Concussion

Concussion is a type of brain injury. It sometimes happens after a head injury, or a forceful knock to the body. It can happen even if you’ve stayed conscious (awake) after the injury. Only 10% of concussions involve someone being knocked out.

The most common causes of concussion are falls and violence. They also often happen when someone is playing sport. If you think someone may have a concussion, they should stop doing any sport immediately. Remember, if in doubt, sit them out.

Read more about minor or severe head injuries

Symptoms of concussion

It can take up to 48 hours after an injury for symptoms of concussion to appear.

If someone has a concussion, you may see changes to the way they behave and act. They may:

• lose consciousness
• be confused
• have a blank expression
• take an unusually long amount of time to answer questions
• struggle to balance
• show inappropriate emotional responses, like laughing or crying without explanation
• act out of character, like being unusually irritable
• struggle to remember events before or after the injury

They may also complain about physical symptoms, including:

• having a headache
• being dizzy
• feeling nauseous (sick)
• feeling stunned or dazed
• problems with their sight, like “seeing stars” or having blurry vision

Some symptoms of concussion indicate that there may be a severe head injury.

If you think someone may have a concussion, you should also:

• stop them from taking part in all sport
• have a responsible adult monitor them for 72 hours
• not let them drive or operate heavy machinery
• not let them drink alcohol or take recreational drugs

Diagnosing concussion

There’s no test that can rule out concussion. If someone has a head injury, it’s not possible to say for certain if someone does or does not have a concussion.

If someone has gone to hospital with a suspected concussion, they’ll be examined for a severe head injury. Concussion will only be diagnosed once other injuries have been ruled out.

If someone has a suspected concussion, but has not needed to go to hospital, they may not be given an official concussion diagnosis. You’ll be advised to assume they have a concussion and to follow the GRAS recovery plan.

Concussion can cause complications which can be severe. This is why you should treat anyone with a suspected concussion as if they definitely have one.

Recovery from concussion

When someone is recovering from concussion, they can take paracetamol to help relieve a headache. They should avoid drinking alcohol or taking recreational drugs. Getting plenty of rest and eating well will also help their recovery.

GRAS recovery plan

The graduated return to activity and sport (GRAS) recovery plan is recommended for anyone recovering from a concussion. It involves slowly increasing the amount of activity done over a period of time.

Everyone’s journey is different. It will take some people longer to recover than others. Studies have shown that someone is more likely to take longer to recover if they:

• are a child or young person
• have a significant history of previous concussion
• are a female athlete
• have ADHD or mental health disorders

The minimum time someone should take to return to normal life and sport is 21 days.

There are 6 stages to the GRAS recovery plan. All of them involve light physical activity. This has been shown to be more beneficial than complete rest when recovering from a concussion.

To progress to the next stage of recovery, someone does not need to be symptom free. They can progress as long as:

• they’ve been at their current stage for a minimum of 24 hours
• the activity level they’re currently doing is not making their concussion symptoms significantly worse

If symptoms do become worse, stay at the same stage and phone NHS 24 on 111 for advice.

Read more about gradual return to activity and sport

Stage 1

They should have relative rest for 24 to 48 hours after the injury happens. This does not mean they need to spend all their time in bed. It’s ok to do very gentle things, like taking the dog out for 10 minutes. But they should take it easy.

They should also keep the amount of time they spend looking at screens to a minimum. This includes TVs, computers and devices like smart phones.

Stage 2

During stage 2 they can gradually introduce normal daily activities. They should slowly increase their physical activity around the house at this time. They can also spend more time looking at screens and devices, and doing activities like reading and games.

Stage 3

During stage 3, they can start to do activities that take more mental effort. This is when they can start doing a bit of school work, or start working from home with breaks.

They can also start doing longer bits of gentle activity, like taking longer walks.

Stage 4

During stage 4, they can return to school and work. They can also return to exercise and sports training, as long as there’s no risk of another head injury.

Stage 5

At stage 5, they can fully return to their normal life. They can also return to full training for sports.

Stage 6

They can return to competitive sport, as long as they’ve not had any symptoms for 14 days.

Complications of concussion

Almost everyone who has a concussion will recover well and return to normal life and sport. But, there are some complications that can come from a concussion.

Short-term complications

Poorly managed concussion can lead to poor performance and decision making. This can affect someone in both work and sport. This is why it’s important to follow the 6 stages of recovery for a minimum of 21 days.

Continuing to play in a sport or game with a concussion increases the chance of getting another injury. Someone who has a concussion is 7 times more likely to get a muscle or joint injury if they play on.

Very rarely, some people get a condition called second-impact syndrome. This can happen if one or more concussions happen close together. It can be fatal. This is why it’s important not to play on after a suspected concussion.

Medium-term complications

Having repeated concussions, or a prolonged concussion, can impact someone’s daily life. It can cause problems at work, in their social life, and with their mental health.

In some cases, symptoms of a concussion can last more than 28 days. This is called post-concussion syndrome. If someone’s concussion symptoms last for more than 28 days, they should contact their GP practice.

Long-term complications

Repeated, poorly managed concussions have been linked to conditions like dementia and chronic traumatic encephalopathy (CTE). Research is ongoing about the strength of this link. It’s important to be cautious and follow all recommendations when managing a concussion.