Concussion is the most common form of traumatic brain injury, yet one of the most underestimated. A blow to the head sets the brain moving inside the skull, stretching neural connections and producing disturbance that does not show on a standard CT scan. Most concussions resolve within seven to fourteen days. But some apparent concussions are something far more dangerous like an intracranial haematoma (blood accumulating inside the skull) that compresses the brain and can kill within hours if missed. At CARE Hospitals, every significant head injury is assessed with validated clinical tools and appropriate imaging to ensure nothing serious is overlooked.

What Is a Concussion?

A concussion is a temporary disruption of brain function from a biomechanical force, without structural damage visible on CT. Neurons (nerve cells) and axons (signal-transmitting fibres) are stretched by rapid acceleration and deceleration inside the skull, disrupting electrical signalling and triggering a metabolic crisis: calcium floods the cells, glucose metabolism fails and waste accumulates.

It results in headache, confusion, dizziness, light sensitivity, and slowed thinking that persist days to weeks. A concussion is a functional injury and tissue is usually intact.

Common Causes of Concussion

Any force causing the brain to move rapidly inside the skull can cause a concussion:

• Sports injuries: Contact sports like cricket, football, rugby, boxing or wrestling are common mechanisms
• Road traffic accidents: Sudden deceleration accelerates the brain inside the skull even without direct head impact; whiplash-associated concussion is common
• Falls: The most common cause in children under five and adults over 65
• Assaults and direct blows: A punch or strike to the head is a common cause in young adults and force and direction affect severity
• Blast injuries: Pressure waves from explosions cause concussion through a mechanism distinct from direct impact.

Signs and Symptoms of Concussion

Symptoms may appear immediately or over minutes to hours; delayed onset does not reduce significance:

• Headache: The most common symptom and typically across the forehead or behind the eyes. Worsening headache after initial improvement is a warning sign for intracranial haematoma (blood clot inside the skull)
• Confusion and disorientation: Patients appear dazed, cannot recall what happened, ask the same question repeatedly, or respond slowly
• Loss of consciousness: Occurs in a minority of cases and a duration above one minute raises the risk of more serious brain injury
• Amnesia: Retrograde (inability to recall events before impact) and anterograde (inability to form new memories after) both indicate a significant concussion
• Dizziness and balance problems: The vestibular system (inner ear balance control) is disrupted and the person may stagger
• Nausea and vomiting: One episode may occur in concussion but repeated vomiting is a red flag for raised intracranial pressure (pressure inside the skull)
• Light and noise sensitivity (photophobia and phonophobia): Bright light and loud sounds are poorly tolerated
• Slowed thinking: The person cannot follow a conversation, solve simple problems or process information at normal speed
• Emotional changes: Irritability, anxiety, or tearfulness within hours or days of injury.

First Aid for Concussion (Before Reaching Hospital)

First aid focuses on identifying warning signs and getting the person to an appropriate medical assessment:

• Stop the activity immediately: Remove from sport or physical activity, sit them out. Continuing after a concussion raises the risk of second impact syndrome, where a second concussion before full recovery causes catastrophic brain swelling.
• Do not leave the person alone: Symptoms can worsen over the first one to two hours. A responsible adult must stay to monitor for deterioration.
• Monitor for warning signs: Watch for worsening headache, repeated vomiting, one pupil larger than the other, seizure, deteriorating consciousness, limb weakness or slurred speech. Any requires immediate emergency assessment.
• Give paracetamol only: NSAIDs and aspirin increase bleeding risk. Use paracetamol only for pain relief in the first 24 hours.
• Avoid screens & cognitive effort: Avoid bright screens, reading and tasks requiring concentration in the first 24 to 48 hours as they can worsen symptoms. Rest in a quiet dimly lit room. 
• Go to the hospital if warning signs appear: A first-time head injury with loss of consciousness, persistent vomiting, worsening headache or any neurological symptom requires immediate emergency assessment.

