out anxiety….I’ve also worked myself up over reading about chronic subdural hematoma…not good. I think its maybe of not to mention that I’m not really experiencing headaches. I had no bruises or cuts on my forehead/head..My face absorbed the impact (mouth/nose).

    I am considering asking to be referred for a CT/MRI; just to categorically rule out anything sinister.

    • James Hubbard, MD, MPH

      Any head trauma could result in a concussion. Sounds like you need a thorough evaluation by, maybe your family doctor, or a neurologist?

  • 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.