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Although called a "mild" traumatic brain injury, concussions should be taken seriously. Happily, most concussions fully resolve in a few weeks, and life returns to normal. But not always. Even though a concussion isn't physically visible, it's a serious injury. Knowing what a concussion is and what needs to be done in the days and weeks following the injury make the difference in whether symptoms go away in a few weeks or persist for months or years.
What is a concussion?
A concussion is a mild traumatic brain injury (TBI) that disrupts brain function. A blow to the head, whiplash, or anything that causes the head to jerk can cause a concussion.
The exact mechanism of concussions is not well understood. A concussion may or may not involve actual physical damage to the brain tissues. Instead, the injury involves physiological and biochemical disruptions in brain function. It produces all the classic symptoms of a concussion, such as a headache, disorientation, memory loss, and even loss of consciousness.
The Centers for Disease Control and Prevention (CDC) estimates that 1.4 to 3.8 million people in the U.S. have a concussion every year. Car accidents, falls, assault, blows to the head, and sports injuries are the most common causes of concussions.
Although sports injuries make up only a small percentage of concussions, athletes, particularly those in contact sports (especially those that do not require protective headgear), are more at risk for concussion than others. Younger people are more vulnerable than adults. Women may be more vulnerable than men and require more time to recover.
People with previous concussions are considerably more susceptible to a second concussion, which is usually more severe and requires a longer recovery. This heightened vulnerability could linger for months or years. If symptoms from the first concussion have not resolved, a second concussion can sometimes lead to second impact syndrome (SIS)—rare but serious brain damage that could be lethal.
Even though most concussions are mild and quickly resolved, other outcomes are possible depending on the severity of brain trauma and how well the concussion heals.
- Acute concussion: In most people, almost all the concussion symptoms will resolve in two to four weeks.
- Post-concussion syndrome: About 10% to 15% of people who have a concussion will continue to experience concussion symptoms for months or even years after the injury.
- Second-impact syndrome: In rare cases, a second impact before a concussion has healed may cause the brain to swell, a potentially life-threatening condition. Brain swelling may happen days after the concussion, even without a second impact in more exceptional cases.
- Post-traumatic epilepsy: Seizures may follow a concussion in the weeks following the head trauma. The risk for seizures is related to the severity of the injury and how well the concussion has healed.
- Mental illness: Repeat concussions may eventually produce personality changes, depression, or anxiety, depending on the severity of the injuries.
- Chronic traumatic encephalopathy: A long history of repeat concussions can eventually result in progressive brain degeneration with symptoms similar to Alzheimer's or Parkinson's disease.
How is a concussion diagnosed?
The diagnosis of concussion is clinical. The healthcare provider will look for symptoms or signs of a concussion, determine how the injury happened, how long it took for symptoms to appear, any history of previous concussions, and how long the symptoms have lasted.
The doctor will perform a thorough exam that includes a neurological workup, cognition evaluation, and a determination of any emotional changes. They also will assess for more severe brain injury, neck injury, or a skull fracture, all of which are risks.
The doctor will not need blood tests or imaging, such as a CT scan unless there is a more severe injury.
However, people must know concussion symptoms so that they can get medical care if they or another person appears to be concussed. A concussion can disrupt the physical, cognitive, emotional, and sleep functions.
The most common symptoms of concussion are:
Physical concussion symptoms
- Headache
- Dizziness
- Balance problems
- Loss of coordination
- Vision problems
Cognitive concussion symptoms
- Confusion
- Disorientation
- Fogginess
- Loss of memory
- Inability to concentrate
Emotional concussion symptoms
- Irritability
- Mood changes
Sleep problems
- Drowsiness
- Sleeping less or more than usual
- Difficulty falling asleep
Coaches, athletes, and parents should be familiar with concussion assessment tools such as the Sports Concussion Assessment Tool 5 (SCAT5) or the Child SCAT5.
