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Concussion

Concussion is one of the most common sports injuries, but kids, older adults, and nonathletes can get them, too. Concussion happens because of a blow to your head or an injury that shakes your brain inside your skull.

Concussions are treatable, but sometimes people miss the signs. The symptoms can be physical (like a headache) and mental (like feeling confused).

Once you’ve had a concussion, your brain is more sensitive to damage. That’s why it’s important to know concussion symptoms and to get treatment as soon as possible.

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What Is Concussion?

A concussion is a mild traumatic brain injury. You can get a concussion if you take a direct or indirect hit to your head or body. Athletes often wind up with concussions from falls or blows to the head.

Your brain is a soft organ that sits in spinal fluid, which acts like a cushion to keep your brain from banging into your skull. But if you get hit hard, your brain can “crash” into your skull.

The impact of that crash causes chemical and cellular changes in your brain — and can damage your brain. This is why any level of concussion can be a serious health problem. An injured brain is much easier to reinjure.

Some people heal from concussions quickly, while others may need weeks or even months. If you don’t get the right care for a concussion, you can end up with long-term effects.

How common are concussions?

Concussions are common in athletes. Each year, the UPMC Sports Medicine Concussion Program in Pittsburgh sees as many as 7,000 people, of which 70% are high school athletes.

We’ve found that:

  • Between 1.7 and 3 million sports- and recreation-related concussions happen each year. Around 300,000 of those are from football.
  • Five in 10 concussions go unreported or undetected.
  • Two in 10 high school athletes who play contact sports — including soccer and lacrosse — will get a concussion this year.
  • Girls' soccer sees the 2nd most concussions of all high school sports, while girls' basketball sees the 3rd most.

Concussions aren’t limited to athletes. They can happen to anyone. They happen in older adults, too, especially as a result of falls. People often miss the signs of concussion in older adults because they aren’t looking for them.

What are the types of concussion?

The path your concussion takes depends on how severe it is and how your brain responds.

There are generally six different types of concussion, organized around the symptoms you may feel.

Cognitive fatigue

This type of concussion can cause trouble with complex mental tasks and make you extra tired after long days.

You might:

  • Be less able to multitask.
  • Feel more distracted.
  • Have less concentration than usual.
  • Have trouble learning or retaining new information.

Vestibular

Your vestibular system is your brain’s balance center. This type of concussion can cause trouble with balance, motion, and vision.

You might struggle to:

  • Coordinate your head and eye movements.
  • Interpret motion.
  • Steady or balance your vision when you move your head.

Ocular

This type of concussion can cause you to have trouble with visual tasks like:

  • Looking at a computer screen or cell phone.
  • Moving your eyes together to track motion.
  • Reading long passages.

Post-traumatic migraine

This type of concussion affects your senses. You can feel overwhelmed by loud places, such as concerts or sporting events.

Symptoms include:

  • Headaches.
  • Nausea.
  • Sensitivity to light or noise.

Cervical (neck)

This type of concussion causes trouble with stress or pressure on the neck, spine, or spinal cord. You may start having more frequent headaches.

Things such as slouching while on the computer or carrying a heavy backpack may worsen symptoms.

Anxiety/mood

This type of concussion makes it hard to turn off your thoughts. You might have excessive worry and feel restless.

It can also make social interactions difficult. But on the flip side, your symptoms may get worse if you isolate yourself and avoid normal activities.

What causes concussion?

Since your brain is a soft organ, it needs the skull to protect it. And even though your brain sits in fluid that acts like a cushion, that cushion isn't enough when your head or body takes a hit.

A hard impact can make your brain shake around inside your skull — and crash into your skull. Think of this like an egg yolk moving freely inside an eggshell. This can cause small amounts of damage to your brain, which is why a concussion is a type of brain injury.

There are many ways to get a concussion that aren't related to athletic injuries. Some common causes of concussion include fights, falls, playground injuries, car crashes, and bike accidents.

What are concussion risk factors and complications?

Concussion risk factors

Anyone can get a concussion, but athletes who take part in certain sports have a higher likelihood of concussion.

These include:

  • Basketball
  • Boxing
  • Football
  • Hockey
  • Lacrosse
  • Skiing
  • Soccer
  • Snowboarding

Younger athletes and females tend to take longer to get better from concussions.

Concussion complications

No athlete should return to playing a sport until all of their symptoms are gone and a concussion expert has cleared them to play.

A concussion changes how the brain functions. This side effect can reduce reaction time and cause changes in vision and perception.

If a player continues playing with a concussion that hasn’t healed, they’re more likely to get another one.

Having one concussion doesn’t mean that the effects will “add up” if you get another concussion at some point. If you get the right treatment, you can make a complete recovery.

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What Are the Signs and Symptoms of Concussion?

Concussion doesn’t always have obvious signs, and the signs can happen quickly or hours later. Some people have immediate symptoms; for others, symptoms may show up as much as two days later.

