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What is a Concussion?
A concussion is typically a short-lived brain injury caused by a bump, blow or jolt to the head that causes a mild, transient disturbance of brain function. Most concussions occur without loss of consciousness, and most do not cause brain swelling or permanent brain injury.
Signs & Symptoms
Symptoms of a concussion can occur immediately, or even hours or days after the initial “hit” or fall. Symptoms can change over time, depending on activity level and potentially other associated injuries, making them difficult to recognize and manage. The sooner the injury is evaluated and treatment starts, the better. Anyone who experiences any of the following symptoms after an injury to the head should be evaluated by a healthcare provider.
Signs:
- A dazed or stunned appearance
- Personality or behavioral changes
- Confusion
- Loss of consciousness — even brief
- Clumsiness
- Forgets plays or assignments
- Seems “out of it” Forgetting events prior to or after a “hit”
- Slow response to questions, or repeatedly asking questions
Symptoms:
- Headache
- Nausea
- Balance problems
- Double, blurry or changed vision
- Sensitivity to light and/or noise
- Excessive fatigue or drowsiness
- Changes in sleep patterns
- Trouble comprehending, concentrating and/or paying attention
- Irritability, nervousness, feeling emotional or sad
- Feeling “just not right” or in a “fog”
It’s important to know that concussion symptoms often worsen with physical and mental activity, such as using a computer, gaming system, texting, or any activity that may increase your heart rate. It is recommended that you recognize and avoid the triggers that worsen any of your symptoms.
Risk factors include:
- Individuals with a history of previous brain impairment
- Younger individuals whose brains aren’t fully developed
- Previous concussion
- Not wearing correctly fitting or worn out protective equipment when working or playing sports
- Careless or reckless behaviors
- Ignoring the signs and symptoms of concussion and continuing to play
- Non-adherence to rules of play
Evaluations & Treatments
If an individual is suspected of having a concussion, the most important thing is for them to be assessed by a healthcare provider experienced in evaluating and treating concussions.
A medical professional should provide a thorough neurological examination. This includes a comprehensive history of the injury, a review of their concussion symptoms, a pertinent physical exam to identify any subtle abnormal findings or other injuries, balance testing, and cognitive functions such as memory, concentration and recall. No concussed athlete should return to their sport that same day. Caution should be exhibited in returning to school or work.
Recovery from a concussion isn’t always smooth sailing. Know that symptoms may worsen within the first 48 hours. Anyone who has suffered a concussion should be monitored closely during this period of time and should be taken to the emergency room, if they are experiencing any of the following symptoms:
- Increasing confusion, inability to recognize people or places, significant decline in alertness
- Nausea and repetitive vomiting
- Pupils that are unequal in size
- Worsening headache
- Unusual, bizarre or irritable behavior
- Seizures (arms and legs jerking uncontrollably)
- New clear watery discharge from the nose or ears
- Bloody discharge from the ears after injury
- Fainting
- Slurred speech
- Declining level of consciousness
- Weakness or numbness in arms or legs
Recovery
Steps to a rapid, but safe recovery:
The Three “R’s”:
1. Recognize your symptoms.
Identify and avoid triggers causing symptoms. Individuals should steer clear of any activities that bring on symptoms—some of the most common include reading, studying, texting, watching TV, playing video games, or even just walking. Limit other common triggers including light and noise.
2. Rest and Recover. Listen to your symptoms.
Allow your body and brain to rest immediately after the injury. If symptoms arise during any activity, don’t push through them; stop, rest and recover before you return to the activity again. Sleep allows the brain to heal. A good night’s sleep can refresh the brain for the next day so don’t cut your sleep short. There are times when your health care professional may suggest sleeping aids, if disordered sleeping is inhibiting recovery.
Light and noise sensitivity should be managed with sunglasses and noise-reducing devices.
Avoid alcohol immediately after the injury.
Don’t mask your symptoms during waking hours. You may unintentionally push through activities and potentially hinder your healing progress if you cannot recognize your symptoms. After an appropriate initial evaluation, if medications are needed for head or neck pain, it is preferable to take them prior to bed to decrease pain that may potentially interfere with restful sleep. Taking the medications prior to sleep should not interfere with the recognition of symptoms during other activities. If you have questions regarding medications, contact a healthcare provider.
