Deal with a Concussion

A concussion is a mild traumatic brain injury (TBI) that causes damage to the brain on a level that’s so small, you can’t see it with medical imaging. However, concussions can alter the way you feel and the way your brain functions – including memory, coordination, balance, concentration, and stimulus sensitivity. Concussions can result from a blow to the head and are common sports injuries, but also occur from being shaken roughly or getting whiplash, such as from a car accident. Most concussion symptoms are temporary and resolve with time, but resting, taking it slow, and avoiding further injury will help you recover faster and more fully.

Steps

Responding Immediately to Your Head Injury

1. Stop your activity and do not return to it the same day. Some symptoms of a concussion can occur immediately after your injury, such as losing consciousness (“blacking out”), nausea, headache or a feeling of pressure in the head, dizziness, confusion, and ringing in the ears. However, sometimes you feel fine immediately after an injury, and symptoms do not begin until hours or even days later. If you hit your head, fall, or jar your head or neck like with whiplash, immediately stop what you’re doing and do not return to activity that day.
   • Do not try to walk or stand immediately after your injury, unless you are in immediate physical danger. Rest seated or lying down until you know you can move without feeling ill.
   • Athletes, usually hockey and football players, must be medically evaluated before returning to play.
2. Call for medical assistance immediately if you’re incapacitated. If you feel weak on one side of your body, are vomiting continuously, are confused or anxious, have neck pain, or are very drowsy, call for immediate medical care. Severe symptoms like these may indicate a more severe brain injury.
   • Someone may have to call for help for you if you are unable.
   • If you have neck or head pain, do NOT move until help arrives. Injuries that cause concussions can also result in spinal injuries, which can cause permanent damage.
3. Seek emergency care if you start to feel worse. Even if you had minimal discomfort immediately after your injury, you should get medical help right away if your symptoms worsen in the next few hours or days. You may have a headache that gets worse and worse, begin to feel clumsy or start to stumble, get progressively dizzier, or feel confused or have problems with speech.
4. Get help right away if you have a seizure. Unless you had epilepsy before your injury and have frequent seizures, having a seizure after getting a concussion may indicate a serious problem. Don’t wait to get medical attention. Post-traumatic seizures are those that occur one week after the brain injury. Post-traumatic seizures are common in those who suffer from a severe traumatic brain injury, especially those that have an intracranial hemorrhage.
5. Go to the hospital if your pupils are different sizes. In general, your pupils (the black centers of your eyes) should be the same size. If one pupil becomes larger than the other, it may indicate a neurological condition. Go to your doctor right away.
6. See a doctor within two days of your injury, no matter what. Even if you did not lose consciousness or experience immediate symptoms, see your doctor after any head injury. They will be able to evaluate you for other injuries that may have occurred, assess the severity of your symptoms, and give you further treatment advice. They may refer you for a CT scan or an MRI so they can rule out other brain injuries.
   • Bring a friend or loved one with you to the appointment to take notes and help you later. You might have trouble concentrating and need reminders.
   • Sometimes your doctor may refer you to other specialists, like a neurologist if you’re having severe symptoms or problems with your nerves, or a chiropractor or physical therapist to help with pain from your car accident, for instance.
7. Watch for signs of concussion in children. Young children can get concussions, too, but are often unable to tell you how they feel. If a child receives any injury that could cause damage to their head, watch for behavior changes and problems with balance and coordination. Children with a concussion may:
   • Seem dazed, overly tired, or listless.
   • Be irritable, cranky, or very tearful.
   • Lose interest in toys and normal activities.
   • Appear off-balance or unsteady when walking or standing.
   • Experience changes in sleep and eating habits.
8. Prevent children from returning to play right away. Before returning to play, recovered child athletes should complete a full-course of non-contact exercise, this should include challenges of gradually increasing intensity.