Some immediate symptoms of concussion are:

  • Amnesia. Some people have memory loss of the moments just before the hit or injury.
  • Feeling disoriented or confused. Concussion can cause an immediate change in mental status.
  • Losing consciousness. Most people with a concussion don’t pass out because of it. But if someone becomes unconscious, don’t ignore it.
  • Vomiting. Throwing up right after a hit to the head is a red flag for concussion.

Other common symptoms of concussion that may happen quickly or appear later:

  • Changes in mood, such as feeling irritable, anxious, or overly emotional over things that wouldn’t normally bother you.
  • Cognitive trouble, such as feeling foggy and having attention and memory problems.
  • Dizziness, especially the feeling of being carsick.
  • Fatigue, and a general feeling of sluggishness, especially after a long day.
  • Headache or a feeling of pressure in the head.
  • Migraine headache, which is a headache with nausea and light sensitivity (you might also have light sensitivity without a headache).
  • Nausea, which can last for a few days or even weeks.
  • Sleeping problems, including wanting to sleep a lot, or having trouble falling and staying asleep.
  • Vision problems, especially blurry vision.

An athlete who has any of these concussion signs should leave the field of play immediately. 

Concussion symptoms in young children

Young children have the same symptoms as older children and adults, but sometimes it can be harder to tell if a small child has a concussion.

They may have symptoms like:

  • A sad mood.
  • Being upset easily or having more temper tantrums.
  • Crying more than usual.
  • Changes in the way they play or act.
  • Changes in the way they nurse, eat, or sleep.
  • Headache that doesn't go away.
  • Lack of interest in their usual activities or favorite toys.
  • Loss of new skills, such as toilet training.
  • Loss of balance and trouble walking.
  • Not being able to pay attention.

When should I see a doctor about my concussion symptoms?

All concussions are serious. If you suspect you, your child, or an athlete on your team has one, make an appointment right away. Research shows that the sooner you seek medical attention for a concussion, the faster your recovery will be.

You can request an appointment with the UPMC Sports Medicine Concussion Program in Pittsburgh by filling out this form or calling 412-432-3681.

If you’ve been treated for a concussion, but your symptoms aren’t getting better, always call your doctor. Otherwise, you could be at risk for lingering symptoms.

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How Do You Diagnose Concussion?

To confirm if you have a concussion and which type you have, a concussion specialist will:

  • Review your health history.
  • Ask about your symptoms.
  • Perform several tests.

They’ll do an exam and may ask you questions to test your memory and ability to pay attention.

Your doctor might also:

  • See how quickly you can solve problems.
  • Show you objects and then hide them and ask you to recall what they are.
  • Check your strength, balance, eye motion, coordination, reflexes, and sensation.

Tests to diagnose concussion

Imaging does not diagnose a concussion specifically.

To rule out bruising or bleeding in your brain, your doctor may order imaging tests, such as:

At UPMC, we also use ImPACT, or Immediate Post-Concussion Assessment and Cognitive Testing.

This test looks at the following before a concussion occurs and after a concussion as a comparison tool:

  • Brain processing speed.
  • Reaction time.
  • Verbal and visual memory.

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How Do You Treat Concussion?

Concussions are highly treatable. The key is to get treatment as soon as possible. For athletes, that means immediately leaving the field of play if you have any concussion signs.

At the UPMC Sports Medicine Concussion Program, we personalize active treatment plans for people. We understand that you want to get back to doing what you love.

No two concussions are the same.

While a short rest period is sometimes helpful immediately following a concussion, our research and exceptional patient outcomes show it takes more than that.

An active treatment approach — one that forces the brain to readapt to stimuli — is key to making a full recovery.

Your treatment may involve:

  • Behavioral or vision therapy.
  • Guidance from primary care sports medicine doctors for medication management.
  • Physical and exertion training and rehab.
  • Vestibular ocular motor screening.
  • Vestibular physical therapy.

Why am I more likely to get another concussion if I don’t heal properly?

When your brain suffers a blow, a series of things happen at the cellular level. Essentially, there’s a chain reaction. The result is that you have decreased blood supply to your brain.

This makes your cells vulnerable, and another injury can damage them more severely. This is why it’s so dangerous for athletes with concussions to stay in a game or continue their activity. The dizziness, blurry vision, headache, and perception issues mean they’re more likely to fall or get hit again.

Even a person who isn’t an athlete is at risk for reinjury. For example, an older person with an undiagnosed concussion is more likely to fall again.

When will I start to feel better if I have a concussion?

Concussions are complex injuries with a wide range of outcomes. Since each case is unique, there's no standard timeline for recovery.

Some people get better in days, while others need weeks or months. Some may endure long-term effects, usually if they didn't get the proper care. But the sooner you get the right treatment, the better chance you have of recovering fully, and faster.

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Risk Factors

Injury Overview

Types and Triggers

Anxiety and Mood Trajectory

Post-Trauma Migraine

Cervical Trajectory