Concussions are graded as mild, moderate, or severe. Mild, or grade 1 concussions have symptoms that resolve in less than 15 minutes. Moderate, or grade 2 concussions, have symptoms that hang on for longer than 15 minutes. Losing consciousness for any amount of time automatically moves the injury into a grade 3 or severe concussion.
The ever-present danger of a concussion is that the problem may be more severe, such as bleeding in the brain (hematoma), or involve other potentially serious injuries, such as neck injury or a skull fracture.
The danger signs of concussion indicating that emergency medical care is needed are:
- Neck pain or tenderness
- One pupil bigger than another
- Double vision
- Slurred speech
- Sleepiness or an inability to be awakened
- Weakness, tingling, or burning in the legs or arms
- Severe headache or increasingly severe headache
- Seizure or convulsions
- Deteriorating conscious state or mental abilities
- Loss of consciousness, even briefly
- Repeated vomiting
- Unusual behavior, restlessness, agitation, or combativeness
Concussion treatment options
Concussions resolve themselves in days or weeks, depending on the severity of the injury. Most people can expect to be 90% recovered in three or four weeks after the injury. The most important treatment is rest and a gradual return to physical and mental activity.
In the days following a concussion, headaches are the most common and often the most debilitating symptom. They can persist for several months after the injury. More than 50% of patients who have headaches after a concussion continue to have headaches up to a year later.
Dizziness is also very common and can persist for a while. About 8 in 10 patients will experience dizziness in the days following a concussion. Finally, most people with concussions will experience problems with sleeping. These symptoms, too, may persist for weeks.
Rest
The gold standard treatment for a concussion is rest from both mental and physical activity. There is no agreement as to how much rest is needed. Too much rest may actually prolong the symptoms.
As a good rule of thumb, the initial rest period should be 24 to 48 hours. As the symptoms subside, patients can gradually resume normal physical and mental activities. Most patients will follow a predetermined set of steps in which they steadily progress back to their normal lives.
Concussion medications
There are no medications that treat concussion or post-concussion syndrome. Medicines may treat symptoms such as headaches or nausea. However, in the first four hours after the injury, bleeding in the brain is a serious risk, so NSAIDs, such as aspirin or ibuprofen, should be avoided. The safest pain medication in the hours or days after a concussion is acetaminophen.
In general, though, health professionals tend to avoid medications during the recovery period. Concussion deranges brain function. It's generally believed that avoiding medications helps the healing process following a head injury. Doctors are in agreement, however, that acetaminophen and drugs to treat dizziness and nausea are useful and don't interfere with the healing process.
Post-concussion syndrome
Most patients (85%-90%) fully recover in a few weeks. In others, however, some or all the symptoms persist. Called post-concussion or post-concussive syndrome, this condition of persisting concussion symptoms will require additional treatment.
Medications can help specific post-concussion syndrome symptoms such as headaches, tension headaches, nausea, dizziness, sleep problems, lack of energy, blood pressure dysregulation, and others.
Cognitive therapy, occupational therapy, sensory-motor therapies, neuromuscular rehabilitation, exercise therapy, and cognitive behavioral therapy can target particular problems and resolve them in support of or in place of medications.
Concussion medications
No medication cures a concussion or expedites recovery. The primary treatment is time and rest. However, many of the symptoms of concussions are treatable with medications.
Pain relievers
The most common concussion symptom is headache, which can be mild, severe, or similar to a tension headache or migraine. Headaches may persist for months after the injury.
In the hours and days following a concussion, over-the-counter acetaminophen is the recommended pain reliever. NSAIDs, such as aspirin and ibuprofen, can cause bleeding problems, and one of the most pressing concerns of a concussion is bleeding in the brain.
Post-concussion syndrome headaches are treatable with over-the-counter or prescription NSAIDs. Opioids, such as tramadol, are rarely used.
Vestibular suppressants
Next to headaches, dizziness and nausea are the most common concussion symptoms. They are both caused by the same mechanism and can be treated with motion sickness drugs (vestibular suppressants), such as antihistamines (over-the-counter Dramamine) or anticholinergics (Scopolamine). These drugs reduce the brain's sensitivity to movement in the inner ear (vestibule) that causes dizziness and nausea after a concussion.
