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

See what people are saying about The Survival Doctor e-books.

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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  • 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

  • Alexandra

    I have had a concussion before. It was like 5 months ago. Everything was fine for a while and then school started again and i have been having trouble with tests, reading, etc. I don’t know if I should go back to the doctor. He cleared me and I have been taking it easy, but I’m still having heaving symptoms such as:
    -amnesia
    -short term memory loss
    -long term memory loss
    -confusion
    -blurry vision
    -headaches
    -insomnia(which happened after incident)
    -pounding temples when concentrating
    -messed up speech. ex: “I’m going to go tqke a sleep” or “we have a sleeping bag that can keep you warm when it is -0.”
    -trouble concentrating.
    -forgetfulness

    So, my question is should I go to the doctor, ER, or leave it. It is normal. Please reply or i’m going to ignore it. I have a soccer season.

    ~Alexandra

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      You should schedule and see a doctor asap.

      • Alexandra

        Ok. Thank you. So, no soccer?

        • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

          No

          • Alexandra

            Great…but thank you so much. The good thing is that I will be safe.

  • caitlin

    I was in cheerleading today and my flyers calve muscle hit my head I can see talk move and do everything perfectly fine I just have a slight headache nothing major I realized my Headband I had on scratch my head a little not deep no stitches just a small scratch my mom cleaned it out, do I have a concussion?

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Have your mother check you out. But, to diagnose a concussion, you have to have trauma plus symptoms. A slight headache would depend on how slight and if over-the-counter medicines gets rid of it.

      • caitlin

        Ok thank you so much I really appreciate it

        • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

          You’re welcome

  • Alicia

    I was hit in the face by a soccer ball. I did not have any signs of trauma at the time. This happened July 27th. I started showing signs in mid August. I have been to the doctor due to arm injury. I tore my rotator cuff. I was going to physical therapy because they thought it was a pinched nerve. Well in Therapy I started to get dull headaches, dizziness and some vomiting. I forgot to mention being hit when I went to the doc due to arm issues. In September the signs started getting a little more intense. It is all on the side of my arm injury. I was hit on that side. Could it be symptoms of concussion or just the arm trauma?

  • Ben

    Hello. Yesterday I was on a high chair, and I fell off and hit my head on a sofa arm. Of course it hurt, but it didn’t knock me out or anything, and I’ve been able to function normally. I feel a bit drowsy, but it may be because I was up late last night, and am a bit tired. I felt fine a few hours ago once I woke up from a nap. I can balance, talk to people easily, and I’ve been walking around my campus with no problems. It hurts where I hit it when i touch it, and my head feels a bit heavy, but only now that I’ve started thinking about it. Am I overreacting? I’ve hit my head harder before this on the sidewalk on the child and I never had a concussion, so I feel like I’m just overreacting. Am I?

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Ben, you didn’t mention any symptoms other than tenderness around the bruised area. In general, a concussion needs two things. And injury and symptoms. Certainly there are other potential problems after an injury such as a bruised bone (most always) or a fracture, or bleeding inside. (http://www.thesurvivaldoctor.com/2013/08/21/head-trauma-symptoms/ ) but for a concussion you’re going to have symptoms many of which I write in the post, at least feel funny or different. The bottom line though is, if you have concerned get the campus clinic to check you out.

  • 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.

    • http://thesurvivaldoctor.com/ 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?

    • http://thesurvivaldoctor.com/ 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?

    • http://thesurvivaldoctor.com/ 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?

    • http://thesurvivaldoctor.com/ 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?

    • http://thesurvivaldoctor.com/ 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.