What is concussion?
Concussion is a mild and often temporary form of brain injury, also called ‘mild traumatic brain injury’ (mTBI). It happens when the brain is shaken inside the skull following a strong force to the head. It usually causes temporary symptoms, which typically resolve in a few weeks. Some people continue to experience symptoms for longer, known as post-concussion syndrome.
How is a concussion caused?
A concussion can be caused by a strong blow to the head, causing the brain to shake around inside. This can be from something directly striking the head (such as from a sporting accident or the head striking the ground), or from rapid movement of the head (such as from blast injuries or whiplash injuries).
Common causes of concussion include:
accidents in the home or at work, such as hitting the head against a low shelf or car door;
sporting accidents, such as players’ heads knocking against one another, the ground or sporting equipment;
motor vehicle accidents;
assaults in which the head is struck;
falls.
Wendy's story
“Wendy hit a pothole and was thrown over the handlebars of the e-scooter. She hit her head on the pavement and was left unconscious. “My life changed in that second,” she recalled. “I have no memory of the accident or the 24 hours following it. Apparently, I went from 15mph to 0pmh in a millisecond.” A CT scan showed no damage to her skull or brain and she was diagnosed with concussion.”
Find out more about Wendy’s experience with concussion.
What happens in a concussion?
The brain is protected inside the skull. However, if the head is knocked, shaken or hit with force, this can injure the brain inside. There is no visible breakage of the skin or open wound. Therefore, it is not always obvious that the brain has been affected. However, the brain has followed the rapid movement of the head, and this has caused twisting, stretching and tearing of its nerve fibres.
Further damage can be caused if the brain collides against the sharp, bony ridges found at the front of the skull.
A person with concussion may experience immediate symptoms after a blow to the head, such as dizziness, confusion, nausea or feeling dazed. They may experience loss of consciousness, but this only happens in around 10% of cases.
A concussion can also commonly cause the following effects over the next few days or weeks:
Headaches;
Dizziness;
Nausea;
Sensitivity to light or sound;
Problems with sleeping;
Fatigue;
Problems with concentrating, remembering things, processing information or reacting to information;
Anxiety, sadness, or feeling more emotional than usual;
Slowed reaction times;
Hormonal imbalances, resulting in a range of symptoms such as depression, mood swings, constipation, dry skin, increased sensitivity to cold, hot flashes, weight changes, muscle weakness among others.
These symptoms may last for several weeks. This can be a concerning and difficult experience, but it is important to remember that most people do eventually make a complete recovery.
The following symptoms suggest that a more serious brain injury may have taken place:
Any loss of consciousness or deteriorating consciousness;
Drowsiness, difficulty staying awake or keeping eyes open, or inability to be woken up;
Repeated vomiting;
Bleeding from one or both ears;
Loss of balance or problems with walking;
Decreased sensation, numbness, weakness, or pins and needles down arms/legs;
Reduced neck movement or severe neck pain;
Any new seizures;
Clear fluid coming out of the ears or the nose;
Any new problems with vision or hearing;
Severe and worsening headache not relieved by painkillers;
Any new problems with thinking skills such as memory, understanding information or communicating;
Changes in behaviour, unusual behaviour or irritability that is out of character.
Any of these symptoms in the days or weeks that follow a concussion require immediate medical attention. Call 999 and ask for an ambulance.
How is a concussion treated?
In any case of suspected or confirmed concussion, the person should:
Stop the activity they are doing immediately, including participating in sports or working.
Get medical advice if available, for instance through a sports doctor, their GP or NHS 111.
Report the accident or injury to a manager if necessary.
Avoid driving. This may mean someone else has to give them a lift to return home.
Be supervised for the next 24 hours, so that someone can monitor their symptoms and be available to help if their condition worsens.
When the person is considered safe to return home, they should be given advice on what to do over the next few weeks and what symptoms to look out for. It is very important to follow the guidance given to prevent the effects of concussion from getting any worse.
Tips for coping with concussion
Living with concussion can feel tough, but for most people the symptoms improve within a few weeks. Concussion can usually be self-managed in the meantime by doing the following.
Resting; this includes keeping screen-time limited (such as watching TV or using phones).
Doing some gentle exercise, such as walking and avoiding overly strenuous physical activity.
Making lifestyle changes, such as having a more gently paced routine and avoiding stressful situations where possible.
Having someone supervising for the first 24 hours after injury and keeping a phone at hand in the weeks that follow, in case the person with concussion needs medical help.
Using adaptations to cope with the effects of the concussion, such as using diaries and calendars if the person with concussion has problems with remembering information.
Avoiding drinking alcohol, as the brain will be more sensitive to its effects.
Avoiding driving until the person with concussion feels better. A GP can offer guidance on fitness to drive if needed.
Getting support from the GP for particularly problematic symptoms. There may be medications or therapies that can help. You should also speak to your GP if you are experiencing longer-term symptoms (known as post-concussion syndrome). Your GP might also be able to refer you onto professionals for specialised support, for example you may be referred onto a neuropsychologist for help with cognitive, emotional or behavioural issues, or an endocrinologist for hormonal imbalances.