Antidepressants
The next most common symptoms are sleep problems and mood problems. Behavior changes and depression are much more common after a concussion than people realize. Tricyclic antidepressants, SSRIs (selective serotonin reuptake inhibitors), and SNRIs (serotonin and norepinephrine reuptake inhibitors) can alleviate sleep problems and mood problems.
Stimulants
To help with confusion, inattention, concentration, a healthcare provider may prescribe a stimulant such as methylphenidate or dextroamphetamine.
Other medications
The brain is a complex organ. Damage done to the brain by a concussion can spawn any number of problems. Specialized medications are useful when these problems persist for weeks or months.
- Sleep medications: For post-concussion syndrome, the recommended sleep medications are antidepressants and trazodone. Benzodiazepines, antihistamines, and sedatives are generally not advised for sleep problems due to concussion.
- Anxiety medications: Anti-anxiety medications may relieve anxiety and sleep problems due to post-concussion syndrome. Benzodiazepines, such as Xanax, are generally not advised.
- Triptans: Triptans prevent tension headaches or migraines.
- Blood pressure medications: Blood pressure dysregulation sometimes occurs after a concussion and is controlled with blood pressure medications.
- Seizure medications: Post-traumatic epilepsy is treatable with seizure medications.
- Hormone medications: Concussions can sometimes damage the parts of the brain that regulate hormones—the pituitary gland and the hypothalamus. A doctor may prescribe hormone replacement medications or hormone inhibitors.
What are the best medications for a concussion?
No medication treats concussion. Sometimes, however, medications will be used to treat symptoms like headaches, dizziness, or nausea. For headache pain, the drug of choice is acetaminophen. A variety of medications may treat post-concussion syndrome, depending on the symptoms.
| Best medications for a concussion | ||||
|---|---|---|---|---|
| Drug Name | Drug Class | Administration Route | Standard Dosage | Common Side Effects |
| Tylenol (acetaminophen) | Analgesic | Oral | 2, 325 mg tablets every 4-6 hours | Nausea, stomach pain, loss of appetite |
| Dramamine (dimenhydrinate) | Antihistamine (vestibular suppressant) | Oral | 1-2 tablets every 4-6 hours | Drowsiness, constipation, dry mouth |
| Transderm scop (scopolamine transdermal system) | Anticholinergic (vestibular suppressant) | Transdermal | 1, 1 mg patch placed behind the ear for 3 days | Dry mouth, dizziness, sleepiness |
The standard dosages above are from the U.S. Food and Drug Administration (FDA) and the National Institutes of Health (NIH). Your doctor determines your dosage based on your medical condition, response to treatment, age, and weight. Other possible side effects exist; this is not a complete list.
What are the common side effects of concussion medications?
Different classes of medications have different side effects. However, this is not a complete list. You should consult with a healthcare professional for medical advice on how to avoid possible side effects and drug interactions based on your specific situation.
Acetaminophen is a safe drug with relatively few side effects, including nausea, stomach pain, and appetite loss. The most dangerous adverse event is acetaminophen poisoning due to overdose or misuse. Excessive intake of acetaminophen can damage the liver permanently.
Anticholinergics and antihistamines can cause drowsiness and dizziness, primarily due to standing up suddenly. Other side effects include dry mouth, dry eyes, blurred vision, and urinary retention. Anticholinergics may cause heart rhythm problems and confusion. Antihistamines can result in anemia, low blood pressure, seizures, shock, and heart rhythm problems.
The most common side effect of antidepressants is dry mouth, but they can also cause digestion problems, dizziness, loss of appetite, and agitation. The most serious side effect, mainly when used to treat depression, is an increased risk of suicide.
Stimulants can cause excitability, restlessness, nausea, and behavior changes. The most serious side effects of stimulants are fast heart rate, increased blood pressure, and psychosis.
