Brain injury & concussion

A traumatic brain injury, or TBI, happens when a blow or jolt to the head, or a force to the body, makes the brain move quickly inside the skull. The brain can bounce or twist, which can stretch and damage brain cells and cause chemical changes in the brain.

Most TBIs are mild, and these are often called concussions. But “mild” describes the injury, not how it feels to live with. The effects of a concussion can still be serious, and getting care early can help you recover faster.

Brain injuries range from mild (a concussion) to moderate and severe. Most people with a concussion recover fully, usually within days to a few months.

A moderate or severe TBI can bring lasting changes that touch work, relationships, independence and mood, much like living with a long-term health condition. People often need ongoing care and rehabilitation, and the whole family is affected.

In the U.S., about half of hospital stays for a brain injury come from unintentional falls, and about a quarter from motor vehicle crashes. Assaults, sports and other accidents cause many more.

Who is most at risk

• Adults age 75 and older, mostly from falls
• Males, who are hurt and hospitalized more often than females
• Young adults age 15 to 34, from car crashes
• Kids and teens, from sports, play and bikes

Simple ways to protect your head

• Ask your clinical provider about your fall risk if you are older
• Use car seats, booster seats and seatbelts every time
• Wear a helmet for biking and motorcycling
• Never drive impaired, and keep to the speed limit

Preventing falls at home

• Remove tripping hazards at home and add good lighting
• Use handrails and grab bars
• Ask about balance exercises if you’re worried about falling

A brain injury can affect the parts of the brain that handle emotions. Thinking may also be slower, so busy places feel overwhelming. And losing a job, a sport or a role in the family is a real loss that brings grief and frustration.

See “Mood and personality changes after a brain injury” below for what can help.

Physical changes people notice

• Being bothered by light or noise
• Dizziness or balance problems
• Feeling sick to your stomach or throwing up (early on)
• Feeling tired, with no energy
• Headaches
• Vision problems

An injured brain uses a lot of energy to heal. That’s one reason people feel so tired, and why bright screens, loud rooms and busy places can feel like “too much.”

Thinking changes people notice

• Feeling foggy or groggy
• Feeling slowed down
• Problems with short- or long-term memory
• Trouble paying attention or concentrating
• Trouble thinking clearly

Many people describe it as their brain running on “low battery.” Reading takes longer, multi-step tasks feel hard, and you might lose your train of thought mid-sentence.

What can help

• Break big tasks into small steps
• Do harder thinking tasks when you feel freshest
• Do one thing at a time
• Write things down: lists, notes, a calendar

Emotional changes people notice

• Anxiety or nervousness
• Feeling more emotional than usual
• Irritability, or getting angry easily
• Sadness

These changes happen partly because the injury affects areas of the brain that handle emotions. They also happen because it’s frustrating and scary to suddenly not feel like yourself.

Sleep changes people notice

• Sleeping less than usual
• Sleeping more than usual
• Trouble falling asleep

Sleep is when the brain does a lot of its repair work. Poor sleep can make headaches, mood and focus worse, and can slow recovery, so it’s worth protecting.

Gentle sleep habits

• Dim screens and lights in the hour before bed
• Go to bed and wake up at about the same time
• Keep naps short and early in the day
• See the Sleep & mental health guide for more ideas

If you think a player may have a concussion

1. Take them out of the game or practice right away
2. If you see any danger signs, get them to the emergency room
3. Keep them out for the rest of that day, and until a clinical provider says it’s OK
4. Don’t try to judge how serious it is yourself
5. Write down how it happened and any symptoms, to share with the provider

Returning to sports too soon raises the risk of another injury while the brain is still healing. The CDC’s HEADS UP program describes a six-step return. Each step takes at least 24 hours, and you only move up if no new symptoms come back.

The six steps (with a provider’s OK)

1. Back to regular daily activities, like school
2. Light activity that raises the heart rate a little: walking or easy biking
3. Moderate activity: jogging, brief running, lighter lifting
4. Heavy, non-contact activity: sprinting, harder training, non-contact drills
5. Practice and full contact, if the sport allows it
6. Back to games and competition

Among high school athletes, tackling causes almost 2 in 3 football concussions, and takedowns cause more than half in wrestling. About 1 in 3 concussions in girls’ soccer happen while heading the ball, and almost all cheerleading concussions are linked to stunts.

In sports with the same rules, like soccer and basketball, girls have a higher concussion risk than boys. Bikes, playgrounds and ATVs also cause many brain injuries in children.

Chronic traumatic encephalopathy, or CTE, is a brain disease linked to repeated brain injury. It is still poorly understood, and most studies have looked at elite athletes with many years of hits.

Based on current evidence, experts think one or two concussions do not lead to long-term conditions like CTE or dementia. But repeated concussions can mean longer recovery and longer-lasting problems, which is why healing fully matters.

Wearing a helmet for biking and motorcycling lowers the risk of a brain injury. Seatbelts and car seats protect heads on the way to practice too.

