A concussion is a mild traumatic brain injury that results from a bump, violent jolt or blow to your head that disrupts normal brain function. A concussion can also be caused by a hit to your body that is strong enough to cause your head to forcefully jerk backwards, forwards or to the side.
Concussions stretch and bruise nerves and blood vessels and cause chemical changes in your brain that result in a temporary loss of normal brain function. A single concussion usually doesn’t cause permanent damage to your brain. Multiple concussions over a lifetime may result in structural changes in your brain.
Concussions are not usually life-threatening. However, the effects from a concussion can be serious and last for days, weeks or even longer.
No, you don’t have to lose consciousness to have a concussion. In fact, most people who have a concussion never lose consciousness.
Yes, sure. Although the jaw or chin can absorb some of the blow, if you are hit in the right place, it can definitely cause a concussion.
Really there is no difference. Both are considered injuries to the brain. These are virtually the same terms.
People at greater risk for concussion include:
Adolescents are at higher risk of concussion than any other age group. Researchers think this is because their brains are still developing. The brain is still laying down its neural pathways and adolescents’ necks are typically weaker at this age than in young adults and older people.
Brain tissue is soft and squishy. It’s surrounded by cerebrospinal fluid, which acts as a cushion between it and the hard protective exterior, the skull. A concussion occurs when your brain bounces or twists inside your skull or experiences rapid, whiplash-type back and forth movement that causes it to collide with the inside of your skull. This brain movement stretches and damages brain cells and leads to chemical changes in the brain.
These injuries cause your brain not to function normally for a brief period of time and result in the signs and symptoms of concussion.
Motor vehicle accidents, falls, and sports injuries are common causes of concussions. Any sport that involves contact can result in a concussion.
Among children, most concussions happen on the playground, while bike riding, or when playing sports such as football, basketball, ice hockey, wrestling, or soccer.
The most common symptoms of concussion include:
It’s very common for infants and toddlers to hit their head. Concussions in these little ones can be difficult to diagnose because they can’t say how they feel. Look for these signs of concussion in children:
It’s always best to call your pediatrician if your child experiences a bump to their head. In fact, the American Academy of Pediatrics recommends you call your doctor for anything more than a mild head bump.
Concussion symptoms usually appear within minutes of the head injury. However, some symptoms may take several hours to appear. Symptoms can change days later; others can develop when the brain is stressed with use.
If a child or adult experiences any of the following symptoms in the hours or days after the head injury, get them to the hospital or call 911:
Seek emergency care if your infant has any of these symptoms:
The force of a hit can cause a concussion on the part of the brain that was directly hit or on the opposite side of the brain (as the brain tissue itself moves from the force of the blow and hits the opposite side of the skull).
Different areas of the brain control different functions, so blows to your head can predict your symptoms. A concussion to the back of the brain causes balance issues, fogginess, neck pain and difficulty concentrating. These symptoms usually predict a longer recovery from a concussion.
Yes. Call an ambulance if your child or elderly loved one has lost consciousness for longer than one minute, is not arousable, has a possible neck injury, shows a worsening of symptoms, has numbness that lasts or has weakness on one side of their body (can’t raise arm or leg or has unequal smile). If you have any doubt, it’s always safest to not move your loved one, call your local emergency department and closely monitor your loved one until help arrives.
Your healthcare provider will ask about the event leading to your head injury, your symptoms and perform a neurological exam. The neurological exam will check your:
Verbal, written or computerized tests may be used to check your:
You will also be asked if you’ve experienced mood changes, sleeping changes or any changes in behavior.
Imaging with CT scan or MRI isn’t always needed in the early evaluation of concussion. This is because most of the effects of a concussion aren’t seen on imaging. However, these imaging tests might be ordered if more serious effects of a concussion are suspected – like bleeding inside the skull, brain swelling or spinal cord or cervical spine injury – or if symptoms are worsening.
After the hands on neurological examination is complete, other neuropsychological tests can be used to assess a student-athlete’s ability to go back to school and sport.
ImPACT neuropsychological test
The immediate post-concussion assessment and cognitive test (ImPACT) is a concussion management tool used to help diagnose and evaluate student athletes. This computerized test measures a student athlete’s visual and verbal memory, reaction time, and processing speed.
The 30-minute test is ideally performed before the start of a sport season (a baseline test) and after a head injury (at various time points). Evaluating the test results and comparing with the baseline test helps care providers (healthcare, educational or sports organizations) document brain function and see if it has returned back to a student athlete’s healthy normal. It can assist with treatment decisions and help determine when it’s safe for a student athlete to return to their activity.
