Facts About Concussion and Brain Injury

What Is a Concussion?

A concussion is a type of traumatic brain injury—or TBI—caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging brain cells.

Concussions Are Serious

Medical providers may describe a concussion as a “mild” brain injury because concussions are usually not life-threatening. Even so, the effects of a concussion can be serious.

Because the brain is very complex, every brain injury is different. Some symptoms may appear right away, while others may not show up for days or weeks after the concussion. Sometimes the injury makes it hard for people to recognize or to admit that they are having problems.

The signs of concussion can be subtle. Early on, problems may be missed by patients, family members, and doctors. People may look fine even though they’re acting or feeling differently.

Because all brain injuries are different, so is concussion recovery. Most people with mild injuries recover fully, but it can take time. Some symptoms can last for days, weeks, or longer.

In general, recovery is slower in older persons. Also, persons who have had a concussion in the past may find that it takes longer to recover from their current injury.

This article explains what can happen after a concussion, how to get better, and where to go for more information and help when needed.

Medical Help

People with a concussion need to be seen by a doctor. While most are seen in an emergency department or a doctor’s office, some people must stay in the hospital overnight.

Your doctor may do a scan of your brain (such as a CT scan) or other tests. Other tests, known as “neuropsychological” or “neurocognitive” tests, assess your learning and memory skills, your ability to pay attention or concentrate, and how quickly you can think and solve problems. These tests can help your doctor identify the effects of a concussion. Even if the concussion doesn’t show up on these tests, you may still have a concussion.

Your doctor will send you home with important instructions to follow. Be sure to follow all of your doctor’s instructions carefully.

If you are taking medications—prescription, over-the-counter medicines, or “natural remedies”—or if you drink alcohol or take illicit drugs, tell your doctor. Also, tell your doctor if you are taking blood thinners (anticoagulant drugs), such as Coumadin and aspirin, because they can increase the chance of complications.

Danger Signs

In rare cases, a dangerous collection of blood (hematoma) may form on the brain after a bump, blow, or jolt to the head or body that may squeeze the brain against the skull. Call 9-1-1 right away or contact your doctor or emergency department if you have one or more of the following danger signs after a bump, blow, or jolt to the head or body:

• One pupil larger than the other.
• Drowsiness or inability to wake up.
• A headache that gets worse and does not go away.
• Slurred speech, weakness, numbness, or decreased coordination.
• Repeated vomiting or nausea, convulsions or seizures (shaking or twitching).
• Unusual behavior, increased confusion, restlessness, or agitation.
• Loss of consciousness (passed out/knocked out). Even a brief loss of consciousness should be taken seriously.

Danger Signs — Children, Toddlers, and Infants

Take your child to the emergency department right away if the child has received a blow or jolt to the head and:

• Any of the signs and symptoms listed in the Danger Signs & Symptoms of a Concussion list.
• Will not stop crying and cannot be consoled.
• Will not nurse or eat.

Symptoms of Brain Injury

“I just don’t feel like myself.”

Persons of All Ages

Most people with a concussion have one or more of the symptoms listed below and recover fully within days, weeks or a few months. But for some people, symptoms of concussion can last even longer. Generally, if you feel that “something is not quite right,” or if you are feeling “foggy,” you should talk with your doctor.

Concussion symptoms are often grouped into four categories, including:

• Remembering and Thinking
  • Difficulty thinking clearly
  • Feeling slowed down
  • Difficulty concentrating
  • Difficulty remembering new information
• Physical
  • Headache
  • Nausea or vomiting (early on)
  • Balance problems
  • Dizziness
  • Fuzzy or blurry vision
  • Feeling tired, having no energy
  • Sensitivity to noise or light
• Emotional/Mood
  • Irritability
  • Sadness
  • More emotional
  • Nervousness or anxiety
• Sleep Disturbance
  • Sleeping more than usual
  • Sleeping less than usual
  • Trouble falling asleep

Some of these symptoms may appear right away, while others may not be noticed for days or months after the injury, or until the person starts resuming their everyday life and more demands are placed upon them. Sometimes, people do not recognize or admit that they are having problems. Others may not understand why they are having problems and what their problems really are, which can make them nervous and upset.

The signs and symptoms of a concussion can be difficult to sort out. Early on, problems may be missed by the person with the concussion, family members, or doctors. People may look fine even though they are acting or feeling differently.