Other ways to play safer

• Ask the coach about the team’s concussion plan
• Know the signs of concussion, as a player, parent or coach
• Speak up if you or a teammate feel “off” after a hit

Irritability is one of the most common changes families notice. Anger can come from the brain injury itself, from tiredness, or from frustration at not being able to do things the way you used to. Sometimes a person doesn’t yet see how much the injury has changed them, which can lead to more arguments.

If it’s you

• Keep a steady daily routine with rest breaks built in
• Notice your early warning signs (hot face, tight jaw, racing thoughts)
• Step away to a quiet place before it boils over
• Try slow breathing or muscle relaxation (see the Breathing basics guide)

If it’s someone you love

• Offer a quiet space and gently change the subject
• Stay calm and don’t argue in the heat of the moment
• Talk about what happened later, when things are calm
• Try not to take it personally. The injury is part of what’s talking

Depression is common after a brain injury. Across studies, about 27% of people with TBI have depression that meets a clinical level, and 38% have depression symptoms strong enough to get in the way of daily life.

Feeling sad about the changes after an injury is normal. But when sadness, hopelessness or a loss of interest lasts for weeks and gets in the way of life, it’s time to talk to someone. Risk is highest in the first five years after the injury.

Supports that can help

• Acceptance and commitment therapy (ACT), which uses mindfulness and values
• Behavioral activation: slowly adding back activities that feel meaningful or enjoyable
• Gentle, regular exercise, as your care team allows
• TBI support groups
• Talk therapy such as CBT (cognitive behavioral therapy)
• Therapy by phone or video if getting out is hard

Anxiety is common after a moderate or severe TBI. It often shows up in situations that need fast thinking: crowds, being rushed, sudden changes in plans, or having to handle a lot of information at once. More than half of people with TBI who feel depressed also have strong anxiety.

What can help

• Go to busy places at quieter times
• Plan ahead so there are fewer surprises
• Tell people what helps you: “Can we slow down?”
• Use one calming skill you’ve practiced, like slow breathing

As many as 70% of TBI survivors say they struggle with mental fatigue. Simple things like walking, talking or following a conversation can take extra effort after a brain injury, so the brain tires sooner.

Tiredness often shows up first as being more irritable or distracted. Stress, low mood and poor sleep can make it worse.

What can help

• Do the hardest tasks earlier in the day, when you’re fresher
• Keep naps to about 30 minutes, and avoid evening naps
• Notice your early signs of tiredness and stop before you’re worn out
• Plan your day and don’t over-schedule
• Regular exercise, which can build stamina and alertness over time

Many people with a brain injury say the hardest part is not the headaches, but the sense of being a different person. Roles change, at home, at work, at school, on a team. That brings real grief, even if others can’t see the injury.

What can help

• Be patient. Recovery is often slow, and not a straight line
• Meet others who “get it” in a brain injury support group
• Name what you’ve lost, and also what is still you: your values, humor, people
• Set small goals and notice progress week by week, not day by day

Many people are extra sensitive to light and sound after a concussion. A crowded hallway, a noisy lunchroom or a bright screen can quickly bring on a headache or make it hard to think.

What helps

• A quiet place to study, work or eat lunch
• Leaving class or meetings a few minutes early to avoid crowds
• Sunglasses, or sitting away from bright windows
• Turning screen brightness down and taking regular screen breaks

An injured brain is using lots of energy to heal, so mental effort tires it out sooner. People often find reading slower and finishing work harder for a while.

What helps

• Doing the hardest thinking at the time of day you feel best
• Extra time for assignments and tests
• Short breaks to rest between tasks
• Written instructions instead of only spoken ones

If symptoms get worse, or new ones appear, it may be a sign you’re pushing yourself too hard. Slow down and take care of yourself, then build back up gradually.

What helps

• Add one new activity at a time
• Cut back a little if symptoms rise, rather than stopping everything
• Plan rest breaks before you need them

Trouble sleeping, and stress in the family or with friends, can slow recovery. Stress, worry and pain can also cause symptoms that feel like concussion.

Alcohol and marijuana generally make fatigue worse, and caffeine after lunch can make sleep harder.

What helps

• A steady bedtime and wake time
• A few calm minutes each day: breathing, a walk, music
• Talking to someone you trust about worries

In the first 1 to 2 days, it helps to cut back on screens and on hard physical or mental activity. But staying in a dark room all day isn’t recommended. Light activity, like short walks, is encouraged even with mild symptoms.

Gentle first steps

• Cut back if symptoms get worse, then try again
• Ease back into screens as symptoms improve
• Keep your usual sleep schedule and bedtime routine
• Take short walks or do light chores

Most children can go back to school within 1 to 2 days after a concussion. Getting back to school, with support, can actually shorten recovery and lower the risk of mental health symptoms.

