How to Treat a Concussion

A concussion occurs when a blow causes the brain to shake within the space between the brain and skull. Concussions are the most common form of head injury. They can happen from car accidents, sports injuries, falls, or any significant blow to the head or upper body. While most concussions cause only temporary dizziness and don't result in long-term damage, they can lead to serious problems if not treated promptly and properly.

Assess the victim's condition. Check for injuries and carefully observe the person. Look for any external bleeding on the head. A concussion may not always cause external bleeding, but a swelling (often referred to as a "goose egg") or a blood clot (large bruise) can appear beneath the scalp.

• Visible wounds on the scalp are not always a reliable sign of a concussion, as minor scalp wounds can bleed profusely, while more severe internal injuries can be harder to spot but may harm the brain.
• Physical symptoms to watch for include signs of a basilar skull fracture. Bruising behind the ear (a swollen bruise appearing days after a skull fracture due to blood leaking into the area behind the ear), bruising around the eyes, and nosebleeds (a sign of cerebrospinal fluid leakage).

Check for physical symptoms. Both mild and severe concussions can lead to various physical symptoms. Be on the lookout for any of the following signs:

• Loss of consciousness
• Severe headache
• Sensitivity to light
• Double vision or blurred images
• Seeing "flashes", dark spots, or other unusual images
• Loss of motor coordination and balance
• Dizziness
• Tingling, pins and needles, or weakness in limbs
• Nausea and vomiting
• Memory loss
• Confusion

Assess cognitive symptoms. A concussion is a brain injury that often disrupts brain function. These disruptions include:

• Unusual irritability or agitation
• Lack of focus or difficulty thinking logically and remembering
• Emotional instability, inappropriate outbursts, or crying spells
• Excessive drowsiness or unconsciousness

Evaluate the victim's level of consciousness. When assessing a concussion, it's important to determine if the victim is alert and how aware they are. To check consciousness, you can use the AVPU method:

• A – (Alert). Is the victim alert? Do they look at you? Do they respond? Do they react to normal environmental stimuli?
• V – (Voice). Does the victim respond to voice? Do they respond when you speak to them, even if only faintly or in an unalert manner? If they reply with "Huh?" when you speak to them, they respond to voice but are not fully alert.
• P – (Pain). Does the victim respond to pain or touch? Try pinching their skin or applying pressure to their nails to check for movement or eye-opening. Be careful not to cause further harm to the victim. You are merely testing their body’s response.
• U – (Unresponsive). Is the victim unresponsive to any of these tests?

Continue monitoring the victim. Most concussion symptoms appear within minutes after the injury. Other symptoms may show up within hours. Some symptoms can change over a few days. Keep monitoring the victim and contact a doctor if symptoms worsen or change.

Ice pack application. To reduce swelling on a mild injury, apply an ice pack to the affected area. Reapply the ice every 2-4 hours for 20-30 minutes.

• Do not place the ice directly on the skin. Wrap it in cloth or a plastic bag. If ice is unavailable, a bag of frozen vegetables can be used as an alternative.
• Avoid pressing on head injuries as the added pressure may push bone fragments into the brain.

Pain relief medication. To treat a headache at home, you can take acetaminophen (Tylenol). Avoid ibuprofen or aspirin, as they may worsen bruising or bleeding.

Constant monitoring. If the victim is conscious, you should keep asking them questions. This serves two purposes: first, to assess the severity of the injury, and second, to keep them alert. Asking questions frequently helps detect changes in their cognitive state if they are unable to respond to questions they could previously answer. If their condition worsens, seek medical help. Questions you might ask include:

• What day is it today?
• Where are you right now?
• What just happened?
• What is your name?
• How are you feeling?
• Can you repeat the following words after me...?

Stay with the victim. During the first 24 hours after the injury, remain with the victim. Do not leave them alone. Monitor their physical and cognitive functions for any changes. If the victim wants to sleep, wake them every 15 minutes for the first 2 hours, then every 30 minutes for the next 2 hours, and then every hour thereafter.

• Each time you wake them, use the AVPU consciousness test as described above. You should continue monitoring their physical and cognitive state for any symptoms that appear or worsen later.
• If the victim does not respond when awakened, treat them as unconscious.

Avoid strenuous activities. In the days following the injury, refrain from engaging in sports or intense physical activities. Also avoid stressful situations during this period. The brain needs rest and recovery. Before resuming any athletic activity, consult with a doctor.

• Engaging in physical activity too soon may increase the risk of a second concussion and long-term memory issues.

Do not drive. Avoid operating any vehicles or riding a bicycle until you have fully recovered. It's best to have someone else drive you to the clinic or hospital.

Rest. Refrain from activities such as reading, watching TV, listening to music, playing games, or doing any tasks that require mental effort. Allow both your body and mind to rest.

Consume brain-boosting foods. Certain foods can positively or negatively affect the brain's healing process. Avoid alcohol after a concussion. Also, steer clear of fried foods, sugary items, caffeine, artificial colorings, and flavorings. Instead, incorporate these foods into your diet:

• Avocados
• Blueberries
• Coconut oil
• Nuts and seeds
• Salmon
• Butter, cheese, and eggs
• Honey
• Any vegetables and fruits you enjoy

Contact a doctor. Any suspected head injury or concussion should be evaluated by a medical professional. Even a seemingly minor head injury can be life-threatening. If the victim does not regain consciousness, call emergency services. Alternatively, you can transport the victim to the nearest emergency room or clinic.

• If the victim is unconscious or you're unsure about the severity of the injury, call for emergency help. Transporting someone with a head injury requires stabilizing their head, as movement could be fatal.
• It's crucial for the victim to undergo a thorough examination in the emergency room if they are unconscious or experiencing severe memory loss. A CT scan might be needed to assess swelling or bleeding and to diagnose the concussion, also known as mild traumatic brain injury.

Visit the hospital. In cases of severe concussion, it may be necessary to take the victim to the emergency room. If the victim displays any of the following symptoms, you should immediately seek emergency care:

• Loss of consciousness, even if brief
• Episodes of memory loss
• Feeling dizzy or confused
• Severe headache
• Frequent vomiting
• Seizures

Keep still and avoid movement. If you suspect that the injury may involve the neck or spine along with the concussion, avoid moving the victim while waiting for the medical team to arrive. Moving the victim could cause further damage.

• If moving the victim is absolutely necessary, exercise extreme caution. Ensure that the victim's head and back move as little as possible.

Continue monitoring. If symptoms do not improve within 7-10 days, contact a doctor. Anytime the symptoms change or worsen, it's crucial to reach out to a doctor immediately.

Continue treatment. The effects of traumatic brain injury on the brain and cognitive functions are still not fully understood. However, some treatments prescribed by doctors may help alleviate persistent symptoms.

• Your doctor may recommend certain imaging tests, such as an MRI, CT scan, or EEG. They may also conduct a neurological exam, assessing vision, hearing, reflexes, and coordination. Another possible test could be a cognitive assessment, which evaluates memory, attention, and recall ability.

• It is not recommended to return to sports activities on the same day as a concussion. Athletes should refrain from playing until they are symptom-free and no longer need medication. Extra precautions are necessary for children and teenagers.
• Preventive measures include wearing helmets during sports such as football, baseball, ice hockey, mountain skiing, and snowboarding.