Concussion: Symptoms, Red Flags After a Head Injury and How to Recover Safely

Most people with concussion are never knocked out. A bump on a sports pitch, a fall on ice or a minor car crash can shake the brain enough to cause headaches, fogginess and sleep problems for days or weeks. Knowing the red flags, and how to rest the right way, makes a big difference.

Imagine your teenager clashes heads during a football match. They get up, say they’re fine and want to keep playing. But they seem a bit dazed and keep asking what the score is. That evening they have a headache and feel sick. They weren’t knocked out, so is it really a concussion? Quite possibly, and they should not have gone back on the pitch.

Common concussion symptoms

• Headache or a feeling of pressure in the head
• Dizziness, balance problems or blurred vision
• Feeling dazed, foggy or slowed down
• Confusion or memory problems about the event
• Nausea, sensitivity to light or noise
• Irritability, low mood, anxiety or sleeping more or less than usual

Red flags: go to the emergency department or call for help

• Loss of consciousness, even briefly, or difficulty staying awake
• A headache that gets worse and won’t go away
• Repeated vomiting
• A seizure or fit
• Weakness, numbness, slurred speech or problems with vision
• Increasing confusion, agitation or unusual behaviour
• Clear fluid or blood from the ears or nose, or bruising behind the ears
• Any head injury in someone taking blood thinners, older adults, or babies and young children who are not acting normally

Someone should stay with the injured person for the first 24 hours to watch for these signs.

How to recover

• Rest for the first day or two, but complete darkness and bed rest for days is no longer advised. Gentle activity such as short walks can help recovery.
• Cut back on screens, reading and busy places if they make symptoms worse, then build up gradually.
• Avoid alcohol and don’t drive until you feel fully recovered.
• Use paracetamol (acetaminophen) for headache, following the pack. Ask before using other painkillers in the first days.
• Return to school or work step by step, starting with shorter days if needed.

But when is it safe to play sport again?

“If in doubt, sit them out.” No one should return to sport on the same day as a suspected concussion. Return follows a graded plan, moving from light activity to full contact only when symptoms have gone at each stage, and usually not before about three weeks for full-contact sport in children and young people. A second knock before the brain has recovered can be very dangerous. Most people recover within two to four weeks; see a doctor if symptoms last longer.

Sources: US Centers for Disease Control and Prevention (HEADS UP concussion), NHS (Concussion; Head injury), NICE guideline on head injury, UK concussion guidelines for grassroots sport. This guide is for general information and does not replace advice from your own nurse, doctor or emergency services.