3. Return to activity.
The individual must be symptom-free, feel back to their “normal” self, and cleared to return to school, work or play by their health care provider. No one should pressure someone who has suffered a concussion to return to their regular activities before they’re ready.
Living With
How long after a concussion can individuals return to normal activities?
Appropriate relative physical and mental rest is the key to a successful and full recovery. Activities such as driving, riding a bike, or using a computer, may need to be limited or eliminated while recovering from a concussion.
If an activity bothers the brain while it is being performed, limit or avoid it. If at any point signs or symptoms of concussion recur, the individual should return to rest until they are symptom-free. The individual should be symptom-free and cleared to return to school, work or play by their healthcare provider.
What is the danger of returning to activities too soon?
Individuals who resume activities too soon could suffer second-impact syndrome (SIS) or post-concussion syndrome (PCS). SIS occurs when someone suffers another blow to the head while still healing from a first concussion. While this is a rare occurrence, it is very serious and can result in permanent brain injury, paralysis or death. Post-concussion syndrome is a condition when recovery from a concussion is delayed. Symptoms persist for weeks, months or years. Additional therapies are often prescribed to help individuals with PCS recover from their injury.
Prevention
How can concussions be prevented?
Concussions happen for a number of reasons — not all of which are entirely under an individual’s control. But these general tips can help reduce the chance of suffering a concussion:
- For sports, use the proper sports equipment. It must be the correctequipment for the game, be worn correctly, fit well, used every time, and be in good condition. Always follow the rules of the game and practice good sportsmanship
- Protect yourself on the roads. Always wear your seatbelt. Use the appropriate helmet when biking, or riding a motorcycle. Never consume alcohol or use drugs, and drive.
- Use all necessary safety equipment at work to avoid injuries or falls.
- For older adults, it is important to reduce any chances of a fall. They should increase strength and balance with exercise, talk to their doctors about any medications that make them dizzy, have regular vision checks, and get rid of hazards in the home — such as objects that are easy to trip over — and ensure they have adequate lighting.
Special Protocols
Cleveland Clinic has a comprehensive, multidisciplinary program that utilizes special concussion protocols, which are helping improve care for patients. These include:
Cleveland Clinic Imaging
Our Imaging Institute, when needed to assist in the evaluation of head injuries, uses leading edge MRI scanners. Based on the latest research and developments in imaging we designed and utilize concussion specific protocols such as image sequencing, These Cleveland Clinic-designed sequences are used to examine patients who have sustained a concussion. This testing helps detect more subtle signs of injury than other more commonly used MRI sequences.
Specialized protocols used in the emergency room also help determine which patients would benefit most from CT scanning, helping avoid unnecessary radiation exposure.
Other Protocols Available
Return to play
Cleveland Clinic has specialized protocols designed to help transition athletes with concussion back to play in the safest manner possible. A Return to Learn protocol also helps students appropriately continue their studies.
Neurocognitive assessment and rehabilitation
Cleveland Clinic neuropsychologists specialize evaluating memory and thinking problems that may occur following head trauma. Using this testing and other specially designed assessments, our speech therapists will develop a tailored program of cognitive rehabilitation to help patients recover.
Physical therapy
Cleveland Clinic’s physical therapists use specific criteria to evaluate patients and provide rehabilitation for head and neck discomfort, balance, function and pain management.
Chronic head and neck pain
We provide unique multidisciplinary care for children through our Pediatric Chronic Pain Program and for adults in our Center for Neurological Restauration.
Sleep evaluations
For patients who have suffered a concussion and are having trouble sleeping, Cleveland Clinic offers individualized evaluations and treatment.
Patient Services
Virtual Visits
You can now stay connected to your healthcare team through virtual visits, using your smartphone, tablet or computer.
Why go virtual? It's an easy, convenient and secure way to see your provider face-to-face without having to leave home. This saves you travel time, parking fees and time spent in the waiting room — and you can also have a loved one or caregiver join you. If appropriate, you can also get a prescription sent to the pharmacy of your choice.
Many insurance companies cover the cost of virtual visits, so check with your insurance company ahead of time. Interested in getting started? Call your provider to find out what virtual visit options are available.
