A concussion is defined as a mild traumatic brain injury (TBI) that temporarily alters brain function. This injury occurs when a blow or jolt causes the brain to move rapidly inside the skull, leading to chemical and physiological changes in the brain cells. Since symptoms can be subtle or worsen unexpectedly, deciding on the appropriate level of medical attention is crucial. Understanding which symptoms signal a life-threatening complication versus a typical recovery process ensures the best possible outcome. This guidance clarifies when an emergency room visit is necessary and when other care options are more suitable.
Immediate Danger Signs That Require an Emergency Room Visit
Specific symptoms, often called “Red Flags,” signal a potentially serious injury, such as a brain bleed or swelling inside the skull. These require immediate medical attention and neurosurgical evaluation. If these signs are present, calling emergency services or going directly to the nearest Emergency Department is the correct course of action.
Red Flags Requiring Immediate ER Visit
- A headache that continuously worsens or fails to improve with non-prescription pain relief, suggesting rising pressure within the skull.
- Repeated vomiting or nausea, especially if it occurs multiple times after the initial injury.
- Any episode of seizure activity, characterized by uncontrolled shaking or twitching.
- Changes in consciousness, including inability to wake the person up, excessive drowsiness, or losing consciousness for any length of time.
- Physical signs like slurred speech, noticeable weakness or numbness in the arms or legs, or a lack of coordination.
- A difference in pupil size, where one pupil appears larger than the other, indicating a life-threatening increase in intracranial pressure.
- Increasing confusion, restlessness, or agitation, where the person cannot recognize people or places.
When Urgent Care or Primary Care is Sufficient
Many concussion symptoms are disruptive but do not indicate a life-threatening emergency. These can be evaluated appropriately in an urgent care center or by a primary care provider, provided none of the severe “Red Flags” were present. Symptoms like a mild, steady headache, minor dizziness, or feeling temporarily dazed are common indicators of a concussion.
Other typical signs include sensitivity to light or noise, a feeling of “fogginess,” or difficulty with concentration and memory. Experiencing mood changes, such as increased irritability or sadness, or minor sleep disturbances are also frequently reported symptoms.
Evaluation should typically occur within 24 to 48 hours to formally diagnose the concussion and establish a recovery baseline. The primary goal is to rule out the need for immediate advanced imaging and receive detailed instructions for safe recovery at home. These providers can also assess the patient’s cognitive function and provide necessary accommodations for school or work. If symptoms worsen rapidly, the emergency department remains the safest option.
Initial Management and Monitoring at Home
Initial management focuses on safety and symptom mitigation following a suspected concussion. The first 24 to 48 hours require relative rest, limiting both physical and cognitive exertion to avoid worsening symptoms. This means reducing activities like intense reading, screen time, and strenuous physical exercise.
The injured person must be monitored and should not be left alone for the first 24 hours to allow a caregiver to watch for any delayed onset of serious symptoms. Normal sleep is necessary for brain recovery, but a caregiver should ensure the person can be roused.
For pain relief, Acetaminophen (Tylenol) is generally recommended. Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or aspirin should be avoided for the first 48 hours due to the potential increased risk of bleeding. Light, non-symptom-provoking physical activity, such as walking, is now encouraged during the first two days. The person should also avoid alcohol and recreational drugs, as these substances interfere with the brain’s recovery process and can mask developing symptoms. If symptoms begin to worsen at any point, immediate medical reassessment is necessary.
Recovery Timelines and Safe Return to Activity
The typical recovery timeline for a concussion varies widely, with most symptoms resolving within a few days to a few weeks. It is important to prioritize a gradual return to normal daily life, including school or work, before attempting a return to high-risk activities. Recovery is guided by a symptom-limited approach, meaning activity levels should not be advanced until symptoms have resolved or stabilized.
A structured, stepwise progression is required for athletes to safely return to sports and physical activity, often referred to as a Return-to-Play protocol. This process involves minimum 24-hour steps of increasing exertion, beginning with light aerobic exercise and progressing to sport-specific activities and non-contact training. If symptoms return during any step, the person must drop back to the previous level of activity and rest until symptom-free for another 24 hours before trying to advance again.
The concept of “Second Impact Syndrome” highlights the danger of sustaining a second concussion before the first has completely healed, which can lead to rapid and severe brain swelling. For this reason, a medical professional must clear the person before they resume any contact sports or activities where there is a risk of a head impact. A full return to cognitive activities should precede a full return to high-intensity sports.