by Dr. Lisa Brekke

Concussions are a common but serious type of traumatic brain injury (TBI) that occurs when a blow to the head or body causes the brain to move within the skull. While many concussions do not warrant a trip to the emergency room, it is important to take any potential concussion seriously and seek medical attention if necessary.

When to Go to the Emergency Room

If you’ve experienced a blow to the head or a violent jolt and are wondering whether a concussion has occurred, there are several signs that should prompt a visit to the ER. Immediate medical attention is crucial when:

• Loss of Consciousness: Even a brief loss of consciousness is a red flag. If you were knocked out, even for a few seconds, you should go to the ER immediately.
• Severe Headache: A headache that is intense or worsening over time may indicate a more serious brain injury or bleeding, which requires immediate evaluation.
• Vomiting or Nausea: Persistent vomiting or nausea after a head injury could signal a more severe condition that needs urgent treatment.
• Seizures: If you experience seizures following a head injury, seek immediate medical help, as this could indicate a serious problem.
• Confusion or Difficulty Thinking Clearly: Feeling disoriented, struggling to remember details of the event, or having trouble processing information may indicate a more significant brain injury.
• Unusual Behavior or Personality Changes: A concussion can sometimes cause behavioral changes. If you or the injured person exhibits unusual behaviors, aggression, or confusion, seek urgent medical attention.
• Unequal Pupils or Slurred Speech: Changes in vision, such as one pupil appearing larger than the other, or slurred or incoherent speech, could indicate a more serious condition, like bleeding in the brain.
• Weakness or Numbness: If you feel weakness or numbness in any part of the body, especially on one side, this could be a sign of a stroke or other serious condition requiring immediate medical intervention.

When to See a Physician

If symptoms are less severe but still noticeable, a follow-up with your physician is warranted. You may also consult a sports medicine physician specializing in concussion management.

Other reasons to schedule an appointment with your physician:

• Follow-up after an ER visit: Emergency rooms address immediate concerns like brain bleeds or skull fractures. Scheduling a follow-up with your physician or a physical therapist specializing in concussion management can help determine the next steps in your recovery.
• Gradual Onset of Symptoms: If symptoms like headaches, dizziness, or fatigue worsen or do not improve in the days following a concussion, seek a healthcare provider for further evaluation.
• Cognitive Symptoms: Feeling foggy, having trouble concentrating, or struggling with memory problems are common after a concussion. A doctor can help manage these symptoms and provide strategies for recovery.
• Gradual Return to Normal Activity: An athletic trainer or physical therapist can create a structured plan to help you safely return to your daily routine. This typically involves a step-by-step increase in activity, starting with light tasks and gradually progressing to more demanding activities as tolerated.

What to Expect During Your Visit

Whether you’re going to the ER or seeing your physician, here’s what you can expect:

• Thorough Evaluation: The healthcare provider will ask about how the injury occurred, your symptoms, and any prior concussions or head injuries. They will also perform a physical exam to assess balance, coordination, and cognitive abilities.
• Imaging Tests: If a physician or ER doctor suspects a more serious brain injury, they may order imaging tests like a CT scan or MRI to rule out bleeding, swelling, or other complications. Currently, there is no imaging or lab test that diagnoses a concussion—these tests are done to rule out more severe issues.
• Observation: If symptoms are mild or unclear, you may be observed for a period of time, especially in the ER, to monitor for any worsening symptoms.

Red Flags for When to Seek Immediate Attention

If you are ever uncertain about whether your symptoms require urgent care, look for the following red flags:

• Severe or worsening headaches
• Difficulty waking up or staying awake
• Slurred speech
• Weakness, numbness, or decreased coordination
• Severe confusion or agitation
• Sudden changes in vision

How to Care for Yourself or a Loved One After a Concussion

Once a concussion is diagnosed, recovery time varies depending on multiple factors. However, there are general guidelines to follow:

• Rest is Key: Relative rest—both physically and mentally—is crucial in the days following a concussion. This means avoiding physical exertion as well as mentally taxing activities like reading, using electronics, and even socializing for 24-48 hours.
• Gradual Return to Activity: As symptoms improve, you can slowly ease back into your normal routine, starting with light activities. If symptoms return, reduce activity levels and rest until they subside. In Iowa, students must return to learning symptom-free without additional modifications before beginning the return-to-sport protocol. This protocol is typically overseen by an athletic trainer or physical therapist. If you or your child are not an athlete, finding a physical therapist specializing in concussion recovery can be beneficial for returning to work or school without lingering symptoms.
• Follow-Up Care: Attend follow-up appointments to monitor recovery. A healthcare provider can ensure symptoms are improving and guide your return to daily activities.

Conclusion

Concussions should never be taken lightly. Whether you visit the ER or your primary care physician depends on symptom severity, but seeking a proper evaluation after any brain injury is crucial for your health. Early diagnosis, rest, and appropriate treatment can help ensure a safe recovery and prevent long-term complications. When in doubt, always seek medical attention—your brain’s health is too important to ignore.

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