Your doctor will evaluate your signs and symptoms, review your medical history, and conduct a neurological examination. Signs and symptoms of a concussion may not appear until hours or days after the injury.
Tests your doctor may perform or recommend include a neurological examination, cognitive testing and imaging tests.
After your doctor asks detailed questions about your injury, he or she may perform a neurological examination. This evaluation includes checking your:
- Strength and sensation
Your doctor may conduct several tests to evaluate your thinking (cognitive) skills during a neurological examination. Testing may evaluate several factors, including your:
- Ability to recall information
Brain imaging may be recommended for some people with signs and symptoms such as severe headaches, seizures, repeated vomiting or symptoms that are becoming worse. Brain imaging may determine whether the injury is severe and has caused bleeding or swelling in the skull.
A cranial computerized tomography (CT) scan is the standard test in adults to assess the brain right after injury. A CT scan uses a series of X-rays to obtain cross-sectional images of your skull and brain.
For children with suspected concussion, CT scans are only used if there are specific criteria met, such as the type of injury or signs of a skull fracture. This is to avoid radiation exposure in young children.
Magnetic resonance imaging (MRI) may be used to identify changes in your brain or to diagnose complications that may occur after a concussion.
An MRI uses powerful magnets and radio waves to produce detailed images of your brain.
You may need to be hospitalized overnight for observation after a concussion.
If your doctor agrees that you may be observed at home, someone should stay with you and check on you for at least 24 hours to ensure that your symptoms aren't worsening.
Your caregiver may need to awaken you regularly to make sure you can awaken normally.
There are steps you can take to help your brain heal and speed recovery.
Physical and mental rest
In the first few days after a concussion, relative rest is the most appropriate way to allow your brain to recover. Your doctor will recommend that you physically and mentally rest to recover from a concussion.
Relative rest, which includes limiting activities that require thinking and mental concentration, is recommended for the first two days after a concussion. However, complete rest, such as lying in a dark room and avoiding all stimuli, does not help recovery and is not recommended. In the first 48 hours, you should overall limit activities that require high mental concentration — such as playing video games, watching TV, doing schoolwork, reading, texting or using a computer — if these activities cause your symptoms to worsen.
You also should avoid physical activities that increase any of your symptoms, such as general physical exertion, sports or any vigorous movements, until these activities no longer provoke your symptoms.
After a period of relative rest, it's recommended that you gradually increase daily activities such as screen time if you can tolerate them without triggering symptoms. You can start both physical and mental activities at levels that do not cause a major worsening of symptoms. Light exercise and physical activity as tolerated starting a few days after injury have been shown to speed recovery; however, you should avoid any activities that have a high risk of exposure to another head impact until you are fully recovered.
Your doctor may recommend that you have shortened school days or workdays, take breaks during the day, or have modified or reduced school workloads or work assignments as you recover from a concussion. Your doctor may recommend different therapies as well, such as rehabilitation for vision, rehabilitation for balance problems, or cognitive rehabilitation for problems with thinking and memory.
Returning to routine activity
As your symptoms improve, you may gradually add more activities that involve thinking, such as doing more schoolwork or work assignments, or increasing your time spent at school or work.
Your doctor will tell you when it's safe for you to resume light physical activity. Usually after the first few days after injury, you're allowed to do light physical activity — such as riding a stationary bike or light jogging — before your symptoms are completely gone, so long as it doesn't significantly worsen symptoms.
Eventually, once all signs and symptoms of concussion have resolved, you and your doctor can discuss the steps you'll need to take to safely play sports again. Resuming sports too soon increases the risk of another brain injury.
Headaches may occur in the days or weeks after a concussion. To manage pain, ask your doctor if it's safe to take a pain reliever such as acetaminophen (Tylenol, others). Avoid other pain relievers such as ibuprofen (Advil, Motrin IB, others) and aspirin, as these medications may increase the risk of bleeding.
Preparing for your appointment
It's important for anyone who has a head injury to be evaluated by a doctor, even if emergency care isn't required.
If your child has received a head injury that concerns you, call your child's doctor immediately. Depending on the signs and symptoms, your doctor may recommend seeking immediate medical care.
Here's some information to help you get ready for and make the most of your medical appointment.
What you can do
- Be aware of any pre-appointment restrictions or instructions. The most important thing for you to do while waiting for your appointment is to avoid activities that cause or worsen your symptoms. Avoid sports or vigorous physical activities and minimize difficult, stressful or prolonged mental tasks. At the time you make the appointment, ask what steps you or your child should take to encourage recovery or prevent re-injury. Experts recommend that athletes not return to play until they have been medically evaluated.
- List any symptoms you or your child has been experiencing and how long they've been occurring.
- List key medical information, including other medical problems for which you or your child is being treated and any history of previous head injuries. Also write down the names of any medications, vitamins, supplements or other natural remedies you or your child is taking.
- Take a family member or friend along. Sometimes it can be difficult to remember all the information provided to you during an appointment. Someone who comes with you may recall something that you missed or forgot.
- Write down questions to ask your doctor.
For a concussion, some basic questions to ask your doctor include:
- Do I have a concussion?
- What kinds of tests are needed?
- What treatment approach do you recommend?
- How soon will symptoms begin to improve?
- What is the risk of future concussions?
- What is the risk of long-term complications?
- When will it be safe to return to competitive sports?
- When will it be safe to resume vigorous exercise?
- Is it safe to return to school or work?
- Is it safe to drive a car or operate power equipment?
- I have other medical problems. How can they be managed together?
- Should a specialist be consulted? What will that cost, and will my insurance cover seeing a specialist? You may need to call your insurance provider for some of these answers.
- Are there any brochures or other printed material that I can take home with me? What websites do you recommend?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions that come up during your appointment.
What to expect from your doctor
Being ready to answer your doctor's questions may reserve time to go over any points you want to talk about in-depth.
You or your child should be prepared to answer the following questions about the injury and related signs and symptoms:
- Do you play contact sports?
- How did you get this injury?
- What symptoms did you experience immediately after the injury?
- Do you remember what happened right before and after the injury?
- Did you lose consciousness after the injury?
- Did you have seizures?
- Have you experienced nausea or vomiting since the injury?
- Have you had a headache? How soon after the injury did it start?
- Have you noticed any difficulty with physical coordination since the injury?
- Have you had any problems with memory or concentration since the injury?
- Have you noticed any sensitivity or problems with your vision and hearing?
- Have you had any mood changes, including irritability, anxiety or depression?
- Have you felt lethargic or easily fatigued since the injury?
- Are you having trouble sleeping or waking from sleep?
- Have you noticed changes in your sense of smell or taste?
- Do you have any dizziness or vertigo?
- What other signs or symptoms are you concerned about?
- Have you had any previous head injuries?
What you can do in the meantime
The most important thing to do before your appointment is to avoid activities that significantly increase your symptoms and those that have an increased risk of another head impact. This includes avoiding sports or other physical activities that increase your heart rate, such as running, or require vigorous muscle contractions, such as weightlifting.
Gradually resume your normal daily activities, including screen time, as you're able to tolerate them without significantly worsening symptoms.
If you have a headache, acetaminophen (Tylenol, others) may ease the pain. Avoid taking other pain relievers such as aspirin or ibuprofen (Advil, Motrin IB, others) if you suspect you've had a concussion. These may increase the risk of bleeding.