Diagnosis

To diagnose a concussion, your healthcare professional evaluates your symptoms and reviews your medical history. You may need tests that help diagnose a concussion. Tests may include a neurological exam, cognitive testing and imaging tests.

Neurological exam

Your healthcare professional asks detailed questions about your injury and then performs a neurological exam. This evaluation includes checking your:

  • Vision.
  • Hearing.
  • Strength and sensation.
  • Balance.
  • Coordination.
  • Reflexes.

Cognitive testing

Your healthcare professional may conduct several tests to evaluate your thinking skills, also known as cognitive skills. Testing may evaluate several factors, including your:

  • Memory.
  • Concentration.
  • Ability to recall information.

Imaging tests

Brain imaging may be recommended for some people who have had a concussion. Imaging may be done in people with symptoms such as bad headaches, seizures, repeated vomiting or symptoms that are becoming worse. Imaging tests may determine whether the injury has caused bleeding or swelling in the skull.

A computerized tomography (CT) scan of the head is the standard test in adults to assess the brain right after injury. A CT scan uses a series of X-rays to obtain cross-sectional images of the skull and brain.

For children with a suspected concussion, CT scans are used only if specific criteria are met, such as the type of injury or signs of a skull fracture. This is to limit radiation exposure in young children.

Magnetic resonance imaging (MRI) may be used to identify changes in your brain or to diagnose complications that may occur after a concussion. An MRI uses powerful magnets and radio waves to produce detailed images of your brain.

Observation

After a diagnosis of a concussion, you or your child may need to be hospitalized overnight for observation.

Or your healthcare professional may agree that you or your child can be observed at home. Have someone stay with you and check on you for at least 24 hours to ensure that your symptoms aren't getting worse.

Treatment

There are steps you can take to help your brain heal and speed recovery.

Physical and mental rest

In the first couple of days after a concussion, relative rest allows your brain to recover. Healthcare professionals recommend that you physically and mentally rest during this time. However, complete rest, such as lying in a dark room without any stimuli, does not help recovery and is not recommended.

In the first 48 hours, limit activities that require a lot of concentration if those activities makes your symptoms worse. This includes playing video games, watching TV, doing schoolwork, reading, texting or using a computer.

Don't do physical activities that increase your symptoms. This may include general physical exertion, sports or any vigorous movements. Don't do these activities until they no longer provoke your symptoms.

After a period of relative rest, gradually increase daily activities if you can tolerate them without triggering symptoms. You can start both physical and mental activities at levels that do not cause a major worsening of symptoms.

Light exercise and physical activity as tolerated starting a couple of days after injury have been shown to speed recovery. Activities might include riding a stationary bike or light jogging. But don't engage in any activities that have a high risk of another head impact until you are fully recovered.

Your healthcare professional may recommend that you have shortened school days or workdays. You may need to take breaks during the day, or have modified or reduced school workloads or work assignments as you recover.

Your healthcare professional also may recommend different therapies. You may need rehabilitation for symptoms related to vision, balance, or thinking and memory.

Returning to routine activity

As your symptoms improve, you may gradually add more activities that involve thinking. You may do more schoolwork or work assignments, or increase your time spent at school or work.

Some physical activity can help speed brain recovery. Specific return to physical activity sport protocols may be suggested by your healthcare professional. These typically involve specific levels of physical activity to make sure you return to activity safely. Don't resume contact sports until you are symptom-free and cleared by your healthcare professional.

Pain relief

Headaches may occur in the days or weeks after a concussion. To manage pain, ask your healthcare professional if it's safe to take a pain reliever such as acetaminophen (Tylenol, others). Don't take other pain relievers such as ibuprofen (Advil, Motrin IB, others) and aspirin. These medicines may increase the risk of bleeding.

Preparing for your appointment

It's important for anyone who has a head injury to be evaluated by a healthcare professional, even if emergency care isn't required.

If your child has received a head injury that concerns you, call your child's healthcare professional right away. Depending on the symptoms, your healthcare professional may recommend that your child get medical care right away.

Here's some information to help you get ready for and make the most of your medical appointment.

What you can do

  • Be aware of any pre-appointment restrictions or instructions. The most important thing for you to do while waiting for your appointment is not to do activities that cause or worsen symptoms. Don't play sports or do vigorous physical activities. Minimize stressful or prolonged mental tasks. At the time you make the appointment, ask what steps you or your child need to take to encourage recovery or prevent another injury. Experts recommend that athletes not return to play until they have been medically evaluated.
  • List any symptoms you or your child has been experiencing and how long they've been occurring.
  • List key medical information, such as other medical conditions for which you or your child is being treated. Include any history of head injuries. Also write down the names of any medicines, vitamins, supplements or other natural remedies you or your child is taking.
  • Take a family member or friend along. Sometimes it can be hard to remember all the information provided to you during an appointment. Someone who comes with you may recall something that you missed or forgot.
  • Write down questions to ask your healthcare professional.

For a concussion, some basic questions to ask include:

  • Do I have a concussion?
  • What kinds of tests are needed?
  • What treatment approach do you recommend?
  • How soon will symptoms begin to improve?
  • What is the risk of future concussions?
  • What is the risk of long-term complications?
  • When will it be safe to return to competitive sports?
  • When will it be safe to resume vigorous exercise?
  • Is it safe to return to school or work?
  • Is it safe to drive a car or operate power equipment?
  • I have other medical conditions. How can they be managed together?
  • Should I see a specialist? What will that cost, and will my insurance cover a visit to a specialist? You may need to call your insurance provider for some of these answers.
  • Are there any brochures or other printed material that I can take home with me? What websites do you recommend?

In addition to the questions that you've prepared, don't hesitate to ask questions that come up during your appointment.

What to expect from your doctor

Being ready to answer your healthcare professional's questions may reserve time to go over any points you want to talk about in-depth.

You or your child should be prepared to answer the following questions about the injury and related symptoms:

  • Do you play contact sports?
  • How did you get this injury?
  • What symptoms did you experience immediately after the injury?
  • Do you remember what happened right before and after the injury?
  • Did you lose consciousness after the injury?
  • Did you have seizures?
  • Have you experienced nausea or vomiting since the injury?
  • Have you had a headache? How soon after the injury did it start?
  • Have you noticed any trouble with physical coordination since the injury?
  • Have you had any issues with memory or concentration since the injury?
  • Have you noticed any sensitivity or changes with your vision and hearing?
  • Have you had any mood changes, including irritability, anxiety or depression?
  • Have you felt sluggish or easily fatigued since the injury?
  • Are you having trouble sleeping or waking from sleep?
  • Have you noticed changes in your sense of smell or taste?
  • Do you have any dizziness?
  • What other symptoms are you concerned about?
  • Have you had any previous head injuries?

What you can do in the meantime

Before your appointment, don't do activities that increase your symptoms and risk another head injury. This includes not playing sports or activities that require vigorous movements.

Gradually resume your usual daily activities, including screen time, as you're able to tolerate them without worsening symptoms.

If you have a headache, acetaminophen (Tylenol, others) may ease the pain. Don't take other pain relievers such as aspirin or ibuprofen (Advil, Motrin IB, others) if you suspect you've had a concussion. These may increase the risk of bleeding.

By Mayo Clinic Staff