Concussion Symptoms and Emergency Warning Signs
Concussion symptoms can affect thinking, balance, mood, sleep and vision and may appear later; worsening headache, repeated vomiting, seizure, unequal pupils, weakness, slurred speech, confusion or inability to wake require emergency care.
Timeline
- Immediately: Stop sport or hazardous activity, check for emergency danger signs, avoid another impact and arrange an appropriate medical assessment.
- Next hours and days: Have a responsible person monitor for new or worsening symptoms and follow individualized instructions for sleep, medicines, school, work and light activity.
- Return gradually: Increase cognitive and physical activity under clinical guidance; athletes require clearance and a stepwise return before unrestricted play.
A concussion is a mild traumatic brain injury caused by a bump, blow or jolt to the head, or a hit to the body that rapidly moves the head and brain. Loss of consciousness is not required. Symptoms can begin immediately or emerge over hours or days, and they may change during recovery. Anyone with a suspected concussion should stop the activity that caused the risk and be assessed by an appropriate health professional. [1][2][3]
Possible symptoms include headache, dizziness, balance difficulty, nausea, vision problems, sensitivity to light or noise and unusual fatigue. Thinking may feel slowed or foggy, with difficulty concentrating or remembering. Sleep can increase, decrease or become difficult, and mood may shift toward irritability, sadness, anxiety or unusual emotion. In young children, clues may include changed play, feeding, speech, comfort-seeking, coordination or behavior. [1]
Call emergency services or go to an emergency department after a head injury for a worsening headache, repeated vomiting, seizure, one pupil larger than the other, double vision, weakness or numbness, decreasing coordination, slurred speech, unusual agitation or confusion, inability to recognize people or places, increasing drowsiness or inability to wake. These signs can reflect a more dangerous brain injury that cannot be distinguished safely at home. [1][4]
Do not move someone unnecessarily if a serious neck or spinal injury is possible, and do not allow the person to drive. A responsible adult should follow the discharge or clinician instructions and watch for change. It is generally unnecessary to keep an otherwise assessed person awake solely because they may have a concussion, but abnormal difficulty waking is an emergency sign. Ask the treating clinician about medicines and sleep in the specific case. [1][4][5]
For sport, remove the athlete immediately and keep them out for the rest of that day. CDC says return is a medical decision and should proceed through a supervised stepwise process only after clearance. Symptoms that return with exertion mean the person is pushing too hard and should stop and contact the provider. Helmets reduce some head injuries but no helmet makes it safe to play through suspected concussion. [2][3]
Recovery is individualized. Briefly reducing demanding physical and cognitive activity may be necessary, followed by a gradual return guided by symptoms and clinical advice. Many children can return to school with temporary adjustments before all symptoms disappear, while contact sport waits longer. Driving, heights, machinery and other activities requiring fast reaction deserve caution when attention, processing speed, balance or vision remains affected. [3][5][6]
Keep a record of symptoms, sleep, medicines and activity tolerance and share it at follow-up. Seek reassessment if symptoms worsen at any time, fail to improve as expected or interfere substantially with school, work or daily life. A history of previous concussions, migraine, mood conditions or learning differences may affect recovery planning. Another impact before recovery can be serious, so feeling somewhat better is not the same as being cleared. [3][5]
Sources
- Centers for Disease Control and Prevention — Signs and Symptoms of Concussion
- Centers for Disease Control and Prevention — Responding to a Sports-Related Concussion
- Centers for Disease Control and Prevention — HEADS UP Guidelines and Recommendations
- MedlinePlus — Concussion Tests and Emergency Symptoms
- Centers for Disease Control and Prevention — Managing Return to Activities
- Centers for Disease Control and Prevention — Returning to School After a Concussion