Telling others in the person’s life how they are feeling, such as family, friends and colleagues. This can help others to understand why someone may be needing to take time to recover, or why they may be needing extra support.
Getting emotional support from family, friends, professional services or charities. Remember that our nurse-led helpline is available to offer you information, advice and emotional support on living with concussion.
Learning about concussion so that the person can better understand their experiences.
Asking for time off work or reasonable adjustments to be made to the person’s role. Concussion can make it particularly difficult to concentrate, meet deadlines, multitask, prioritise workloads or remember information. Depending on the role or workplace environment, it might even be dangerous to continue working.
Keeping things in perspective, and reminding oneself that although things are difficult now, for most people the effects of concussion do improve within a few weeks, and help is available in the meantime.
If there is any suspicion that a more serious traumatic brain injury has occurred (see previous section), the person should immediately seek medical attention. Call 999 and ask for an ambulance.
More information on treatment for traumatic brain injury is available on Treatment and rehabilitation.
What is post-concussion syndrome?
Most people make a good recovery from concussion after a few weeks. However, some people may have ongoing problems, lasting for weeks, months or, in a few cases, even longer. This is sometimes known as post-concussion syndrome (PCS).
Symptoms of PCS include headaches, fatigue, changes in vision, problems with balance and dizziness, confusion, changes in mood, problems with sleeping, cognitive impairment such as problems with memory, learning and concentration, and hormonal imbalances.
Some people with PCS develop more severe effects, such as anxiety, depression, mental health changes, aggression, or suicidal thoughts.
PCS may cause difficulties with the person’s ability to socialise, work or complete daily activities.
Elle's story
“For a long time, I felt like I was broken, which led to some pretty bad mental health struggles.”
Find out more about Elle’s experience of living with post-concussion syndrome.
PCS can be very difficult to cope with, and it can be concerning or frightening to experience such intense symptoms for such a long time. Try to remember that things can improve. Sometimes this will involve learning new ways to do things, helping others to understand how they can offer support or adjusting one’s lifestyle.
Anyone struggling with PCS should talk to their GP about the difficulties they are having. They may be prescribed medication or referred to other professional services that can help. For example, if someone is having problems with depression, anxiety or suicidal thoughts, their GP may refer them onto local mental health services, counselling services or neurological/neuropsychological support. They may also be directed onto mental health charities such as Samaritans or Mind. Or if they are having problems associated with hormonal imbalances, they may get referred to an endocrinologist.
Laura's story
"Despite the initial accident feeling like a relatively minor incident, it has been over two years now, and Alex still hasn’t fully recovered. His long-term symptoms have ranged from losing his balance and barely being able to walk to an inability to hear a loud noise and severe migraines, to name a few - very much putting his life on hold. Alex is working hard on his recovery and making progress daily.”
Learn more about Alex’s experience of living with post-concussion syndrome, as shared by his fiancée Laura.
It is understandable to worry about PCS if someone is having difficulties, but it is also important for them to consider, as time goes on, whether the issues they think are related to PCS may in fact be due to other things going on in their life, such as other health conditions. These could be new health conditions that have developed since the concussion, or underlying health conditions that the concussion has worsened.
For example, memory and concentration difficulties can arise from anxiety, low mood, pain, chronic fatigue and/or sleep difficulties. Some people do not notice their concussion improving because their symptoms over time become increasingly caused by these other factors, rather than the brain injury itself.
It is always advisable to talk to one’s GP about their concerns, as they will be able to best advise on the support needed.
Concussion in sport
Want to find out more about concussion in sport and our work in this area? Visit Concussion Aware.
Concussion in construction industry
Want to find out more about concussion in the construction industry and our work in this area? Visit Hard Hat Awareness Week.
Concussion FAQs
Why is concussion called a 'mild' brain injury?
Concussions are also called ‘mild traumatic brain injury’ (mTBI). People living with concussion may question why it is classified as ‘mild’, when their personal experience is far from this.
All traumatic brain injuries (TBIs) are classified as either mild, moderate or severe. The classification given to a TBI helps to identify what level of treatment may be needed and what the outcome of the injury may be.
TBI classifications are based on the following clinical characteristics of the injury:
· Length of loss of consciousness (LOC) – in mTBI, this is either less than 30 minutes or there is no LOC.
· Length of post-traumatic amnesia (PTA) - in mTBI, this is less than 24 hours or there is no PTA;
· Glasgow Coma Scale score – in mTBI this is 13 or more.
Never feel like you can’t ask for help for coping with concussion or post-concussion syndrome, even if this injury is classified as ‘mild’.
How do I help others understand concussion?
Concussions are not visible to others because you cannot see the brain and the injury may not appear on a brain scan. This may make it difficult for others in your life, such as relatives, friends, your GP, sports coaches or an employer to understand what you are going through.
Concussion is being talked about a lot in the media and research these days. There is now more awareness of it, but there may still be a need to educate others in your life about concussion, and more specifically how it affects you.
No two concussions are ever exactly the same, and the impact of it will vary from one person to another. You should therefore be open and honest about how you feel with concussion, and work with others to identify ways they can support you through this time.