Young Children

Very young children (i.e., infants, toddlers, and preschoolers) often bump and bruise their heads. This can happen as a result of motor vehicle crashes, falls, getting hit in the head with a ball or toy, or from tricycle/bike accidents. Sometimes these events can be serious and result in a concussion.

Young children can have the same symptoms of a concussion as older children, but it is harder for them to let others know how they are feeling. In addition to the symptoms mentioned on page 5, call your child’s doctor right away if your child seems to be getting worse or if you notice any of the following:

• Crying more than usual
• Headache that will not go away
• Change in the way they play, perform or act at school
• Change in nursing, eating, or sleeping patterns
• Becoming easily upset or increased temper tantrums
• Sad mood
• Lack of interest in usual activities or favorite toys
• Loss of new skills, such as toilet training
• Loss of balance, unsteady walking
• Poor attention

Older Adults

Because concussions are often missed or misdiagnosed among older adults, be especially alert if you know that an older adult has fallen or has a fall-related injury, such as a hip fracture. Older adults may have a higher risk of serious complications from a concussion, such as bleeding on the brain. Headaches that get worse or increased confusion are signs of this complication. If they occur, see a doctor right away. Older adults often take blood thinners; if they do, they should be seen immediately by a health care provider if they have a bump or blow to the head or body even if they do not have any of the symptoms listed above.

Getting Better

“Sometimes the best thing you can do is just rest and then try again later.”

Although most people recover fully after a concussion, how quickly they improve depends on many factors. These factors include how severe their concussion was, their age, how healthy they were before the concussion, and how they take care of themselves after the injury.

Some people who have had a concussion find that at first it is hard to do their daily activities, their job, to get along with everyone at home, or to relax. Ignoring your symptoms and trying to “tough it out” often makes symptoms worse.

Rest is very important after a concussion because it helps the brain to heal. You’ll need to be patient because healing takes time. Only when the symptoms have reduced significantly, in consultation with your doctor, should you slowly and gradually return to your daily activities, such as work or school. If your symptoms come back or you get new symptoms as you become more active, this is a sign that you are pushing yourself too hard. Stop these activities and take more time to rest and recover. As the days go by, you can expect to gradually feel better.

If you already had a medical condition at the time of your concussion (such as chronic headaches), it may take longer for you to recover from the concussion. Anxiety and depression may also make it harder to adjust to the symptoms of a concussion. While you are healing, you should be very careful to avoid doing anything that could cause a bump, blow, or jolt to the head or body. On rare occasions, receiving another concussion before the brain has healed can result in brain swelling, permanent brain damage, and even death, particularly among children and teens.

After you have recovered from your concussion, you should protect yourself from having another one. People who have had repeated concussions may have serious long-term problems, including chronic difficulty with concentration, memory, headache, and occasionally, physical skills, such as keeping one’s balance.

Tips for Healing: Adults

Here are a few tips to help you get better:

• Get plenty of sleep at night, and rest during the day.
• Avoid activities that are physically demanding (e.g., heavy housecleaning, weightlifting/working-out) or require a lot of concentration (e.g., balancing your checkbook). They can make your symptoms worse and slow your recovery.
• Avoid activities, such as contact or recreational sports, that could lead to a second concussion. (It is best to avoid roller coasters or other high-speed rides that can make your symptoms worse or even cause a concussion.)
• When your doctor says you are well enough, return to your normal activities gradually, not all at once.
• Because your ability to react may be slower after a concussion, ask your doctor when you can safely drive a car, ride a bike, or operate heavy equipment.
• Talk with your doctor about when you can return to work. Ask about how you can help your employer understand what has happened to you.
• Consider talking with your employer about returning to work gradually and about changing your work activities or schedule until you recover (e.g., work half-days).
• Take only those drugs that your doctor has approved.
• Do not drink alcoholic beverages until your doctor says you are well enough. Alcohol and other drugs may slow your recovery and put you at risk of further injury.
• Write down the things that may be harder than usual for you to remember.
• If you’re easily distracted, try to do one thing at a time. For example, don’t try to watch TV while fixing dinner.
• Consult with family members or close friends when making important decisions.
• Do not neglect your basic needs, such as eating well and getting enough rest.
• Avoid sustained computer use, including computer/video games early in the recovery process.
• Some people report that flying in airplanes makes their symptoms worse shortly after a concussion.

