“Follow my finger with your eyes…”
“What’s your name?”
“Do you know where you are?”
These are the kinds of questions that we commonly see asked when someone hits their head to check for signs of a concussion.
Whether you’ve seen the Will Smith movie, Concussion, about Dr. Bennet Omalu’s research on traumatic brain injuries in professional football players, or watched enough Grey’s Anatomy to know what to look for, there’s still a lot more to a concussion than you may realize.
Perhaps you’re thinking it’s weird to find an article about concussions on Girls Gone Strong. If so, you may be as surprised as I was to learn that females experience and recover from concussions differently than males. In fact, research shows that when playing sports with similar rules, female athletes sustain concussions at rates significantly higher than males. Females also report a larger variety of symptoms, have higher rates of neurocognitive impairment, and often take longer recover from concussions.1,2
Concussions are most frequently discussed in the media in relation to sports injuries, but you don’t have to be a professional football player (or any type of athlete) to sustain a head injury significant enough to cause symptoms needing medical attention.
A year and a half ago I passed out in the shower. As I collapsed, I hit my head on the edge of the porcelain tub. After a trip to the emergency room I was sent home with the diagnosis of vasovagal syncope and no diagnosis of concussion.
Overall, I felt fine. I returned to my normal routine the following day without difficulty.
I didn’t start to sense that something wasn’t right until eleven days after my fall. I began to feel exhausted, dizzy, irritable, and had difficulty concentrating. I couldn’t fall asleep at night despite feeling exhausted and I couldn’t stare at my computer for longer than a few minutes. I started to get headaches every day and loud noises made me so upset that I would sometimes cry. I felt like my daily life was moving in slow motion.
As it turns out, I had a concussion.
I was fortunate to have access to clinicians who are experts in the diagnosis and treatment of concussion and post-concussion syndrome, and I was able to feel better within a few months of starting a rehabilitation program. However, many people don’t have access to these types of resources, so it’s important to understand when there might be cause for concern, and when to talk to a doctor.
What is a concussion?
A concussion is a mild traumatic brain injury. You can get a concussion in various ways:3
- When your head hits an object (e.g., slipping on an icy sidewalk and hitting the back of your head on the concrete).
- When a moving objects strikes your head (e.g., not seeing the foul ball during your Sunday night softball game until it hits the side of your helmet).
- When your head experiences a sudden force without receiving a direct hit (e.g., getting rear-ended in your car at a stoplight and being violently jolted, although your head doesn’t hit the steering wheel or seat)
These direct or indirect forces cause the brain to accelerate, decelerate, and/or rotate inside the skull. This uncontrolled motion initiates a complex process that alters the brain’s chemistry and function, which can result in a wide array of physical, emotional, and cognitive symptoms.4
This video from the CDC provides a realistic visual of what can occur during these rapid and uncontrolled head movements.
What causes a concussion?
As mentioned before, football is not the only — or the most common — cause of a concussion. In fact, concussions are most commonly caused by:5
- Car accidents (head impact, or whiplash)
- Work accidents (falls, head trauma)
- Playground accidents (falling from a slide or swing)
- Sports injury to the head or neck
- Any type of fall or direct blow to the head, face, or neck
- Physical abuse during which the head is shaken
- Being too close to a blast or explosion
What does a concussion look like?
If you think you or someone you know might have a concussion, look for the following signs:3
- Behavior or personality changes
- Blank stare, dazed look
- Changes to balance, coordination, reaction time
- Delayed or slower spoken or physical responses
- Disorientation (confusion about time, date, location, game)
- Memory loss of event before, during, or after injury occurred
- Slurred/unclear speech
- Trouble controlling emotions
- Loss of consciousness/blackout (occurs in less than 10 percent of people with concussion)
If you have a concussion, you might sense or feel the following:3
- Difficulty with balance and coordination
- Difficulty sleeping
- Increased sleepiness
- Double or blurred vision
- Sensitivity to light and sound
- Slurred speech
- Mood swings
- Decreased tolerance of stress
- Change in personality or behavior
- Difficulty with short-term or long-term memory
- Slowed “processing” (for example, decreased ability to think through problems)
- Difficulty concentrating
- Worsening academic or work performance
What should you do if you think you have sustained a concussion?
If you suspect that you may have a concussion it is imperative that you receive an evaluation by a health care provider.
This evaluation will involve a conversation about your health history, your current symptoms, and if you have a previous history of concussion. You may undergo a physical and neurocognitive exam at this appointment or be referred to a different health care provider who specializes in the assessment, diagnosis, and treatment of concussions.
A concussion-specific examination will vary based on your individual symptoms, but could entail the following:6
- Testing for attention, concentration, memory, and orientation to person, place, and time.