When to Seek Emergency Care for a Concussion

These signs require immediate emergency assessment:

• Loss of consciousness for any duration
• Persistent or worsening headache not settling with paracetamol
• Repeated vomiting 
• Seizure after a head injury
• One pupil is larger than the other 
• Increasing drowsiness or difficulty waking 
• Weakness, numbness, or clumsiness of a limb
• Slurred speech or facial drooping
• Head injury on anticoagulants 
• Head injury in a patient over 65 or a child under two.

Emergency Treatment at the Hospital for Concussion

The treatment follows a step by step protocol:

• Assessment: Doctors use validated clinical decision tools to identify who needs a CT and who can be observed. The NICE Head Injury Guidelines, PECARN rules for children, and the Canadian CT Head Rule assess: GCS (Glasgow Coma Scale - eye opening, verbal, and motor response scored 3 to 15); duration of loss of consciousness; post-traumatic amnesia; mechanism; age; anticoagulant use; and associated injuries.
• CT head scan: CT detects intracranial haemorrhage (extradural, subdural, subarachnoid, and intracerebral bleeds) but not the functional disturbance of concussion. A normal CT does not mean the brain is uninjured.
• Neurological monitoring: GCS, pupils, limb power, and coordination are assessed and repeated. Deterioration in GCS or any new deficit triggers repeat imaging and neurosurgical review.
• Management of intracranial haematoma: Extradural haematoma (arterial bleeding between the skull and the brain's outer covering) is a neurosurgical emergency and craniotomy drains the clot without delay. 
• Subdural haematoma: Venous bleeding between the dura and the brain surface is managed surgically or conservatively based on size and clinical status.
• Discharge and observation: Patients not meeting CT criteria are discharged with a head injury observation card; a responsible adult observes for 24 hours and returns if headache worsens, vomiting recurs or consciousness deteriorates.

What Not to Do

These actions increase risk or delay detection of a serious injury:

• Do not allow return to sport the same day 
• Do not leave a concussed person alone for the first 24 hours 
• Do not give aspirin or ibuprofen as both increase bleeding risk
• Do not drink alcohol for at least 48 hours
• Do not use screens or engage in cognitively demanding tasks for 24 to 48 hours 
• Do not assume a normal CT means full recovery as CT does not detect the functional disturbance of concussion.

Conclusion

A concussion is a functional brain injury that most people recover from fully, but an intracranial haemorrhage can look identical before it worsens and its surgical window is hours. At CARE Hospitals, every significant head injury is assessed with validated decision tools, CT is applied by evidence-based criteria and neurosurgical review is available around the clock.

FAQs

1. When should I seek emergency care after a head injury?

Loss of consciousness, worsening headache, repeated vomiting, seizure, unequal pupils, increasing drowsiness, limb weakness, slurred speech or head injury on blood thinners or in a patient over 65 - all require immediate emergency assessment.

2. Can a concussion happen without losing consciousness?

Yes most concussions occur without loss of consciousness; dazed feeling, confusion, amnesia, or dizziness after head impact is sufficient for diagnosis.

3. What should I do immediately after a concussion?

Remove from activity; do not leave alone; monitor for red flags (worsening headache, vomiting, unequal pupils, seizure, deteriorating consciousness); give paracetamol only; avoid screens and seek emergency assessment if any warning sign appears.

4. Is it safe to sleep after a concussion?

Yes in most cases, a responsible adult should check every two to three hours during the first night to confirm the person can be roused. Difficulty waking requires immediate emergency assessment.

5. When is a CT scan needed after a concussion?

A CT scan is needed when decision tools identify risk factors: loss of consciousness above one minute, post-traumatic amnesia above 30 minutes, GCS below 15 at two hours, age over 65, suspected skull fracture or anticoagulant use.

6. What activities should be avoided after a concussion?

Avoid:

• Contact sport, strenuous exercise, alcohol, and screens for at least 24 to 48 hours
• No driving until fully symptom-free
• No contact sport until medically cleared and return to sport follows a graduated protocol.

CARE Medical Team