Is It a Concussion – or Worse? How You Can Tell

Less than 10 percent involve losing consciousness

Female having terrible headache

Millions of concussions occur each year. But if you or a loved one suffer a blow to the head, it’s important to keep a close watch for symptoms of an even more severe brain injury.

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What to watch for

The most common symptoms of concussion are a simple headache or dizziness. Fewer than 10 percent of sports-related concussions involve a loss of consciousness.

But certain symptoms should send up a red flag, says neurologist Andrew Russman, DO.

“Worrisome things that make you think that something more than a concussion is going on are symptoms like severe unrelenting headache, excessive drowsiness, severe nausea or significant vomiting, and bizarre or unusual behavior,” Dr. Russman says.

Bloody or clear discharge from the nose or ear, severe neck pain, fogginess and dizziness also are cause for concern, Dr. Russman says.

Such symptoms may worsen over the first 48 hours. Someone who has suffered a concussion should not be left alone during this time.

Some of these symptoms could signal a more serious, potentially life-threatening condition like bleeding in the brain, or swelling of the brain tissue.

If you or your loved one notice any of these warning signs, Dr. Russman says, it’s extremely important to see a doctor immediately.

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“All these are very worrisome signs that should take us to the emergency department,” he says. “Don’t wait for an office appointment or outpatient evaluation.”

How to heal

Most concussions will resolve within 10 to 14 days, Dr. Russman says. However, some people will take much longer to recover.

Undiagnosed, unrecognized or poorly treated concussions can significantly prolong the recovery period. This can take anywhere from the expected short, one- to two-week recovery to months or possibly even longer.

Athletes who have had a concussion should be completely symptom-free and off medications that helped them to improve before they’re allowed to return to play to prevent more serious complications, Dr. Russman says.

But waiting until your child is symptom-free before returning to play sports doesn’t mean a complete rest for the brain while recuperating.

Studies over the past few years show that excessive cognitive rest may be associated with prolonged concussion symptoms.

“I don’t tell people anymore to avoid TV or the phone or the computer,” Dr. Russman says, “I tell them to avoid symptoms getting significantly worse with these activities.”

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Sensitized to stimuli

When someone rests too long mentally, they may become sensitive to stimuli that they no longer experience. Once those stimuli are introduced again, concussion symptoms can reappear.

Ideally, a slow progression of mental activity is best for most kids.

Dr. Russman tells his patients to use their devices, watch TV, etc. in small doses. If symptoms begin to flare, like headaches or confusion, he suggests simply backing off of the activity a bit.

“Give them an exposure that doesn’t worsen their symptoms,” Dr. Russman says.

More information

Concussion treatment guide


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