Concussion (Mild Traumatic Brain Injury)

Condition Basics

What is a concussion?

A concussion is a type of traumatic brain injury (TBI). It is caused by a blow to the head or body, a fall, or another injury that jars or shakes the brain inside the skull. Although there may be cuts or bruises on the head or face, there may be no other visible signs of a brain injury.

You don't have to pass out (lose consciousness) to have a concussion. Some people will have obvious symptoms of a concussion, such as passing out or forgetting what happened right before the injury. But other people won't. With rest, most people fully recover from a concussion. Some people recover within a few hours. But you will likely feel better within a couple of weeks. It may take up to a month to recover. This depends on how severe the concussion is.

It's important to know that after a concussion the brain is more sensitive to damage. So while you are recovering, be sure to avoid activities that might injure you again.

In rare cases, concussions cause more serious problems. Repeated concussions or a severe concussion may lead to long-lasting problems with movement, learning, or speaking. Because of the small chance of serious problems, it is important to contact a doctor if you or someone you know has symptoms of a concussion.

What causes it?

Your brain is a soft organ that is surrounded by spinal fluid and protected by your hard skull. Normally, the fluid around your brain acts like a cushion that keeps your brain from banging into your skull. But if your head or your body is hit hard, your brain can crash into your skull and be injured.

There are many ways to get a concussion. Some common ways include fights, falls, playground injuries, car crashes, and bike accidents. Concussions can also happen while participating in any sport or activity, such as football, boxing, hockey, soccer, skiing, or snowboarding.

What are the symptoms?

Symptoms of a concussion can happen soon after the head injury. Or they may develop later. They include things like thinking and memory problems, nausea, headaches, emotional changes, and sleep problems. Some people will lose consciousness after the head injury, but not everyone will. And symptoms can last for hours to months.

How is it diagnosed?

If you've had a concussion, you need to see a doctor. They will ask questions and do tests to check your thinking, memory, strength, balance, and reflexes. An imaging test, such as a CT scan or an MRI, may be done to check for a brain injury.

How is a concussion treated?

After seeing a doctor, most people can go home. Others need to be watched in the hospital. Rest can help you recover. Get plenty of sleep, avoid alcohol and drugs, and don't do activities that are physically or mentally demanding. Don't return to sports or activities until the doctor says it's okay.

Prevention

To reduce your chances of getting a head injury:

• Wear a seat belt every time you drive or ride in a motor vehicle.
• Never drive when you are under the influence of drugs or alcohol.
• Make your home safer to prevent falls. Here are some ideas:
  • Keep walking paths free of rugs and clutter.
  • Install sturdy handrails in stairways.
  • Train pets not to jump up or get underfoot, and keep them in one place at night.
  • Keep your house and stairways well lit and free of clutter.
  • Put grab bars in your shower or tub and near the toilet.

Wear a helmet for any activity that can cause a fall or impact to the head or neck. Examples include bike riding, football, baseball, ATV riding, skateboarding, skiing, snowboarding, inline skating, and horseback riding. Helmets help protect your skull from injury. But a brain injury can occur even when a helmet is worn.

To reduce your child's chances of getting a concussion:

• Use child car seats and booster seats correctly.
• Teach your child bicycle safety.
• Teach your child how to be safe around streets and cars.
• Keep your child safe from falls.
• Teach your child playground safety.
• Help your child prevent injury from sports and other activities.

Symptoms

It is not always easy to know if someone has a concussion. You don't have to pass out (lose consciousness) to have a concussion.

Symptoms of a concussion range from mild to severe and can last for hours, days, weeks, or even months. If you have multiple or repeated concussions, you may have more severe symptoms that can last longer. And it may take longer to recover. If you notice any symptoms of a concussion, contact your doctor.

Symptoms of a concussion fit into four main categories:

• Thinking and remembering
  • Not thinking clearly
  • Feeling slowed down
  • Not being able to concentrate
  • Not being able to remember new information
• Physical
  • Nausea and vomiting
  • Headache
  • Fuzzy or blurry vision
  • Dizziness
  • Sensitivity to light or noise
  • Balance problems
  • Feeling tired or having no energy
• Emotional and mood
  • Easily upset or angered
  • Sad
  • Nervous or anxious
  • More emotional
• Sleep
  • Sleeping more than usual
  • Sleeping less than usual
  • Having a hard time falling asleep

Symptoms in young children

Young children can have the same symptoms of a concussion as older children and adults. But sometimes it can be hard to tell if a small child has a concussion. Young children may also have symptoms like:

• Crying more than usual.
• A headache that does not go away.
• Changes in the way they play or act.
• Changes in the way they nurse, eat, or sleep.
• Being upset easily or having more temper tantrums.
• A sad mood.
• Lack of interest in their usual activities or favorite toys.
• Loss of new skills, such as toilet training.
• Loss of balance and trouble walking.
• Not being able to pay attention.