Hospital or Organization Concussion App
Some sports health centers within hospital systems have developed their own concussion app. These tablet-based, mobile tools are used to report and assess concussion and symptoms.
After baseline data are collected, the app can be used to document the athlete’s description of injury, track symptoms over time, detect loss of brain and memory function, and to help guide the athlete to a return to physical activity in order to get back to sport. The app compares assessments of balance, reaction time, information processing, coordination, memory, and vision after an injury to the athlete’s baseline and normative data. The app-based assessment can show the areas of most concern and help guide treatment and therapies over time.
You need physical and mental rest to recover from a concussion. Although you’ll need more rest and sleep than normal, you don’t need 100% complete rest. In fact, research has shown that too much mental rest can actually lengthen the recovery period and make you more sensitive to activities when you return to them.
Instead of stopping activities entirely, learn to recognize the triggers that bring on concussion symptoms. Start back slowly, in small amounts. When symptoms occur, back off and rest. It’s okay to do some of the activities that don’t make you feel worse. Limit any activities that worsen your symptoms.
For example, activities that may bring on symptoms include:
As your symptoms improve, you can continue to add more of your activities back into your day.
Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDS), such as naproxen (Aleve®) and ibuprofen (Advil®, Motrin®) should not be taken soon after a suspected concussion has occurred. These medications mask symptoms and thin the blood, which may increase the risk of bleeding. This is of special concern in elderly who fall and hit their head, as it’s not uncommon for these people to already be taking these drugs. After a concussion is diagnosed, if pain medication is needed, acetaminophen (Tylenol®) is a safer option. Symptoms need to be monitored closely.
There’s not much information about concussion and diet in the medical literature. There is some on nutrition and general brain health and well-being in the elderly. Some of the more researched supplements on diet include fish oils, turmeric, green tea extract and resveratrol. Any supplements taken should be in addition to a well-balanced diet high in fruits and vegetables and low in saturated fat and processed foods.
One thing to consider is that a concussed person may not feel as hungry or thirsty as before. Make sure to encourage eating throughout the day to keep blood sugar up and to try and drink six 8 oz. glasses of fluid (water, juice, Gatorade®) throughout the day. The brain is sensitive to low blood sugar and dehydration and these conditions can mimic or worsen concussion symptoms like headache, dizziness, fogginess, stomachache and irritability.
It’s important to know that recovery plans need to be individualized for each person. Your concussion specialist or family doctor can assist in creating this individualized plan and providing it to the student so they can share with the school.
At first students may need to miss several days of school for symptoms to calm down. Once the student can manage their symptoms at home in a controlled environment, they should gradually add some mental work like reading or writing in journal. If they can perform an hour of mental activity at home without worsening symptoms, they can try to return to school.
Students should not return to school for half days. Rather, they should try to complete as many classes as concussion symptoms allow each day. This may require getting more rest each day. Students should not set an alarm clock but wake when their body and brain are ready and then, if symptoms allow it, go to school. If the student gets symptoms during the school day, they should go to an agreed upon location, such as the nurse’s office or counselor’s office, and rest before returning to class. Should the student's symptoms result in them spending more time in the space designated for rest and recovery than in class, the student should consider going home.
Parents should work with teachers, school nurses, counselors or psychologists to make other adjustments in their school day. For example, students may:
If symptoms get worse or problems that had resolved come back, cut back again and rest. Let concussion symptoms be your guide to your own recovery timeline.
Each concussion in each person is somewhat unique and so is their recovery timetable. In general though, most concussion symptoms resolve within 14 to 21 days. However, undiagnosed, unrecognized or poorly treated concussions can delay your recovery – increasing it from the typical two weeks to months or even longer.
If you’ve been diagnosed with a concussion and concussion symptoms are still present after 14 days or symptoms worsen, see a healthcare professional who specializes in concussion management.
Concussion protocol is an organization’s set of policies and procedures for caring for someone who has had a head injury. Even though concussions aren’t limited to sports, concussion protocol is most often associated with sports-related head injury.
The people involved in making sure the concussion protocol is followed include trained healthcare providers with knowledge of concussion care, athletic trainers, school nurse/counselor/teachers, rehabilitation specialists and parents.
A concussion protocol includes such information as:
To reduce the risk of concussions:
Student athletes are ready to return to play when they are:
The thinking used to be that the student athlete needed to be symptom free for 24 hours before starting the multiphase process of physical activity toward the goal of returning to play. However, research has now shown that if the patient’s concussion symptoms are improving each day and they are able to attend a full school day with a few breaks for symptoms, they can begin to add very low level cardiovascular activities. These activities should consist of walking or biking on a stationary bike at an intensity that doesn’t make symptoms worse.