Tips for Healing: Children

Parents and caregivers of children who have had a concussion can help them recover by taking an active role in their recovery:

• Having the child get plenty of rest. Keep a regular sleep schedule, including no late nights and no sleepovers.
• Making sure the child avoids high-risk/ high-speed activities such as riding a bicycle, playing sports, or climbing playground equipment, roller coasters or rides that could result in a second bump, blow, or jolt to the head or body. Children should not return to these types of activities until the doctor says they are well enough.
• Giving the child only those drugs that are approved by the pediatrician or family physician.
• Talking with the doctor about when the child should return to school and other activities and how the parent or caregiver can help the child deal with the challenges that the child may face. For example, your child may need to spend fewer hours at school, rest often, or require more time to take tests.
• Sharing information about concussion with parents, siblings, teachers, counselors, babysitters, coaches, and others who interact with the child helps them understand what has happened and how to meet the child’s needs.

Where to Get Help

Help for People with Concussion

“It was the first time in my life that I couldn’t depend on myself.”

There are many people who can help you and your family as you recover from a concussion. You do not have to do it alone.

Show this article to your doctor or health care provider and talk with them about your concerns. Ask your doctor about whether you need specialized treatment and about the availability of rehabilitation programs.

Your doctor can help you find a health care provider who has special training in treating concussion. Early treatment of symptoms by a specialist may speed recovery. Your doctor may refer you to a neuropsychologist, neurologist, or specialist in rehabilitation.

Keep talking with your doctor, family members, and loved ones about how you are feeling, both physically and emotionally. If you do not think you are getting better, tell your doctor.

For more information, see the resources listed below.

Help for Families and Caregivers

“My husband used to be so calm. But after his injury, he started to explode over the littlest things. He didn’t even know that he had changed.”

When someone close to you has a concussion or a more serious brain injury, it can be hard to know how best to help. They may say that they are “fine” but you can tell from how they are acting that something has changed.

If you notice that your family member or friend has symptoms of a concussion that are getting worse, talk to them and their doctor about getting help. They may need help if you can answer YES to any of the following questions:

• Are any of the concussion symptoms substantially affecting their life activities (such as feeling restricted in their activities due to symptoms, performance in school or at work has changed, unhappy with life changes)?
• Has their personality changed?
• Do they get angry for no reason?
• Do they get lost or easily confused?
• Do they have more trouble than usual making decisions?

You might want to talk with people who share your experience. The Brain Injury Association of America can put you in contact with people who can help (listed in the resource section below).

Resources for Getting Help

“I thought I was all alone, but I’m not. There are lots of people out there who understand what I’ve been through.”

Several groups help people and their families deal with concussion and more serious brain injuries. They provide information and put people in touch with local resources, such as support groups, rehabilitation services, and a variety of health care professionals.

• CDC’s Injury Center has created resources and conducts research to help prevent concussion and more serious brain injuries and improve outcomes for survivors. For more information contact CDC toll-free at 1-800-CDC-INFO (1-800-232-4636) or visit CDC’s Injury Center on the Web at www.cdc.gov/TraumaticBrainInjury.
• The Brain Injury Association of America (BIAA) has a national network of many state affiliates and hundreds of local chapters and support groups across the country that provide help in your community.

  You can reach BIAA by calling the toll-free National Brain Injury Information Center at 1-800-444-6443.

  You can also get information through their website at www.biausa.org. Both the help line and the website can provide you with information about the BIAA affiliate closest to you.

• Traumatic Brain Injury Center of Excellence (formerly Defense and Veterans Brain Injury Center - DVBIC) works to ensure that active duty military and veterans with brain injury receive the best evaluation, treatment, and follow-up. You can reach TBICoE by calling toll-free at 1-800-870-9244 or by visiting their website.

  For more information about TBI in the military, including an interactive website for service members, veterans, and families and caregivers, please visit: Traumatic Brain Injury Center of Excellence

From the Centers for Disease Control and Prevention. www.cdc.gov.
Disclaimer: This information is not meant to be a substitute for professional medical advice. The reader is advised to always seek the advice of a physician prior to changing any treatment or to receive answers to questions regarding a specific medical condition.