Help others to understand what concussion is by showing them relevant information such as this webpage. You can also direct them to information on the NHS website.
If relevant, the UK Government and Sport and Recreation Alliance’s Concussion Guidelines for Non-Elite Grassroots Sports guide can be a helpful resource to direct fellow sports players or coaches to. If you are a professional sports player, your sports body may have their own set of concussion guidelines that you can direct others to so that you do not feel pressured into returning to play before you feel ready.
Your GP will usually be the first point of contact if you need help with concussion or post-concussion syndrome. It is therefore vital that your GP understands what a concussion is and how they can best support you. Our GP’s guide to mild brain injury can help with this.
We also offer guidance for employers that can help them with understanding some of the challenges you are experiencing and how they can best support you, both while you are recovering and when you decide to return to work.
It is vital that your nearest and dearest, such as partners, relatives and close friends, understand what you are going through. This is so that you feel well supported through your experiences and do not become socially isolated. Be honest and keep communication open. Don’t be afraid to share your true feelings, to ask for help, or to tell others how they can best support you.
Can I get concussion through sports?
Concussion can be sustained through any injury in which the brain is shaken inside the skull following an impact to the head. Contact, collision and combat sports all carry the risk of concussion.
In sports, concussion can be sustained through players’ heads colliding into one another, falling over, falling from a height or the head striking a hard surface.
Some sports require the use of helmets. These are effective at reducing injuries to the face and skull and can reduce the force of injuries to the brain. However, they are not designed to completely prevent concussion.
It is very important that all sports players are aware of the risks and signs of concussion, as well as what to do if a concussion is suspected. The most important advice to follow is: if in doubt, sit it out! Inform your coach, remain under supervision and seek medical attention or contact NHS 111.
Never risk continuing to play with a suspected concussion, as this can carry the risk of sustaining another injury to the brain too soon, which can be very dangerous and, in very rare cases, even fatal (known as second impact syndrome).
Many sporting bodies have specific guidance about concussion and return-to-play protocols following concussion in their respective sports, and these should be followed closely. Guidance for grassroots sports is available in the UK Government and Sport and Recreation Alliance’s Concussion Guidelines for Non-Elite Grassroots Sports guide.
Can I get concussion at work?
Concussion can be sustained through any injury in which the brain is shaken inside the skull following an impact to the head. In the workplace, concussion can be sustained through objects falling on the head, falling from a height, hitting the head against a hard surface or falling over. Some industries may have higher risks of concussion, such as construction or firefighting.
It is very important that everyone is aware of the risks and signs of concussion, as well as what to do if a concussion is suspected. The guidance to follow is the same as that given for sports-related concussions as described above, namely if in doubt, sit it out! Never risk continuing to work with a suspected concussion, as there may be a risk of sustaining another injury to the brain, especially in industries, settings or roles with a higher risk of concussion. Inform your manager, remain under supervision and seek medical attention or contact NHS 111.
Some industries require the use of hard hats or helmets. These are effective at reducing injuries to the face and skull and can reduce the force of injuries to the brain. However, they are not able to completely prevent concussion. It is very important that users of hard hats or helmets know how to properly look after their headgear and what to do if a concussion is suspected.
Can I claim compensation for concussion?
Anyone can make a claim for compensation if they can show that someone else was either fully or partly responsible for their impairment or injury.
If your concussion was caused by an accident, assault or negligence, you may be entitled to compensation. It is important to consult a solicitor who specialises in head injury for further guidance. We provide a list of approved personal injury solicitors that may be able to help.
Do I need a formal diagnosis to get help for concussion?
Not everybody who sustains a concussion will receive a formal diagnosis from their GP. In fact, many people do not need to see their GP, unless they have ongoing or serious complaints after the injury. If a diagnosis is given, this will be either ‘mild traumatic brain injury’, ‘post-concussion syndrome’ or ‘persistent post-concussive symptoms’.
Whether you receive a diagnosis or not, you can still follow the above guidance to cope, contact our nurse-led helpline for support and information, or speak to your GP about getting help if you are struggling with the long-term impact of concussion.
Can I drive with concussion?
Driving is a complicated skill which we usually take for granted, but concussion can affect important driving-related skills such as reaction times and concentration. Do not drive within the first 24 hours of injury and avoid driving until you feel much better. When you do return to driving, start carefully and avoid long, stressful journeys and heavy traffic where possible.
In some cases, it may be necessary to inform your licensing authority about your injury. You can speak to your GP about this, or any other concerns about your fitness-to-drive.
Can I drink alcohol with concussion?
It is best to avoid drinking alcohol after concussion until your symptoms improve. This is because, at least for a short time, the brain may be more sensitive to the effects of alcohol. Drinking alcohol may also worsen symptoms you are experiencing such as problems with concentrating or balance. This may put you at greater risk of sustaining another injury, for instance if you lose your balance while intoxicated and fall over.
The information on this page was reviewed by Dr Ioannis Mavroudis, Neurologist, and Dr Nigel King, Consultant Clinical Neuropsychologist.