With the help of an athletic trainer or physical therapist, athletes can begin to increase their activity level each day, making sure they can tolerate increasing how hard they exercise over time without triggering symptoms before moving on. For example, start out slow with aerobic exercise, then move on to sport-specific drills, then contact activities and finally full participation. This step up in activity can take up to 10 days or longer, as each increase in activity may bring on symptoms and require rest and return to the previous step.
Following this approach, most student athletes are able to return to play within about three weeks after their symptoms began.
Returning to competition too soon could put you at risk for a second concussion. A repeat concussion that occurs before your brain has recovered from a first one is called second impact syndrome.
Second impact syndrome can:
Long-lasting problems include difficulties with concentration and memory, headaches, and sometimes physical skills like maintaining your balance. Although this is rare, returning to competition without being fully recovered and getting hit again could result in a brain hemorrhage or even death. Never return to competition until ALL your symptoms are gone and you feel you are 100% back to your normal self.
Once you’ve had a concussion, you are three to five times more likely to have another concussion. The highest risk is for those who return to competition before their symptoms have completely gone away. No one should return to active play if they are still having symptoms from a concussion.
Long term complications of concussion include:
Anyone who has symptoms that won’t go away or that are worsening seen be seen by their healthcare provider.
Even if you’ve been told that you’ve only experienced a “mild concussion,” all concussions should be considered serious events. In most cases it’s true that a single concussion is unlikely to cause permanent brain damage. However, even having a mild concussion puts you at an increased risk of another concussion. In addition, if you were to experience another concussion before your concussion symptoms have fully gone away, you could be at greater risk of permanent damage or even death if you have another concussion.
It’s rare, but a concussion can lead to bleeding in the brain or brain swelling that can be fatal. This is one of the reasons why it’s so important to carefully watch a concussed person in the first 24 to 48 hours after the concussion and to seek immediate care if symptoms worsen.
There is no doubt that rest helps a brain recover from a concussion. There is research going on to determine how much rest is needed, but each concussion is treated individually. Typically, mental and physical rest is advocated. There is also research going on looking at medications that may be useful to prevent the progression of concussion, based on the physiology of what happens when the brain is initially concussed, and to help the brain "heal" more quickly.
Yes. Head injuries and concussion can cause pain in your jaw as well as in the bones and muscles of your head, neck and shoulders. Temporomandibular joint disorder (injury to the jaw joint and jaw muscles) is a specific condition that can sometimes happen after hitting your head. Also, the main symptom of concussion – headache – can be the result of spasms and inflammation in your jaw muscles following a blow to the jaw.
First, every person is different. Many people can take a blow to the head without feeling or showing signs of sustaining a concussion. This is called a sub-concussive blow. In theory, one would think that taking several blows to the head would potentially “add up” to the point that the blows would cause concussion or brain injury. However, this has not been shown to be true.
There is no set number of blows and no exact or collected degree of force from blows over time that has been shown to result in a concussive injury. However we do know if you experience a blow and have shown or felt symptoms of concussion or have been diagnosed with a concussion and you continue to participate, you are at increased risk of permanent brain injury if you were to experience another concussion before you have fully healed and are 100% symptom-free.
Ongoing neck pain is a common complaint in both auto accidents and concussions. The head is bent back and forth on the cervical spine, which results in neck muscle injury and irritation. Useful treatments for whiplash include:
Your healthcare provider can give you more specific information on these treatments or where to turn for more help.
This is a myth. This is outdated information that may even slow the recovery process. Rest helps the brain recover from a concussion. However, it’s reasonable to check on the concussed person while they sleep to make sure their breathing pattern hasn’t changed or to briefly wake them up to make sure their symptoms are not getting worse. The concussed person should be immediately seen by doctors if they fall asleep shortly after receiving a concussion or can’t be woken up.
There is no general agreement on when to retire from sports due to head injuries. There are many factors to consider including:
Each concussion ups the odds of having another concussion. Each concussion is different. Each person’s reaction and ability to recover is different. You and your healthcare provider should discuss your history of concussions and be able to decide what is in you or your loved one’s best interest.
If you, your son or daughter or your older parent has experienced a mild blow to the head, you can see your family medical doctor or your pediatrician first for an initial exam. If a concussion is suspected, you may be referred to other doctors and healthcare providers who specialize in the evaluation and management of concussions. These clinicians include:
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition. This document was last reviewed on: 06/02/2020