- Vision screening and an oculomotor exam to assess how your eyes move when tracking a specific target.
- Muscle strength testing looking for unusual weakness in key muscle groups.
- Balance and vestibular system testing to assess for the cause of symptoms like dizziness and difficulty with coordination and balance.
- Assessment of your cognitive function, which may include tests for your reaction time, working memory, and looking for signs of delayed recall.
- Physical examination of your neck to assess for serious injury secondary to head and neck trauma or to look for issues that may contribute to headache complaints.
However, if you or someone you know is involved in an event that could cause a concussion, and they demonstrate any of the symptoms listed below, immediate transportation to the hospital emergency department by ambulance is absolutely necessary.6
- Decreasing level of consciousness
- Increasing confusion
- Increasing irritability
- Loss of or fluctuating level of consciousness
- Numbness in the arms or legs
- Pupils becoming unequal in size
- Repeated vomiting
- Slurred speech or inability to speak
- Inability to recognize people or places
- Worsening headache
Will medical imaging like MRI, CT scan, or x-ray show that you have a concussion?
A concussed brain generally does not present with abnormal structure during imaging studies like a MRI or CT scan. These tests may be used to rule out more serious injuries if you or your healthcare provider feel that there is reason for concern. An x-ray may be used to examine the bony structures of your neck following a head injury if there is suspicion of a serious injury.
What type of healthcare provider typically treats patients with concussion?
The medical treatment of concussion typically involves a multidisciplinary healthcare team that is specific to the patient’s symptoms and the lifestyle that they are returning to. For example, is the patient trying to return to school? A desk job that involves spending most of the day on the computer? A sport or specific recreational activity?
Physicians specializing in the management of concussion will often set up a treatment plan that may involve other healthcare providers, like physical therapists for the treatment of neck pain, vestibular dysfunction, and return to sport progressions and neuropsychologists to assist with cognitive and emotional symptoms.
How long does it typically take for a person to recover from a concussion
Most of the current research on concussion is focused on athletes due to the high frequency of concussions during organized sporting events in high school and collegiate athletics (and professional football – thanks, Dr. Omalu).Most athletes recover from a concussion within three weeks of the initial injury. Those who don’t recover within this time period may be diagnosed with post-concussion syndrome. While the definition of post-concussion syndrome varies, it is typically diagnosed when a patient experiences a head trauma with loss of consciousness preceding symptom onset by a maximum of four weeks and develops symptoms in 3 or more of the following symptom categories:7
- Headache, dizziness, malaise, fatigue, noise intolerance
- Irritability, depression, anxiety, emotional lability
- Subjective concentration, memory, or intellectual difficulties without neuropsychological evidence of marked impairment
- Reduced alcohol tolerance
- Preoccupation with above symptoms and fear of brain damage with hypochondriacal concern and adoption of sick role
Patients with post-concussion syndrome may have delayed onset of symptoms and generally take longer to recover; often needing additional assistance to rehabilitate their physical, emotional, and cognitive symptoms:7
Concussions can significantly impact an individual’s ability to maintain their lifestyle recreationally, academically, socially, and professionally. Understanding the signs and symptoms and knowing when to seek medical care is critical in receiving the proper diagnosis and establishing an appropriate treatment strategy. If you think that you may have sustained a concussion and have not yet spoken with your physician I encourage you to make an appointment and to utilize some of the resources below for additional information.
Information for parents of children with concussion from the CDC:
Information on sports concussions from the American Academy of Neurology:
Resources for parents, families, healthcare providers, and school personnel on how to recognize and manage concussions:
- Harmon KG, Drezner J, Gammons M, et al. American Medical Society for Sports Medicine Position Statement: Concussion in Sport. Clinical Journal of Sport Medicine. 2013;23:1-18.
- Covassin T, Moran R, Elbin RJ. Sex Differences in Reported Concussion Injury Rates and Time Loss From Participation: An Update of the National Collegiate Athletic Association Injury Surveillance Program From 2004-2005 Through 2008-2009. Journal of Athletic training. 2016;51:189-194.
- Concussion During Sports Activities: Summary of Evidence-Based Guideline for Patients and Their Families. American Academy of Neurology. 2013.
- Brain Injury Basics. Centers for Disease Control.
- Heads Up: Facts About Concussion and Brain Injury: Where to Get Help. Centers for Disease Control. 2010
- Broglio SP, Cantu RC, Gioia GA, et al. National Athletic Trainers’ Association position statement: management of sport concussion. Journal of athletic training. 2014;49:245-265.
- Guidelines for Concussion/Mild Traumatic Brain Injury & Persistent Symptoms. (For Adults 18+ Years of Age). Second Edition. Ontario Neurotrauma Foundation. 2013