Concussion

Symptoms

• Headache or pressure in the head
• Dizziness, balance problems, or nausea
• Feeling foggy, slowed down, or having trouble concentrating
• Sensitivity to light or noise
• Sleep changes, irritability, or feeling more emotional
• Loss of consciousness happens in only a minority of concussions

Causes and who gets it

Concussions occur in contact and collision sports such as football, soccer, hockey, and lacrosse, but also in falls, bike crashes, and car accidents.

How it is diagnosed

Concussion is diagnosed clinically. Sideline tools such as the SCAT6 combine symptoms, memory, balance, and neurological checks. CT or MRI is not needed for most concussions but is used when a more serious brain injury is suspected.

Treatment

• Remove the athlete from play the same day; no same-day return to sport
• A short period of relative rest, then light activity that does not significantly worsen symptoms
• Gradual return to school or work before a full return to sport
• A stepwise return-to-sport progression, with medical clearance before full contact
• Persistent symptoms may benefit from targeted therapy such as vestibular rehabilitation or treatment of neck, vision, or mood issues

Recovery time

Most adults feel better within about 2 weeks; children and teens often take up to about 4 weeks. Symptoms lasting longer should be evaluated by a clinician experienced in concussion care.

When to see a doctor

• Worsening headache, repeated vomiting, or seizure (seek emergency care)
• Increasing confusion, drowsiness, or difficulty waking
• Weakness, numbness, slurred speech, or unequal pupils (seek emergency care)
• Neck pain or tenderness after a head injury (protect the neck and seek emergency care)
• Symptoms that are not improving after 2 to 4 weeks

Clinical pearls

• Use the current SCAT6 (age 13 and up) or Child SCAT6 for sideline assessment; the SCOAT6 supports office follow-up
• Red flags for emergency transfer: deteriorating consciousness, focal deficits, seizure, repeated vomiting, severe or worsening headache, suspected skull fracture or cervical spine injury
• Early light aerobic activity below the symptom-exacerbation threshold is supported over strict prolonged rest
• Return to learn should generally be completed before full-contact return to sport
• Persistent symptoms: assess for cervicogenic, vestibulo-ocular, autonomic, sleep, and mood contributors