What is a concussion?

A concussion is a form of a traumatic brain injury that happens when the brain is shaken within the skull. Concussion is also known as mild traumatic brain injury (mTBI) but it does not typically result in structural brain injury identified on diagnostic imaging such as CT or MRI scans. The term mild does not diminish the impacts that concussion can have on your health and activities of daily living (ADLs).

While the majority of people recover within one month, in some cases symptoms resolve more slowly or may persist longer than expected. Prompt medical assessment and management can help diagnose concussions and ensure patients are provided with proper education and guidance as well as treatment as needed.

If you have suffered any trauma to your head and/or whiplash, and you experience symptoms of concussion, it is important to seek medical help. This includes if you have been in a traumatic accident; assaulted; fallen; or injured playing sports. National concussion guidelines recommend that all those with a suspected concussion undergo prompt medical assessment by a physician or nurse practitioner.

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Signs of a concussion

The following symptoms can occur after a concussion [1].

Please note: Most people will not experience all symptoms – but if you are experiencing symptoms after a physical injury, visit your doctor.

  • Headache/migraine
  • Dizziness and balance problems
  • Nausea
  • Fatigue
  • Sleep disturbance
  • Vision changes
  • Sensitivity to light or noise
  • Ringing in the ears
  • Seizure
  • Problems with smell/taste
  • Foggy-feeling
  • Difficulty remembering and focusing
  • Slower information processing
  • Trouble thinking clearly or finding your words
  • Difficulty making decisions or plans
  • Behavioural changes like depression, anxiety, irritability, aggression, or impulsivity

Who can diagnose a concussion?

There is no formal test to officially diagnose a concussion. A registered doctor or nurse practitioner are the medical professionals qualified to assess your symptoms to determine if you have a concussion.

Please note: there are some exceptions to this in Quebec and Manitoba. In Quebec, nurse practitioners are not able to make a concussion diagnosis. In Manitoba, physician assistants are licensed for medical assessments [2].

When to seek medical attention

You should see a doctor right away if you or someone you are caring for is experiencing the following symptoms after a traumatic event.

  • Significant neck pain or tenderness immediately after the injury
  • Double vision
  • Seizure or convulsion
  • Weakness or tingling/burning in arms and legs
  • Severe or increasing headache
  • Deteriorating conscious state
  • Repeated vomiting
  • Increase in restlessness, agitation or combative behaviour

If the person is experiencing these symptoms in extremes, call 911 and use emergency services.

For more information on treatment pathways after someone has sustained a concussion, see the full chart on the Concussion Awareness Training Tool. The difficulty with a concussion is that you may not recognize you have one right away. If you are experiencing symptoms of a concussion after an accident, instance of assault, or serious hit during sports, make an appointment to see a doctor.

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A person with a first-time concussion typically recovers fully within a few days to weeks after the injury. No two concussions are the same. This means that recovery is different for everyone.

The Ontario Neurotrauma Foundation guidelines for Concussion/ mTBI and Persistent Symptoms was developed to improve patient care by creating a framework that can be implemented by healthcare professionals to effectively identify and treat individuals with persistent symptoms following a concussion/mTBI.

The patient version of the Guidelines for Concussion/mTBI and Persistent Symptoms is for adults over the age of 18. These were developed to make communication between healthcare provider and patient easier. Starting in 2019 these guidelines will become living guidelines to ensure that the most current research literature is incorporated into the recommendations.

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Concussion recovery tips

The symptoms you experience can be difficult to manage and have an impact on your daily life. Some symptoms may come and go, and your recovery may take longer than expected. It can be frustrating, debilitating, and scary. You’re not alone – recovery can be challenging for many people. With the right education and support, you’ll be able to face those challenges and make positive progress.

Here are some ways you can proactively assist your concussion recovery. You should make sure to listen to your doctor if they have more specifics steps for your recovery plan.

Appropriate rest and activity
The concussion guidelines say you should slowly become more active after 24 – 48 hours of rest. This is a change from ‘cocoon therapy’ – the practice of long periods of rest in low lighting with little to no activity.  Recent research indicates that long periods of rest may do more harm than good [1].

Daily activities of living should be re-introduced gradually. Overtime as symptoms decrease, the more active you can become [2]. You should always consult with your doctor before resuming activity that includes a significant risk of injury. If your symptoms get worse when you’re active, try scaling back. Every person has a threshold for activity, and it may take awhile to find yours.

There is no set timeline for when you’re supposed to be able to return to regular activity. The important thing is that you take your time and consult with your doctor.

