What Are Signs of a Concussion?

Concussions are caused by bumps, blows, jolts, or other impact to the head, or by hits to the body. 

Common causes of concussions include:

• Motor vehicle accidents
• Sports injuries or hits
• Bicycling accidents
• Falls
• Beatings or other kinds of physical abuse

A concussion is diagnosed with a patient history, neurological assessment, and metal status testing. 

The patient history includes asking the patient to describe the incident in as much detail as possible to assess any memory loss.  

A neurologic examination includes assessment of:

• Cranial nerves III through VII (extraocular movements, pupillary reactivity, face sensation, and movement) 
• Limb strength 
• Coordination 
• Gait

Mental status testing may include assessment of: 

• Attention 
• Concentration
• Short-term memory 

Other tools used to evaluate a concussion include: 

• Standardized Assessment of Concussion (SAC) 
  • A standardized tool for the sideline evaluation of athletes who suffer a head injury
  • Includes measures of orientation, immediate memory, concentration, delayed recall, neurologic screening, and exertional maneuvers 
• Post-Concussion Symptom Scale and Graded Symptom Checklist
  • Requires the patient to rate severity of symptoms on a 7-point scale (0 = none; 6 = severe) for 15 to 30 symptoms associated with concussion (e.g., headache, dizziness, irritability, difficulty concentrating)
• Sport Concussion Assessment Tool (SCAT5) which includes 
  • A review of subjective symptoms
  • The Glasgow Coma Scale (GCS)
  • SAC cognitive assessment
  • Evaluation of balance and coordination
• Westmead post-traumatic amnesia scale (WPTAS) 
  • Takes less than one minute in an emergency department setting 
  • Involves a series of simple questions such as the patient’s name, name of the place, why they are there, month and year, town, age, date of birth, time of day, and pictures for recall
  • Any incorrect response to any question on the WPTAS is considered a sign of cognitive impairment after head injury

Imaging tests used to diagnose the extent of a concussion include: 

• Computed tomography (CT) of the head
• Magnetic resonance imaging (MRI)

A mild concussion may not need treatment. Most concussions get better on their own over time. 

A mild concussion may last only hours to 7 to 10 days. More severe concussions may last weeks to months. Symptoms that persist are called “post-concussion syndrome.”

Home treatment for a mild concussion includes:

• Rest your body and brain
  • Get plenty of sleep
  • Avoid too much physical activity 
  • Avoid activities that need concentration or a lot of attention 
• Avoid alcohol while symptoms are still present
• Over-the-counter (OTC) pain relievers such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin)

Post-concussion syndrome, also called persistent post-concussion symptoms, refers to symptoms of a concussion (traumatic brain injury) that last longer than the normal expected time frame for recovery.

Treatment for post-concussion syndrome may involve a combination of modalities. The goal of treatment is to relieve symptoms of post-concussion syndrome. 

Treatments endorsed by the 5th International Consensus on Concussion include: 

• Individualized aerobic exercise program (also called graduated exercise therapy, or graded exercise therapy) for patients whose symptoms are associated with autonomic nervous system dysfunction (such as problems with blood pressure and breathing)
• Physical therapy program in patients with neck (cervical spine) or vestibular dysfunction
• Cognitive behavioral therapy (CBT) to learn to cope with chronic mood or behavioral issues

Additional treatments for post-concussion syndrome may include:

• Vision therapy
• Vestibular therapy 
• Medications used to treat symptoms such as:
  • Post-traumatic headaches (including migraines)
  • Depression
  • Anxiety
  • Insomnia
  • Pain
• Light therapy (photobiomodulation) 
• CBD/medical marijuana
• Craniosacral therapy
• Massage therapy
• Hormone therapy