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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  • Chelsea

    I’m very worried about my health. I’m a 15 year old female. I was at a friends house for a sleepover a few days ago and she has many slanted roofs. I hit my head several times, HARD. Not until the day after I started to feel extremely lightheaded, nauseated, having a lot of pressure and stabbing pain in my head and throbbing, and started vomiting quite often. I haven’t vomitted for 2 days now but I’m still quite nauseated. The light headedness and the pressure/pain/throbbing of my head won’t go away, not even with Tylenol or with rest. I’m quite worried. I guess my question is, should I go to the hospital/ER? Do i have a concussion? I’ve been also having trouble remembering some stuff since then, for example, I loose track of what I’m saying only the middle of a sentence. It’s been also hard to focus/concentrate.

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

      if you haven’t told your parents, should. And then, perhaps you could call your regular doctor, go to an urgent care clinic, or to the ER.

  • Ila Mcdougal

    I was in the shower and all I remembr is waking up on the floor of the shower. I have a major headache in one spot. Is this a conccussion? If so should I go to the hospital. By the way I’m 13 years old.

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

      Check with your parents. But it sounds like you should be seen either in the ER, by your regular doctor, or an urgent care clinic.

  • Curly Whirly

    A child ran to me today and as I bent down to hug him, he jumped up catching me square under the jaw with the top of his head. The initial collision was painful and felt like my jaw went right up into my head. I immediately felt nauseous, but did not lose consciousness. It is now about 8 hours later and I still feel nauseous and have a mild headache. Should I get this looked out further tonight? In the morning? Stay awake?

  • Cassandra Romero

    I’m not sure what to do. I was wrestling around with my sister and it ended in a very hard head butt to my forehead just above my eyebrow. I’m not sure if I actually lost consciousness or if it was just being dizzy but it’s two days after and I have a large bump there, a headache, and am dizzy. I have two kids and a husband poo out of town so I really don’t want to freak my husband out but I’m in pain.

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

      Ice packs and ibuprofen might help the pain and swelling. You might also go to an urgent care clinic.

  • Katelynn

    Yesterday i was bench pressing a 120 pound barbell and it fell on my nose. Blood was coming out of my nise a lot. Now i have headache. And i never get headaches. And my stomach sometimes doesn’t feel right. I get sensitive to the light sometimes. Do i have a concussion?

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

      Katelynn, all I can do is give you the information in the post. You should have someone check you out if you’re concerned about any part of the injury.

  • Mubin Ahmed

    Yesterday I got hit by a powerful backhand in table tennis, the side of the bat had hit my head and my head started to bleed. At that moment I felt dizzy and drowsy, couldn’t speak as fluently as I normally could; at that moment I started to worry about if I had had a concussion. I put ice on my head to prevent the swelling – it was a slow process. Today I missed school and am starting to wonder if I had a concussion? I still feel pain now when I apply pressure to my forehead. Unfortunately I couldn’t do any of these tests as I had only looked at this post today. This post will be helpful for future concussions (I hope I don’t get any,) but could you give me some feedback on whether I have or haven’t gotten a concussion?

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

      The test are ongoing to see if you’re having symptoms after the injury. And it’s always best to tell someone to check you out and keep an eye on you also.

  • tiffany

    I got hit in the head twice three days ago and im dizzy i have had a horrible headache that just keeps getting worse and sound and light bother me do i have a concussion

  • Auri Woerner

    i got hit on the head (middle of head) with a punted soccer ball. Since then ive been sick and ive had a head ache. I can stand loud noise or light. its hard to walk without falling. Do i have a concussion

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

      You should have someone (parent, teacher, nurse, coach) check you.

  • Charlotte

    I was rear-ended 2 days ago and hit my head on the back of the seat but I don’t remember if it was hard or not, I don’t think so. The next morning I had a bad headache and found it hard to focus and told my mom, but i also was getting a cold and didn’t know if it was just from that. Today at school i really didn’t feel well and lost my balance in one of my glasses and almost fell over, again I don’t know if that was just the cold, but my school nurse said she thought I could have a concussion. I took 2 advil later in the school day and my headache got a lot better. I have been really moody and started crying a couple of times over things I would normally never cry over such as studying for a test or thinking about my work load. My mom doesn’t seem to be all that concerned and I don’t know what to do. Am I just sick or could I have a concussion? Should I go to the doctor?

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

      There are some things you can do on your own. Rest mentally and physically as much as you can. If you do go to school tomorrow and your having symptoms, ask the nurse to check you again. If nothing else, the nurse might talk to your teachers about your workload. Without checking you, that’s all I could recommend. It could very well be a concussion or, possibly, the stress from the accident. And do make sure your mother understands your concerns and your symptoms.

  • msm

    I had a lot of alcohol and fell. On my way back up I hit my head on the Rail. I never lost consciousness. I felt hungover the following day and have mild headache and dizziness now… Day two after my stupid night.