Concussion - adults - discharge
Brain injury - concussion - discharge; Traumatic brain injury - concussion - discharge; Closed head injury - concussion - discharge
A concussion may occur when the head hits an object, or a moving object strikes the head. A concussion is a minor or less severe type of brain injury, which may also be called a traumatic brain injury.
A concussion can affect how the brain works for a while. It may lead to headaches, changes in alertness, or loss of consciousness.
After you go home, follow your health care provider's instructions on how to take care of yourself. Use the information below as a reminder.
A pretty good bump on the head, or a violent collision, can leave you feeling woozy and confused, and with a splitting headache. If it's bad enough, you may even lose consciousness. So, what causes a concussion? Your brain is a delicate organ encased in bone, your skull. When you fall down, suffer violent contact during a sports activity, or hit your head in a car accident, your brain moves but has nowhere to go. Instead, it swirls around inside your head and bumps into your skull. This causes bruising that damages your brain. The classic symptom of a concussion is loss of consciousness. But many people might experience only a brief moment of amnesia or disorientation. Typically, you'll have a headache, feel sleepy, and you may even vomit. Most likely you will not be able to think straight, that is, maybe you can't remember the date or your name. You may see flashing lights and even feel like you've lost time. Sometimes, it may take a day or two after the blow for some symptoms to develop. Your doctor will do a physical exam, checking your pupils, your ability to think, your coordination, and your reflexes. The doctor may want to look for bleeding in your brain, so you may need a CT or MRI scan. You may also have a brain wave test, or EEG. So, how do we treat a concussion? First and foremost, you will need to rest and be watched -- sometimes in the hospital, and sometimes by a parent, friend, or spouse if you're at home. For your headache, you can take acetaminophen. You may need to eat a light diet for a while if you continue to feel sick, or feel like vomiting. You'll want to have someone stay with you for the first 12 to 24 hours after your concussion. It's okay to sleep, but someone should wake you up every few hours and ask you a simple question, such as your name, and then watch you for changes in how you look or act. Obviously, if you were playing sports when you received a concussion, you most likely will need to stop. Sometimes you can't return to a sport for weeks, or longer, especially if your symptoms don't improve. That's because once you've had a concussion, it's easier to get another one, and multiple concussions can lead to long-term brain damage.
What to Expect at Home
Getting better from a concussion takes days to weeks or even months. You may be irritable, have trouble concentrating, or be unable to remember things. You may also have headaches, dizziness, or blurry vision. These problems will likely recover slowly. You may want to get help from family or friends for making important decisions.
When You First Go Home
You may use acetaminophen (Tylenol) for a headache. DO NOT use aspirin, ibuprofen (Motrin or Advil), naproxen, or other non-steroidal anti-inflammatory drugs.
You DO NOT need to stay in bed. Light activity around the home is okay. But avoid exercise, lifting weights, or other heavy activity.
You may want to keep your diet light if you have nausea and vomiting. Drink fluids to stay hydrated.
Have an adult stay with you for the first 12 to 24 hours after you are home from the emergency room.
- Going to sleep is OK. Ask your doctor whether, for at least the first 12 hours, someone should wake you up every 2 or 3 hours. They can ask a simple question, such as your name, and then look for any other changes in the way you look or act.
- Ask your doctor how long you need to do this.
DO NOT drink alcohol until you have fully recovered. Alcohol may slow down how quickly you recover and increase your chance of another injury. It can also make it harder to make decisions.
As long as you have symptoms, avoid sports activities, operating machines, being overly active, doing physical labor. Ask your doctor when you can return to your activities.
If you do sports, a doctor will need to check you before you go back to playing.
Make sure friends, co-workers, and family members know about your recent injury.
Let your family, co-workers, and friends know that you may be more tired, withdrawn, easily upset, or confused. Also tell them that you may have a hard time with tasks that require remembering or concentrating, and may have mild headaches and less tolerance for noise.
Consider asking for more breaks when you return to work.
Talk with your employer about:
- Reducing your workload for a while
- Not doing activities that may place others in danger
- Timing of important projects
- Allowing rest times during the day
- Having extra time to complete projects
- Having others check your work
A doctor should tell you when you can:
- Do heavy labor or operate machines
- Play contact sports, such as football, hockey, and soccer
- Ride a bicycle, motorcycle, or off-road vehicle
- Drive a car
- Ski, snowboard, skate, skateboard, or do gymnastics or martial arts
- Participate in any activity where there is a risk of hitting your head or jolt to the head
When to Call the Doctor
If symptoms DO NOT go away or are not improving after 2 or 3 weeks, talk to your doctor.
Call the doctor if you have:
- A stiff neck
- Fluid and blood leaking from your nose or ears
- A hard time waking up or have become more sleepy
- A headache that is getting worse, lasts a long time, or is not relieved by over-the-counter pain relievers
- Vomiting more than 3 times
- Problems walking or talking
- Changes in speech (slurred, difficult to understand, does not make sense)
- Problems thinking straight
- Seizures (jerking your arms or legs without control)
- Changes in behavior or unusual behavior
- Double vision
Giza CC, Kutcher JS, Ashwal S, et al. Summary of evidence-based guideline update: evaluation and management of concussion in sports: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2013;80(24):2250-2257. PMID: 23508730
Papa L, Goldberg SA. Head trauma. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 34.
Rossetti HC, Barth JT, Broshek DK, Freeman JR. Concussion and brain injury. In: Miller MD, Thompson SR, eds. DeLee & Drez's Orthopaedic Sports Medicine: Principles and Practice. 4th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 125.
Last reviewed on: 4/30/2018
Reviewed by: Amit M. Shelat, DO, FACP, Attending Neurologist and Assistant Professor of Clinical Neurology, SUNY Stony Brook, School of Medicine, Stony Brook, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.