Coping with Your Initial Symptoms

1. Have a caregiver with you for 24 hours. For the first 24 hours after your injury it’s important to have someone stay with you to make sure your symptoms are not getting worse. Your caregiver should be someone who knew you before the injury so that they are familiar with your baseline personality and thinking patterns. If your symptoms worsen at all, your caregiver should take you to the hospital or call for emergency medical assistance.
   • While you sleep during those first 24 hours, your caregiver should wake you up every 1-2 hours to check on your symptoms. You should be able to wake up normally. They can ask you what your name is, what state you live in, or what day of the week it is to ensure you aren’t getting confused. Neurological checks every 2 hours is important in the course of treatment and care.
2. Sleep as much as you want to. Despite popular belief, it’s okay to sleep when you have a concussion. You will likely require more sleep than usual as your brain recovers. Sleep is a great way to rest your brain right after your injury as well as throughout the next several weeks, so continue to nap throughout the day if you need to.
3. Set aside two weeks to rest. If possible, take time off of work or school or find childcare so that you can rest for up to two weeks. Rest truly is the only medicine for a concussion, and the more you can rest after your injury the more quickly you will recover. Enlist family, friends or hired help to ease your burden for several weeks.
4. Minimize light, noise and movement. You may be very sensitive to sounds and light after a concussion, and will likely be more comfortable keeping still than moving around. Your brain needs rest in order to heal, and this includes rest from stimulus. Lie in a quiet room with closed blinds or a towel over your eyes as much as you can.
   • Do not try to read, text, or watch TV to pass the time. This stimulates your brain. True brain rest requires calm, quiet, stillness, and minimal brain activation.
   • Avoid activities that raise your heart rate, like fast walking or lifting weights.
5. Prepare for some discomfort. No matter what you do, you may have post-concussion symptoms beginning a few days after your injury and lasting up to 2-3 weeks. Some people experience post-concussion symptoms for months. Symptoms may include dizziness, headaches, and difficulty concentrating. Some people also develop emotional symptoms like depression, which can last for several weeks to months.
   • Once a concussion has been sustained, you cannot prevent further symptoms. Rest as much as you can. Be patient and know that this is a normal part of the process.
   • Headaches may not develop until weeks or months after a head injury.
6. Use self-calming techniques. This can be an uncomfortable and challenging time. In order to focus on your recovery, try to keep your stress to a minimum. Meditate daily and try mindfulness exercises. Do deep breathing techniques. Give yourself a hand massage. Do whatever calming, non-strenuous activities you enjoy.
7. Take acetaminophen for pain, not aspirin or ibuprofen. If you have a headache, it’s okay to take products like Tylenol that use the ingredient acetaminophen. This may alleviate some discomfort. However, do not take Advil, Motrin, or anything containing ibuprofen or aspirin – this could increase the risk of bleeding in your brain.
8. Do NOT injure your head again while you still have concussion symptoms. If you have any remaining symptoms of concussion whatsoever, do not do anything that may cause further brain injury. Avoid riding a bike, playing sports, going on roller coasters – anything that may injure or jostle your brain. Second impact syndrome is caused when you get another concussion before the first heals, and it can cause fast and potentially fatal swelling of your brain. The term” second impact syndrome” is used when there is diffuse brain swelling after a second impact to the head.

1. Be careful when driving. Your response time and ability to focus may be impaired after a concussion, which can make driving dangerous. Avoid driving until your symptoms improve. Speak with your doctor about your symptoms and whether it’s safe for you to drive, ride a bike, or use heavy equipment.

Dealing with Long-Term Recovery

1. Return to mental activity gradually. After your initial time of complete rest, return to work, school, and other mental activities slowly. Start with half days, and speak with employers or teachers about having a lighter workload for several weeks as you ease back in to mental work.
   • Your doctor will likely be willing to write a note for you requesting this if they think you need it.
2. Go back to physical activity slowly, when you’re symptom-free. Do not restart any physical activities or even anything that raises your heart rate until you are free of concussion symptoms and have been checked by your doctor. Then return to playing your sport, riding your bike, or exercising slowly and gradually.
   • It is not uncommon to feel symptoms return when you start to be physical. Let your body be your guide as you increase your activity level. If you start to feel sick, stop your activity for the day and rest. You will gradually build your stamina back up.
   • Many sports teams have a post-concussion return-to-play protocol to ease you back in to your sport safely. If not, do not let anyone convince you to play before you’re well. Ask your doctor or a sports therapist for guidelines, and take responsibility for your health.
   • According to the American Medical Society for Sports Medicine and the American Academy of Neurology, the concern for recurrent concussions has lead to serious consequences such as second impact syndrome and dementia, which has lead to the development of a series of guidelines that address concussion severity and return to play for athletes.
3. Use lists, notes, and help from others until your thinking improves. It can be frustrating trying to return to your daily life while you are having difficulty concentrating, remembering and thinking. These problems will improve, but in the mean time help yourself by making lists of things you have to remember or writing notes as ideas occur to you. Focus on one task at a time.
   • Consult with loved ones you trust before making any important decisions while your brain is recovering.
4. Avoid alcohol. Drinking alcohol or using any drugs that aren’t prescribed to you can delay your recovery. Do not drink alcohol until your doctor tells you that it is safe to do so.
5. Consider if you need to make lifestyle changes. Having had a previous concussion is a risk-factor for getting another concussion, and unfortunately the effects of concussions are cumulative over your lifetime. This means that each subsequent concussion is easier to get, and has more severe symptoms than the last. Suffering from multiple concussions can even cause permanent problems after many years. If you’ve had a concussion, consider what activities are safe for you to do.
   • You may need to refrain from contact sports like football, rugby, hockey, and roller derby, in which concussions are common.
   • Some people find they can no longer go on roller coasters or handle the loud noise of concerts without feeling unwell.
6. Protect yourself from further concussions to the best of your ability. Always wear a helmet and protective gear when playing sports or riding a bicycle or motorcycle. Fasten your seatbelt any time you are in a vehicle. Check your home to ensure there is nothing you may trip over, like a loose rug.
7. Seek a support group. Some people experience symptoms of a concussion for much longer than others, even months or years. If you have to give up activities that you love, refrain from exercising like you once did, or struggle to be as mentally active as before your injury, you may feel discouraged, isolated or depressed. Find a local support group or join an online community to build solidarity with others who are experiencing similar struggles.
   • If you feel deeply depressed, anxious, or have thoughts of self-harm, seek professional care.

Warnings

• Take acetaminophen only as prescribed and discuss its use with your doctor, as it has been known to cause liver problems.

Related Articles

• Treat a Concussion
• Tell If a Person Has a Concussion
• Identify Symptoms of a Head Injury
• Recognize TBI Symptoms in Children (Traumatic Brain Injury)
• Treat Concussion Headaches

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• Tell If a Person Has a Concussion
• Treat a Concussion
• Identify Symptoms of a Head Injury