Return to work gradually
Like with physical activity, your return to work should be gradual, building up over time. Depending on the severity of your concussion, your return to work could begin a few days to a few weeks after your injury. You should make sure to talk with your employer about your concussion, any symptoms you’re still experiencing, and how best to transition back to your full responsibilities [3].

Keep a journal of how you’re feeling both at and after work. This will help track your symptoms and whether you’re ready to take a step forward and increase your workload. While working, you should take frequent breaks to give your brain time to rest. You should also plan for additional time to finish tasks and try to find a quiet environment to complete your work.

If you’re ready to return to work, but need a little help getting the process started, visit the return to work section for tips and resources.

Ask for help
If you are having trouble with household tasks like cooking or cleaning, ask a family member or friend for assistance. Return to activities gradually according to doctor recommendations.
Bring someone with you to appointments
When you experience a concussion, symptoms can make it difficult for you to keep track of information or get to appointments. Bringing a friend or family member with you to appointments can be helpful. They can write down information and communicate with your medical team.

Risk factors

There are several risk factors that are taken into consideration when doctors are mapping out your recovery.

  • History of previous brain injury
  • Previous neurological or psychiatric problems
  • Effects of other health issues like medications, bodily injuries, etc.
  • Anxiety
  • Depression
  • Insomnia
  • The number of symptoms you are experiencing
Personal or environmental factors that may negatively affect recovery
  • Mechanism of injury (e.g. motor vehicle accident, assault)
  • Significant delays or not returning to work following the injury
  • Being a student
  • Life stressors
  • Older age
  • Lack of social support
  • Female gender
  • Lower resilience
  • Returning to a contact sport too early
Multiple concussions and second impact syndrome
Getting another concussion while still recovering from a previous one may increase the risk for long-term problems. Second impact syndrome is an extremely rare event where a second concussion in close succession to a previous, not yet healed concussion leads to uncontrolled brain swelling. Most reported cases have been in teenagers and young adults. In a few cases worldwide, it has even been linked to death [4].

It’s important to fully heal from a first concussion before returning to any sport or activity that could put you at high risk of getting another. When you do return to a sport or activity, you should speak with your coach/leadership team about safety precautions.

What if my symptoms aren’t going away?

All these factors will impact how quickly you recover from your concussion [5].

If you still have symptoms 1 month after your initial injury, these are called persistent symptoms (sometimes referred to as prolonged symptoms or post-concussion syndrome). Every person’s recovery is different, so don’t be alarmed if you do have some symptoms after the 1-month period. Talk to your doctor about what symptoms you are experiencing.

Persistent symptoms include:

  • Headaches
  • Fatigue or difficulty with sleep
  • Unsteadiness or decreased balance
  • Memory or concentration difficulties

If you’re experiencing seizures, slurred speech, or numbness you should consult with your doctor prior to the 1-month mark.

Prolonged symptoms can affect your daily life and make it difficult for you to perform regular activities. Your doctor may want to do more tests and check in with you more often if it turns out you have persistent symptoms. Their tests and medical investigations will tell them how best to manage your symptoms. Check the ONF guide for more information on managing prolonged symptoms.

What is Chronic Traumatic Encephalopathy (CTE)?

CTE is a neurodegenerative disease that has been found posthumously in a small number of athletes and veterans with a history of multiple head injuries. Research is continually evolving on CTE.

Private concussion clinics

There are many private concussion clinics across Canada offering a wide variety of concussion recovery methods and therapies. These private clinics have no federal or provincial oversight or regulations and there are no assurances of the services they provide. When figuring out whether a private clinic is right for you, ask the following questions [6]:

  • Does the clinic have a medical doctor?
  • Does the clinic have a team of licensed health care professionals?
  • Does the clinic follow the most up-to-date standards of care for managing a concussion?
  • What tools, tests and recommendations is the clinic using?

Disclaimer: There is no shortage of web-based online medical diagnostic tools, self-help or support groups, or sites that make unsubstantiated claims around diagnosis, treatment and recovery. Please note these sources may not be evidence-based, regulated or moderated properly and it is encouraged individuals seek advice and recommendations regarding diagnosis, treatment and symptom management from a regulated healthcare professional such as a physician or nurse practitioner. Individuals should be cautioned about sites that make any of the following statements or claims that:

  • The product or service promises a quick fix
  • Sound too good to be true
  • Are dramatic or sweeping and are not supported by reputable medical and scientific organizations.
  • Use of terminology such as “research is currently underway” or “preliminary research results” which indicate there is no current research.
  • The results or recommendations of product or treatment are based on a single or small number of case studies and has not been peer-reviewed by external experts
  • Use of testimonials from celebrities or previous clients/patients that are anecdotal and not evidence-based 

Always proceed with caution and with the advice of your medical team. 

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