Concussion: signs, recovery and when to get medical help

Falls, sports, road crashes and play can all lead to a bump on the head. Most head injuries are not serious, but a concussion needs care and some injuries need emergency help. This review explains the signs of concussion, how recovery works and when to get urgent care, using information from the NHS, MedlinePlus and the US CDC.

1. Introduction

The NHS says most head injuries are not serious, but any symptoms should be checked. A concussion is a temporary brain injury that can last a few weeks ^[1]. The CDC describes it as a type of traumatic brain injury caused by a bump, blow or jolt to the head, or a hit to the body that makes the head and brain move rapidly back and forth ^[4]. The brain can bounce or twist inside the skull, causing chemical changes and sometimes stretching or damaging brain cells ^{[2, 4]}. MedlinePlus notes that concussions are often called mild but can still be serious ^[2].

Common causes include sports injuries, falls with a head impact, car accidents and being violently shaken ^[2].

2. Signs and symptoms

The CDC says symptoms can appear straight away or take hours or days to show. They vary from person to person and can change during recovery. Headache and nausea may come first, while emotional changes and sleep problems can appear a week or two later ^[3]. Symptoms fall into four groups ^[3]:

• Physical: headache, dizziness or balance problems, tiredness, sensitivity to light or noise, nausea or vomiting early on, and vision problems.
• Thinking and memory: trouble concentrating, feeling slowed down or foggy, and memory problems.
• Emotional: irritability, anxiety, sadness or stronger emotions than usual.
• Sleep: sleeping more or less than usual, or trouble falling asleep.

The CDC adds that an injured person may not recognise or admit they have a problem, and family members and doctors may also overlook it ^[3]. In children, the CDC says symptoms can affect how a child thinks, learns, feels, acts and sleeps ^[4].

3. Danger signs: get emergency care

Some signs mean the injury could be serious. The CDC lists these danger signs in adults ^[3]:

• A headache that keeps getting worse and does not go away
• Weakness, numbness, poor coordination, convulsions or seizures
• Repeated vomiting
• Slurred speech or unusual behaviour
• One pupil larger than the other
• Confusion, not recognising people or places, restlessness or agitation
• Loss of consciousness, extreme drowsiness or being unable to wake up

The CDC adds that a child needs emergency care for any of these, or if the child will not stop crying, cannot be consoled or will not nurse or eat ^[3]. The NHS also lists a fall of more than 1 metre or 5 stairs, clear fluid from the ears or nose, and a bruise, swelling or large cut on a baby under 1 year old ^[1]. The NHS also advises emergency help for vision or hearing problems, trouble walking, balancing, speaking or understanding, new numbness or weakness, bleeding from the ears, or a head injury at high speed such as a road crash ^[1]. In rare cases a dangerous blood clot can press on the brain ^[3].

4. Diagnosis and tests

MedlinePlus explains that a health care provider takes a history and carries out a physical and neurological examination covering vision, balance, coordination and reflexes. Memory and thinking may be checked. A CT scan or MRI is used in some cases to look for bleeding, swelling or a skull fracture ^[2]. The CDC says a child with a concussion should be seen by a health care provider, which can help speed recovery ^[4].

5. Treatment and recovery

Rest is central to healing, according to MedlinePlus. Early on, people may need to limit physical activity and mentally demanding tasks such as studying, computer work or video games, because these can bring symptoms back ^[2]. The NHS gives these self-care steps ^[1]:

• Rest, and do not stay awake just because you are tired.
• Use a wrapped ice pack on the bruised area for short periods in the first few days.
• An adult should stay with the injured person for at least the first 24 hours.
• Avoid alcohol and drugs until you feel better.
• Do not drive until fully recovered, and avoid contact sport for at least 3 weeks.

The NHS also advises not returning to work or school until you feel better, and keeping children from rough play for a few days ^[1].

Most people feel better within a couple of weeks ^[3]. The CDC says most children feel better within 2 to 4 weeks, though some have symptoms for months or longer. A history of earlier concussions or more severe early symptoms makes a longer recovery more likely ^[4]. MedlinePlus says activities should resume gradually and only once a health care provider says it is safe ^[2].

6. Prevention

Avoiding repeat head impacts matters, because multiple concussions raise the risk of more serious, longer-lasting symptoms, including problems with concentration, memory, headaches and balance ^[4]. The CDC recommends learning the signs of concussion ^[4].

7. When to see a doctor

See a doctor if symptoms last more than 2 weeks, or if you are unsure when it is safe to drive or return to work, school or sport ^[1]. The NHS advises urgent medical advice after a recent head injury if there is vomiting, dizziness, a blood-thinning condition or medicine, or alcohol or drugs at the time of injury, and advice from a health professional for any child under 5 ^[1].

In an emergency, call your local emergency number (112 in India, 911 in the United States).

8. Conclusion

A concussion is a temporary brain injury that most people recover from with rest and a gradual return to activity. Knowing the danger signs, asking a doctor when symptoms last, and avoiding repeat head injuries protect the brain during recovery. The doctor decides when it is safe to return to sport.