Symptoms in older adults

Concussions in older adults can also be dangerous. This is because concussions in older adults are often missed. If you are caring for an older adult who has had a fall, check for symptoms of a concussion. Signs of a serious problem include a headache that gets worse, increasing confusion, or both. See a doctor right away if you notice these signs. If you are caring for an older adult who takes a blood thinner and who has had a fall, take them to a doctor right away, even if you don't see any symptoms of a concussion.

When To Call

Call 911 anytime you think you may need emergency care. For example, call if:

• You have a seizure.
• You passed out (lost consciousness).
• You are confused or can't stay awake.
• You have a headache that gets worse and does not go away.
• You have new vision changes or one pupil (the black part in the middle of the eye) that is larger than the other.
• You have slurred speech, balance problems, or decreased coordination.

Call your doctor now or seek immediate medical care if:

• You have new or worse vomiting.
• You feel less alert.
• You have new weakness or numbness in any part of your body.
• You have new symptoms, such as unclear thinking or changes in mood.

Watch closely for changes in your health, and be sure to contact your doctor if:

• You do not get better as expected.

Exams and Tests

Any person who may have a concussion needs to see a doctor. If a doctor thinks you have a concussion, they'll ask questions about the injury. Your doctor may ask you questions that test your ability to pay attention and your learning and memory. They may check how quickly you can solve problems. They may also show you objects and then hide them and ask you to recall what they are. The doctor will check your strength, balance, coordination, reflexes, and sensation.

Neuropsychological testing has become more common after a concussion. It is one of many ways your doctor can test how well you are thinking and remembering after a concussion. These tests can also show if you have any changes in emotions or mood after a concussion.

Sometimes a doctor will order imaging tests, such as a CT scan or an MRI, to make sure that your brain isn't bruised or bleeding.

Treatment Overview

If you think you have a concussion, it's important to see a doctor right away. Most people can be treated for a concussion at home. But your doctor may suggest having someone with you at home for the next day or two. If the symptoms are more severe, you may have to stay in the hospital to be watched.

In the days or weeks after

Rest can help you recover from a concussion. You need to rest your body and your brain. Here are some tips to help you get better:

• Get plenty of sleep at night, and take it easy during the day.
• Avoid alcohol and drugs.
• Avoid activities that are physically or mentally demanding (including housework, exercise, schoolwork, video games, text messaging, or using the computer). You may need to change your school or work schedule while you recover.
• Be careful to prevent another brain injury. Avoid risky activities that could lead to falls.
• Ask your doctor when it's okay for you to drive a car, ride a bike, or operate machinery.
• Use ice or a cold pack on any swelling for 10 to 20 minutes at a time. Put a thin cloth between the ice and your skin.
• Ask your doctor if you can take an over-the-counter pain medicine, such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve). Be safe with medicines. Read and follow all instructions on the label.

Concussion and sports

A person who might have a concussion needs to immediately stop any kind of activity or sport. Being active again too soon increases the person's risk of having a more serious brain injury. Be sure to see a doctor before returning to play.

Self-Care

Pain control

• Put ice or a cold pack on the part of your head that hurts for 10 to 20 minutes at a time. Put a thin cloth between the ice and your skin.
• Ask your doctor if you can take an over-the-counter pain medicine, such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve). Be safe with medicines. Read and follow all instructions on the label.

Recovery

• Follow your doctor's instructions. The doctor will tell you if you need someone to watch you closely for the next 24 hours or longer.
• Rest can help you recover from a concussion. You need to rest your body and your brain:
  • Get plenty of sleep at night. And take rest breaks during the day.
  • Avoid activities that take a lot of physical or mental work. This includes housework, exercise, schoolwork, video games, text messaging, and using the computer.
  • You may need to change your school or work schedule while you recover.
  • Return to your normal activities slowly. Do not try to do too much at once.
• Avoid drinking alcohol or using drugs.
• Avoid activities that could lead to another concussion. Follow your doctor's instructions for a gradual return to activity and sports.
• Ask your doctor when it's okay for you to drive a car, ride a bike, or operate machinery.