What is the best home remedy for a concussion?
A concussion injury isn't visible in the same way as a broken leg or a burn. Patients can't see a concussion "get better," so they often don't allow the injury enough time and rest to heal. Concussion recovery will take anywhere from two to four weeks, so, even in the absence of symptoms, it's crucial to give concussions proper time to mend.
In the days following a concussion, it's a good idea to take time off from work, physical activity, and other exertions. Returning to normal activities should be gradual and take a few weeks to accomplish.
1. Rest
After a concussion, the best treatment is physical and mental rest for one or two days. Plan to take a few days off from work or school. Avoid mental or emotional excitement. It's also a good idea to take a total break from screen time for a couple of days.
2. Exercise
However, you should plan to introduce basic physical exercise (such as walking) one or two days after the concussion. After you exercise, try spending fifteen or twenty minutes engaged in a simple cognitive activity like reading or doing a crossword puzzle. Moderate physical activity and mental exertion help the healing process.
3. Gradually return to normal activities
Plan out a gradual return to normal activities. Along with beginning easy exercise a couple of days after the injury, take some time to read, study, or work, and reintroduce screen time with regular breaks. Monitor your symptoms while you engage in activities. You can gradually increase the time you spend on activities if you don't experience symptoms.
4. Maintain good sleep hygiene
Sleep disturbance is one of the central symptoms of a concussion and can interfere with the healing process. Practice good sleep hygiene by going to bed at the same time every night, turn off the light at bedtime, and eliminate distractions. Relax before bedtime and avoid heavy meals, excitement, or stimulants like caffeine.
5. Avoid activities that may move the head suddenly
Keep your head stable. A concussion is caused by moving the brain around, so avoid exercise or physical activity that may cause the head to move around. Avoid activities that carry a risk of falling, like bicycling. Any fall or sudden head movement may make the concussion worse.
6. Eat healthy foods
Healthcare providers almost universally advise a high protein diet with nutrient-rich foods following a concussion. If ever there was a right time to eat right, it's right after an injury.
Frequently asked questions about a concussion
How do you treat a concussion at home?
A concussion is treated at home by rest and a gradual return to physical and mental activity.
How long does it take to recover from a concussion?
About 85%-90% of patients recover in three to four weeks after the injury. The remainder may have symptoms for months or even years, depending on the severity of the injury, how well the injury healed, and their history of repeat concussions.
How do doctors treat a concussion?
The treatment for a concussion is rest and a gradual return to normal physical, mental, and work activities.
What should you do after a concussion?
Depending on the symptoms, it is a good idea to see a doctor. He or she can diagnose the concussion and rule out any more severe problems. After diagnosis, you should rest from physical or mental activity for 24 to 48 hours. You can gradually reintroduce physical and mental activities over the next few days, depending on symptoms until you are ready to resume normal activities.
What medication is used post-concussion?
Concussion symptoms and post-concussion syndrome symptoms can be treated with medications (though medications don't treat the concussion itself). In general, in the weeks following a concussion, the only medicines advised will be over-the-counter acetaminophen for headache and pain, and Dramamine to help relieve nausea or dizziness.
What medicine should you not take with a concussion?
There is always a risk of bleeding in the brain after a concussion. Pain relievers like ibuprofen, aspirin, and other NSAIDs are blood thinners and increase the risk of bleeding in the brain, so you should not take them following a concussion.
Can Xanax help with a concussion?
Xanax is an anti-anxiety medication and may be used to treat anxiety in patients diagnosed with post-concussion syndrome. It is generally not advised because of other effects on the brain that may interfere with healing.
Resources
- Neuropsychological and Neurophysiological Assessment of Sport Concussion in Children, Adolescents, and Adults
- Trends in Concussion Incidence in High School Sports: A Prospective 11-Year Study
- Concussion
- SCAT5
- Results of otovestibular tests in mild head injuries
- Guideline for Concussion/Mild Traumatic Brain Injury & Persistent Symptoms