You do not have to lose consciousness to have had a concussion. The after-effects are often the part nobody treats.
What is a concussion?
A concussion is a functional brain injury. That means the brain works wrong even though nothing shows on a scan. It comes from the head speeding up and slowing down fast. In a crash it often happens without the head hitting anything.
It often shows up together with whiplash. The two cause overlapping symptoms. That is why sorting them out matters.
What are the symptoms of a concussion?
- Headache, often daily, in the weeks after the injury.
- Trouble focusing, or feeling a step slow.
- Light and noise bother you.
- Poor sleep, and more tiredness than your activity explains.
- Short temper and low mood that is not like you.
- Dizziness or a sense of imbalance.
How is a concussion treated?
- A careful exam, including whether the headache is coming from the neck rather than the brain. A cervicogenic headache is treated very differently.
- A step-by-step return to activity, not complete rest. Complete rest makes recovery take longer.
- Treatment of the neck injury, which often improves the headache.
- Referral when symptoms are severe, worsening or lasting.
To be assessed, call us or request an appointment. If this began with a crash or a fall, see accident and injury care.
What usually gets missed
The costliest miss is blaming a headache after a crash on the brain when it is coming from the neck. Cervicogenic headache (headache from the neck) and post-concussion headache look almost the same. But the neck can be treated in a way the brain injury cannot.
The second miss is thinking a normal CT rules out concussion. A CT looks for blood and broken bone. Concussion is a functional injury. Nothing shows up on routine scans, so a normal scan is expected. It is not reassuring.
How long does a concussion last?
Most concussions clear up within two to four weeks. A smaller group has symptoms for months. How hard the impact was is not the strongest sign of who that will be. The strongest signs are a past concussion, migraine, and, above all, how the first two weeks were handled.
Complete rest past the first day or two makes recovery take longer. A step-by-step return to thinking and physical activity works better, and the results are measurable. Stay just below the point where symptoms kick in, and build up slowly.
When should you go to the ER after a head injury?
Go back to an emergency department for a headache that keeps getting worse, repeated vomiting, seizure, weakness or numbness on one side, slurred speech, pupils of different sizes, or growing drowsiness or confusion. Anyone taking anticoagulants (blood thinners) who has hit their head should be checked, no matter how well they feel.
Common questions
How long do symptoms last?
Most clear up within weeks. A smaller group lasts for months. That group does better with a proper exam than with waiting it out.
The CT was normal. Does that mean no concussion?
A CT looks for bleeding and broken bone. Concussion is a functional injury and does not show up on it.
There is more on this in Post-Concussion Symptoms and PTSD After an Accident.
Can you have a concussion without hitting your head or passing out?
Yes. You do not have to lose consciousness to have a concussion. It is a brain injury caused by fast speeding up and slowing down. In a car crash it often happens without the head hitting anything. It also tends to come with whiplash. The two cause overlapping symptoms, which is why they need to be sorted out.
What do they do at a concussion clinic?
Here, the visit starts with a careful exam. That includes whether your headache is coming from the neck rather than the brain, because a neck-driven headache is treated very differently. Treatment is a step-by-step return to activity, not complete rest. We also treat the neck injury, which often improves the headache. Severe, worsening or lasting symptoms are referred on.
Can you fully recover from a concussion?
Most concussions clear up within two to four weeks. A smaller group has symptoms for months. The strongest predictors of that are a prior concussion, migraine, and how the first two weeks were handled, not how hard the impact was. Staying active just below your symptom level, and building up gradually, gives measurably better results than long rest.
Are concussion clinics worth it?
For the smaller group whose symptoms last beyond a few weeks, yes. That group does better with a proper exam than with waiting it out. The most common miss is blaming a headache after a crash on the brain when it is coming from the neck. The neck can be treated in a way the brain injury cannot. A normal CT scan does not rule out a concussion.
Dizziness and unsteadiness after a head injury can come from the inner ear, the neck, or the concussion itself. Each needs different treatment. Balance and fall-risk assessment tells them apart.
Sources
- Patricios JS et al. Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport-Amsterdam, October 2022. British journal of sports medicine, 2023. PubMed 37316210
- Levin HS et al. Diagnosis, prognosis, and clinical management of mild traumatic brain injury. The Lancet. Neurology, 2015. PubMed 25801547
- Quatman-Yates CC et al. Physical Therapy Evaluation and Treatment After Concussion/Mild Traumatic Brain Injury. The Journal of orthopaedic and sports physical therapy, 2020. PubMed 32241234
- Kim K et al. Evaluation of current post-concussion protocols. Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie, 2020. PubMed 32768934
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