Virtual Second Opinions
If you cannot travel to Cleveland Clinic, help is available. You can connect with Cleveland Clinic specialists from any location in the world via a phone, tablet, or computer, eliminating the burden of travel time and other obstacles.
If you’re facing a significant medical condition or treatment such as surgery, this program provides virtual access to a Cleveland Clinic physician who will review the diagnosis and treatment plan.
Following a comprehensive evaluation of medical records and labs, you’ll receive an educational second opinion from an expert in their medical condition covering diagnosis, treatment options or alternatives as well as recommendations regarding future therapeutic considerations. You’ll also have the unique opportunity to speak with the physician expert directly to address questions or concerns.
Appointments & Locations
Locations
Ready to make an appointment?
Evaluations and management for concussions, from an interdisciplinary and experienced team located across Northeast Ohio and beyond.
To make an appointment call 216.518.3475 or toll free 877.440.TEAM. Same-day appointments are available.
Why Choose Us?
Cleveland Clinic concussion team on the sidelines
Our team utilizes its vast experience taking care of athletes at all levels — recreational, high school, collegiate and professional — to provide customized care to ensure a safe return back to sport. Our certified athletic trainers provide care to athletes at more than 50 high schools and four colleges in Northeast Ohio.
Prompt treatment is key
Every year, an estimated 1.7 million Americans suffer a concussion from falls, sports activities and car accidents. Unlike many more visible injuries, the signs and symptoms of a concussion may be very subtle, and thus much more difficult to see. They also may be more difficult to treat.
Patients and those around them may be slow to recognize the seriousness of a head trauma that leads to a concussion — which may then cause delayed evaluation and treatment. Educating yourself about concussions and their potential dangers can help lead to more prompt recognition, and thus avoid any potential delay in not only the evaluation, but the recovery as well.
At Cleveland Clinic's Concussion Center, we are committed to raising awareness about concussions to help ensure patients of all ages receive early and appropriate care. It is our goal to minimize long-term effects of concussions and further research to improve tomorrow’s care.
Our Concussion Center Brings Together Experts in a Wide Number of Specialties:
- Sports and exercise medicine physicians
- Neurologists
- Primary care physicians
- Pediatricians
- Physiatrists
- Certified athletic trainers
- Physical therapists
- Vestibular therapists
- Neuropsychologists
- Ophthalmologists/ optometrists
- Neurosurgeons
- Radiologists
- Psychologists
- Chiropractors
- Speech therapists
- Acupuncturists
- Massotherapists
- Researchers
Together, they accurately and promptly diagnose concussions, manage symptoms, monitor recovery, and help patients return to their daily activities, as soon as safely possible. Our team develops an individualized, customized treatment plan for each patient, utilizing the most up to date evidence and technology to guide care. Our team approach is tailored to the specific needs of the patient, with attention to the age, activities, concussion history, and any impediments to the recovery process, including identifying and treating any associated injuries that may have occurred at the time of the head trauma.
The Trust
Cleveland Clinic has been named a medical partner for The Trust, a clinical program powered by the NFL Players Association. A team of clinicians provides a two-day brain and body assessment for former NFL players at one of three sites: Cleveland Clinic main campus, Cleveland Clinic Florida (Weston, Florida), and the Lou Ruvo Center for Brain Health in Las Vegas, Nevada. The clinical team is made up of neurologists, internal medicine physicians, neuropsychologists, health behavior psychologists, radiologists, physical therapists and dietitians. For more information about our partnership with The Trust, call 216.445.9815.
Cleveland Clinic Concussion app
Changing the trajectory of sports concussion care, the Cleveland Clinic Concussion (C3) mobile application is a tool used for assessing concussion symptoms. Cleveland Clinic athletic trainers used the C3 app to conduct baseline assessments of motor and cognitive function in nearly 11,000 high school and college athletes who play contact sports across Northeast Ohio and in several locations throughout the United States. After baseline data are collected, the C3 app can be utilized to document the individual’s impairments, to assist in managing symptoms, and to help determine when recovery is complete. The C3 app compares assessments of balance, reaction time, memory and vision after a hit to baseline and normative data. The app-based assessment pinpoints the areas of most concern and helps guide therapy over time.
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