Concussion

Concussion is sometimes called an “invisible injury.” There’s often no cast, no bandage and nothing on a scan. A person may not realize or admit they are having problems, and family or even health providers can overlook them.

Symptoms are usually strongest in the first 1 to 2 days. But some may not appear for hours or days, and they can change during recovery. That’s why it helps to keep watching for a few days after any hit.

While the brain heals, it is more vulnerable to another injury. Repeated concussions, especially without enough healing time between them, raise the risk of longer and more serious symptoms.

Experts think one or two concussions don’t lead to long-term brain conditions. Healing fully before taking more risks is what matters most.

Changes caregivers may notice

• Crying more or being more irritable
• Less interest in play
• Looking dazed or unsteady
• Needing more comfort or to be held
• Refusing to nurse or eat
• Sleep changes
• Slower speech, or needing more help than usual
• Throwing up right after the injury with no other cause

Changes adults may notice

• Clumsiness or being unsteady
• Looking dazed or confused
• Mood or personality changes
• Slower answers and reactions
• Sudden trouble remembering or focusing
• Throwing up right after the injury with no other cause

Kids may describe it in their own words: “My head feels funny,” “I feel weird,” or “Everything is too loud.” Take those words seriously.

Body

• Bothered by light or noise
• Dizziness or balance problems
• Feeling tired, with no energy
• Headaches
• Upset stomach or throwing up (early on)
• Vision problems

Thinking, feelings and sleep

• Anxiety, sadness or irritability
• Feeling foggy or slowed down
• Feeling more emotional
• Memory or focus problems
• Sleeping more, less, or having trouble falling asleep

Falls and car crashes cause most brain injury hospital stays in older adults. Most of these injuries are mild, but older adults are more likely to need hospital care after one.

A concussion can be missed in later life because its signs, like memory trouble or mood changes, can look like other conditions such as dementia. That’s why it’s wise to get checked after any fall or crash, even if you feel fine.

Right after a bump, blow or jolt

1. Stop the activity. No more play that day
2. Check for danger signs. If you see any, call 911 or go to the emergency room
3. If there are none, keep an eye out for concussion signs over the next hours and days
4. Write down how it happened and how they seemed afterward

Anyone with a possible concussion should see a clinical provider. Tell them how the injury happened, whether the person passed out or lost memory, and about any past concussions. Most children don’t need a brain scan.

Gentle ways to rest

• Allow rest when needed, but not all day in a dark room
• Cut back on screens and on hard mental or physical work
• Keep the usual bedtime, and let them sleep as normal
• Take short walks if symptoms allow

After a couple of days, most people do best by slowly adding activities back over about a week. If symptoms get worse or new ones appear, that’s a signal to ease off for a bit, not a failure.

Do

• Add one activity at a time
• Keep in touch with friends and family
• Share what happened with teachers, coaches or a manager
• Watch for new or worsening symptoms

Avoid

• Anything that risks another hit, like contact sports, biking or skateboarding, until a provider says OK
• Keeping someone on the couch or in bed all day
• Rushing recovery or expecting a set timeline

Things linked to a longer recovery

• A past concussion
• Family or social stress
• Learning difficulties, migraines, or a mental health condition before the injury
• More severe symptoms right after the injury
• Sleep problems

Adults over 40 may also need a little more time to recover.

A small number of people take longer to recover and may need more specific care. If symptoms last beyond 2 to 4 weeks, a clinical provider may suggest a specialist in brain injury.

Stress, worry and pain can cause symptoms that feel a lot like concussion. That doesn’t mean it’s “all in your head.” It means caring for your mood and stress is part of healing.

Everyday helpers

• A steady bedtime and wake time
• Breaks before you need them
• Light movement, like short walks, as allowed
• Support from family, friends and peer groups
• Talking about worries instead of carrying them alone

• Class notes, or permission to record lessons
• Extra time for work and tests
• Fewer assignments, focused on key tasks
• Fewer tests in one day, or study guides

• A quiet place for work, tests or lunch
• Extra time between classes to avoid crowds
• Rest breaks and visits to the school nurse
• Sunglasses, or a seat away from bright light

Students can feel frustrated, left out or behind. An emotional support plan with a trusted adult, a quiet place to go, and encouragement to stay connected with friends can make a big difference.

Watch for

• Feeling helpless or hopeless
• Less interest in usual activities
• Pulling away from friends
• Trouble controlling emotions or managing stress

Under the Americans with Disabilities Act, public schools must provide supports for students with short- or long-term disabilities from a brain injury that affects their schoolwork. Options can include a 504 Plan or an Individualized Education Plan (IEP). What’s offered varies by state and district.

It’s normal to have some trouble at work at first, and that can feel stressful. A small number of people need specific workplace supports for days or a few weeks.

Ideas to ask about

• Doing one task at a time
• Fewer meetings or screen-heavy tasks for a while
• Regular short breaks in a quiet spot
• Shorter days at first

The “Work & mental health” guide has tips for talking with a manager about what you need.

Slower reactions and trouble focusing can make driving, ladders or power tools less safe for a while. Ask your clinical provider when it’s safe to drive and return to physical activities.

Noise, busy mornings and screens can wear out a healing brain. It’s OK to let some chores wait, accept meals or rides, and tell family what helps.

Simple supports

• A short rest after busy times
• Lists and phone reminders
• Quieter evenings for a while
• Sharing jobs with a partner, friend or family member

In a survey of nearly 800 former college athletes, about 1 in 3 of those who had a concussion didn’t tell anyone about at least one. The top reasons were not wanting to leave the game, not wanting to let the team down, and not knowing it was a concussion.

Athletes who return too soon are more likely to get another concussion while the brain is still healing.

1. Remove the athlete from play right away
2. Check for danger signs, and go to the emergency room if any appear
3. Keep them out for the rest of the day, and until a clinical provider clears them
4. Don’t try to judge how serious it is yourself

The overview guide “Brain injury & concussion” explains the six-step return to sports in detail.

Frustration, sadness, anger and feeling isolated are common during concussion recovery. For athletes, losing practice, games and teammates can hit hard, especially if sport is a big part of who they are.

Ways to stay connected

• Go to practice or games to watch, if symptoms allow
• Keep a small role: stats, team chats, cheering
• Spend time on other things you enjoy
• Talk with someone if sadness or worry hangs around

• Help players learn what a concussion feels like, since many don’t recognize one
• Know the HEADS UP steps and your team’s plan
• Never pressure an athlete to play through it
• Praise players who speak up

The CDC offers free HEADS UP training for coaches, parents and school staff.

Anxiety and nervousness are common concussion symptoms. Worrying about recovery can also make headaches and poor sleep worse, which can feel like a loop.

What can help

• Slow breathing for a few minutes
• Focusing on what you can do today
• Getting clear information from your provider
• Telling someone what you’re worried about

Sadness is a listed concussion symptom. If low mood, hopelessness or losing interest in things lasts or gets worse, talk with a clinical provider. Depression is treatable.

See “Depression: understanding it” for more.

If the concussion happened in a scary or violent event, nightmares, jumpiness or avoiding reminders can follow. These are stress reactions, and they deserve care just as much as the headache does.

The “PTSD” guide explains these reactions and what helps.

Watch for changes from your child’s usual self and tell their provider if symptoms get worse. Siblings, teachers and babysitters can help if they know what happened.

• Invite them to quiet hangouts
• Don’t joke about them “faking it”
• Speak up if a teammate seems off after a hit