If you have a concussion, your doctor will perform a neurological exam, assess your symptoms and thinking ability, and in most cases send you home with specific instructions for rest and a gradual return to normal activity. CT scans are only ordered when certain red flags are present. The vast majority of concussions don’t require surgery or hospital admission, but they do require medical evaluation and a structured recovery plan.
The Neurological Exam
The first thing a doctor does is a hands-on neurological exam. This checks how well your brain is communicating with the rest of your body. You’ll be asked to follow a finger or light with your eyes, which tests several cranial nerves responsible for eye movement. The doctor will touch your face in different spots, check your hearing, and may have you identify smells with your eyes closed.
Next comes motor function and balance. You’ll push and pull against the doctor’s hands with your arms and legs to check for weakness. You may be asked to stand with your eyes closed while the doctor gently pushes you to one side, or simply walk across the room so they can observe your gait. The doctor will also tap your joints with a reflex hammer to make sure your reflexes are responding normally. A sensory exam using dull needles, tuning forks, or alcohol swabs checks whether you can feel touch and temperature properly.
Cognitive and Memory Testing
Beyond the physical exam, your doctor needs to evaluate how your brain is processing information. A standardized tool called the SCAT6 is widely used, especially in sports settings. It covers three main areas: symptoms, thinking, and memory.
The symptom checklist runs through 22 items you rate by severity, including headache, pressure in the head, nausea, dizziness, blurred vision, feeling “in a fog,” difficulty concentrating, fatigue, and trouble falling asleep. For the cognitive screening, you’ll answer orientation questions (what month it is, today’s date, the current time) and then do concentration tasks like reciting numbers backward or listing the months of the year in reverse order as fast as you can.
Memory testing involves listening to a list of words three times and repeating back as many as you can after each reading. Then, at least five minutes later, the doctor asks you to recall that same list without hearing it again. This delayed recall portion is particularly telling because concussions commonly disrupt short-term memory formation. If you were injured during a game, you might also get situational questions like “What venue are we at?” or “Who scored last?” to check whether you’re oriented to recent events.
When a CT Scan Is Needed
Most concussions don’t show up on imaging because they involve functional brain disruption, not structural damage like bleeding or fractures. Doctors use a specific set of criteria to decide whether a CT scan is necessary. A scan is typically ordered if you have any of these high-risk factors: your level of consciousness hasn’t returned to normal within two hours, there’s a suspected skull fracture, you’ve vomited two or more times, or you’re 65 or older.
Two additional factors raise moderate concern: memory loss of more than 30 minutes for events before the injury, or a dangerous mechanism of injury (like being hit by a car or falling from a significant height). When doctors apply these criteria, only about half of head injury patients actually need a scan, which avoids unnecessary radiation exposure while still catching the injuries that require immediate intervention.
Pain Management in the First Few Days
For headache pain, doctors recommend acetaminophen (Tylenol). They specifically advise against ibuprofen (Advil, Motrin) and aspirin in the early period after a concussion because these medications can increase the risk of bleeding. This is a detail that catches many people off guard since ibuprofen is a go-to for most headaches. If your headaches are severe or not responding to acetaminophen, that’s worth reporting back to your doctor rather than switching to a different over-the-counter option on your own.
Rest, but Not Too Much
The approach to rest after a concussion has changed significantly. Doctors used to prescribe days of lying in a dark room, but current guidelines take a different approach. For the first one to two days, you should limit screen time and avoid activities that are physically or mentally demanding. Rest when you need it, but don’t isolate yourself in darkness all day.
Even in those early days, light physical activity like going for walks is encouraged, even if you still have mild symptoms. The goal is to gradually reintroduce normal activity rather than shutting everything down completely. Prolonged inactivity can actually slow recovery and contribute to mood problems.
The Return-to-School Plan
If you’re a student (or the parent of one), your doctor will outline specific accommodations the school should put in place temporarily. These are practical adjustments that get scaled back as symptoms improve:
- Workload changes: Assignments reduced to key tasks only, extra time on tests (limited to one per day), written instructions, and class notes provided so you’re not relying entirely on focus and memory during lectures.
- Physical accommodations: Rest breaks throughout the day, extra time between classes to avoid crowded hallways, sunglasses or seating away from bright windows, and access to a quiet space for studying or taking tests.
- Emotional support: An identified adult at school to talk to if you’re feeling overwhelmed, plus a quiet place to go during lunch or recess. Concussions commonly cause mood changes, irritability, and anxiety, and schools should have a plan for that.
The Six-Step Return to Sports
Athletes follow a structured, stepwise progression before getting back to competition. Each step takes a minimum of 24 hours, and you only move forward if symptoms don’t worsen. If they do, you drop back to the previous step.
It starts with returning to regular daily activities like school (Step 1), then progresses to light aerobic exercise for 5 to 10 minutes, such as walking or a stationary bike, with no weight lifting (Step 2). Step 3 adds moderate activity with head movement, like jogging and lighter-than-usual weightlifting. Step 4 ramps up to sprinting, high-intensity biking, and full weightlifting, but still no contact. Step 5 is full practice with contact, and Step 6 is competition. Your doctor has to give clearance before you begin this progression and typically before you advance to the contact stages.
What Happens if Symptoms Linger
Most adults recover fully within about two weeks. Children take longer: 70% to 80% are back to normal within one to three months. When symptoms persist beyond those windows, doctors take a multidisciplinary approach. This can mean referral to a physician who specializes in concussion management, formal neuropsychological testing to map exactly which cognitive functions are affected, and coordination with teachers, employers, or coaches to manage ongoing limitations.
Depending on your specific symptoms, you might be referred to a vestibular therapist if you’re dealing with persistent dizziness or balance problems, or to a vision specialist if eye-tracking issues aren’t resolving. The key is that prolonged symptoms don’t mean permanent damage. They mean your brain needs a more targeted recovery plan than the standard rest-and-progression approach.
Danger Signs That Need Emergency Care
After your initial evaluation, your doctor will send you home with a list of warning signs to watch for. Go to an emergency room immediately if you experience any of the following: seizures or convulsions, inability to recognize people or places, repeated vomiting, increasing confusion or agitation, growing drowsiness or inability to stay awake, slurred speech, weakness or numbness on one side of the body, a headache that keeps getting worse, or one pupil that’s noticeably larger than the other. These can signal bleeding or swelling in the brain that wasn’t present at your initial visit.
For infants and toddlers, the same danger signs apply, along with inconsolable crying and refusal to eat or nurse. Someone should check on a concussed person periodically during the first night after injury to make sure they can be woken up and are responding normally.