Supports schools can offer

• A quiet place to study, test or eat lunch
• An adult the student can go to when overwhelmed
• Class notes, or permission to record lessons
• Extra time for tests and work, and tests spread out
• Fewer assignments, focused on the key tasks
• Rest breaks and time with the school nurse
• Seating away from bright lights

Signs to watch for at school

• Headaches or getting very tired
• More irritable, less patient, or stressed
• More trouble learning, remembering or paying attention
• Pulling away from friends, or feeling hopeless

Going back to work after a brain injury can bring up worry, especially if your job needs fast thinking, screens or noisy spaces. Talk with your clinical provider about when and how to return, and follow their advice closely.

Ideas to ask about

• A quieter desk, or noise-reducing headphones
• Doing one task at a time
• Regular breaks in a quiet place
• Starting with shorter days or fewer days
• Written instructions and checklists

The Work & mental health guide has more on talking to your workplace about what you need.

After a more serious brain injury, a rehabilitation team can help. This might include therapists who work on thinking and memory, speech and communication, daily living skills, movement and balance, and emotions. People with moderate or severe TBI may need this support for a long time.

Rehab often works in two ways: practicing skills to make them stronger, and learning tools that work around what is still hard, like phone reminders, calendars, notebooks and checklists.

Emotional supports

• A daily routine with structured activities and exercise
• Counseling or talk therapy (tell them about your injury)
• Learning relaxation skills: deep breathing, muscle relaxation, mindfulness
• Peer support groups or peer mentors

Most children feel better within 2 to 4 weeks, but some have changes in mood, behavior, memory or emotions for months or longer. Adults over 40 may also take a bit longer to get back to normal.

Things that can slow recovery

• A past concussion
• Family or social stress
• More severe symptoms at the start
• Trouble sleeping

If symptoms last beyond a few weeks, or get worse after returning to activities, contact the clinical provider. They may refer you to a brain injury specialist.

After a moderate or severe brain injury, couples often find their relationship changes a lot. The injured partner may focus on getting better, while the other takes on new jobs at home. Some partners say they feel “married to a stranger.”

What helps couples

• Notice and talk about each other’s new responsibilities
• Plan time together that isn’t about the injury
• Say “thank you” every day for what each of you is trying to do
• Seek a counselor who understands brain injury

A brain injury can make it harder to read a child’s feelings, keep track of schedules, or stay patient after a tiring day. Most parents with a TBI are still very capable. A few changes can help.

Ideas that help

• Ask another trusted adult for help when you need it
• If you lose your temper, take a time-out, then apologize and explain
• Set a regular time to check in with your child
• Talk openly about the injury, and invite them to share their feelings
• Use schedules and checklists for routines

Caring for someone with a brain injury can bring stress you feel in your body (tight shoulders, headaches, poor sleep), your thinking (forgetfulness, trouble deciding) and your feelings (sadness, guilt, worry, feeling alone). These feelings are normal.

Ways to cope

• Accept your thoughts and feelings without judging them
• Keep doing things you enjoyed before, even 15 minutes a day
• Reach out for support: friends, family, a counselor or a group
• Try slow breathing or a one-minute mindfulness pause

The Caring for yourself as a long-term carer guide has more on carrying the load over time.

Most TBIs are concussions, and most people recover. But the effects can still be serious, and getting hurt again before healing can lead to longer recovery and worse symptoms.

A CT scan isn’t needed to identify a concussion, and a normal test doesn’t rule one out. A clinical provider looks at symptoms and how you’re doing, not just scans.

Complete rest isn’t recommended. After a day or two of taking it easy, light activity and gentle mental activity may actually help the brain recover.

Keeping a usual sleep schedule is part of recovery. CDC advice for parents is not to keep a child from sleeping. Anyone with danger signs, like being very hard to wake, needs emergency care right away.

Most people recover fully from a concussion. Brain injury overall is one of 14 risk factors linked to dementia, which is why protecting your head matters across life, but a single concussion is not thought to cause dementia.

The Protect your brain for life guide explains risk factors in plain words.

Playing on with a concussion raises the risk of another injury while the brain is still healing, which can be very serious. Telling a coach or parent is the smart move.

The Brain Injury Association of America runs the free National Brain Injury Information Center. It’s open 9 a.m. to 5 p.m. Eastern Time, Monday to Friday. It is an information line, not a crisis line.

They can help you find

• Help with paperwork for benefits
• Legal and money help
• Local support groups
• Rehabilitation services
• State brain injury associations

Many support groups exist for people who have had a brain injury and for their loved ones. TBI support groups can be a good source of information and support, including for low mood after an injury.

Where to look

• Ask at your local senior center or place of worship
• Ask your clinical provider or rehab team
• Call the Brain Injury Association line above for local groups
• Look for online communities run by trusted organizations

More than half a million U.S. service members have been diagnosed with a TBI since 2000, and most of these were mild. The Military Health System’s Traumatic Brain Injury Center of Excellence has resources for patients and families.

See the Veterans guides in this app for more on health care, PTSD and support for military families.

Small kindnesses add up: a ride to an appointment, a meal, a quiet visit, or an hour so a caregiver can rest. Staying connected also protects mood during a long recovery.

Ideas

• Ask a friend to be your “check-in buddy” each week
• Join a walking group or gentle exercise class when you’re ready
• Let your team or club know how to include you while you heal