Overview
A concussion is a mild traumatic brain injury caused by a bump, blow, or jolt to the head that causes the brain to move rapidly inside the skull. It alters brain function temporarily. Most people recover fully within weeks, but repeated concussions can have lasting effects.
How common is it?
Concussion is extremely common, with hundreds of thousands of cases each year in the UK from sport, falls, and road accidents. It is often under-recognised and under-reported.
Causes and risk factors
The sudden movement of the brain inside the skull stretches and damages nerve fibres and disrupts brain chemistry. A direct blow to the head is not required as violent shaking of the head can cause it too.
Common risk factors
- Contact sports (rugby, boxing, football, hockey)
- Falls, especially in the elderly
- Road traffic accidents
- Previous concussion (increases sensitivity to further injury)
- Female sex (some evidence of greater susceptibility)
- Young age (developing brains more vulnerable)
Symptoms
- Headache
- Dizziness or feeling 'foggy'
- Confusion or feeling slowed down
- Nausea or vomiting
- Blurred or double vision
- Balance problems
- Brief loss of consciousness (not always present)
- Memory problems around the time of injury
- Sensitivity to light and noise
- Sleep disturbance
When to see a doctor
Go to A&E immediately for: prolonged unconsciousness, repeated vomiting, seizure, worsening headache, one pupil larger than the other, weakness or numbness, or not waking normally. These suggest a more serious brain injury.
Diagnosis
Concussion is diagnosed clinically. CT scan is used to rule out brain bleeding in patients with red flag symptoms. Neuropsychological testing assesses cognitive impact in athletes and those with prolonged symptoms.
Treatments
Physical and cognitive rest
Initial rest from screen time, reading, exercise, and mental effort. Gradually and carefully returning to normal activities as symptoms allow, using a stepwise protocol.
Symptomatic management
Paracetamol for headache (avoid NSAIDs initially due to small bleeding risk). Sleep hygiene support. Avoiding alcohol and screens during recovery.
Rehabilitation
Physiotherapy, vestibular rehabilitation, and neuropsychological support for people with persistent post-concussion symptoms lasting more than 4 to 6 weeks.
Self-care and lifestyle
- Follow the graduated return-to-sport protocol strictly after concussion in sport
- Never return to play on the same day as a head injury
- Wear appropriate helmets for cycling, skiing, and contact sports
- Report all head injuries to coaches, parents, or medics even if they seem minor
Prevention
Wearing appropriate protective headgear, using correct technique in contact sports, and implementing concussion protocols in sports reduce incidence and severity.