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 an individual’s 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 your family member or friend has suffered any trauma to their head and/or whiplash, and they are experiencing symptoms of concussion, it is important to seek medical help. This includes if they 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.

Topics in this section include:

• Signs of a concussion
• When to seek medical attention
• Who can diagnose a concussion
• Concussion recovery and treatment
• Risk factors
• Tips to help with concussion recovery
• Resources and awareness tools

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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 your friend or family member is experiencing symptoms after a physical injury, they should visit their 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 their words
• Difficulty making decisions or plans
• Behavioural changes like depression, anxiety, irritability, aggression, or impulsivity

When to seek immediate medical attention

If someone you are caring for is experiencing the following symptoms after a traumatic event, they should see a doctor right away.

• 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 your friend or family member has one right away. If they are experiencing symptoms of a concussion after an accident, instance of assault, or serious hit during sports, make an appointment to see a doctor.

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 symptoms to determine if a person has 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].

Concussion recovery and treatment

A person with a first-time concussion 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.

Concussion symptoms can be hard to manage, and often prevent a person from completing activities of daily living (ADLs). The person with a concussion may need assistance during their recovery if their symptoms are impacting their capabilities. They may even need someone to stay with them for long periods of time and help them with ADLs. If you are unable to take extended time away from work, try reaching out to other family members to create a schedule. Alternatively, you could also try short term in-home care professionals.

Living Concussion Guidelines

The Guidelines for Concussion/mTBI and Prolonged 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 Prolonged Symptoms is for adults over the age of 18. These were developed to make communication between 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.

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 you and your loved one are figuring out whether a private clinic is the right choice, ask the following questions [3]:

• 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?

Risk factors and concussion

There are several risk factors that are taken into consideration when doctors are mapping out concussion recovery [4].

Medical

• 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 the patient is 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

All these factors will impact how quickly or effectively a person recovers from a concussion.

Common challenges during a concussion

Some symptoms are more common than others. According to the Living Concussion Guidelines and the Vancouver Coastal Health concussion guide, these are common issues people experience, and how best to treat them.

Headaches

Headaches are one of the most common challenges after a concussion. They come in a variety of types and with different symptoms. Causes of headaches can include dehydration, stress, medications and lack of sleep.

Management techniques for headaches you can do without medication include [5]:

• Apply a cold or hot pack to the patient’s neck or head
• Stretch and massage their head, neck, and shoulders
• Join them in calming breathing exercises
• Provide a quiet spot in the house
• Take them outside to get fresh air
• Lead them in a visualization or other mindfulness-based exercises (you may need to see someone to learn how to do these)
• Make sure they drink water

If your friend or family member does require medication to help with their headaches, your doctor will prescribe preventative or rescue medication. Preventative keeps headaches from happening: doctors will perform an evaluation to determine whether this is something the patient needs. Rescue medication helps when someone already has a headache . Examples of these medications include the tryptans, ibuprofen and acetaminophen. They should not be used daily for extended periods of time as they will result in medication overuse headaches. Other rescue medications, such as opiates, should rarely if ever be used and only for short periods under the close supervision of a physician [6].

Trouble sleeping

It’s common to have issues with sleep after a concussion. This includes insomnia. If your friend or family member is experiencing some odd sleep, encourage them to download and keep a sleep diary. They should track when they go to bed, if they have trouble falling asleep, and anything else they think is abnormal. Share this with the doctor.

Depending on what the doctor discovers from tests and questions, they may suggest different treatments, such as:

• Good sleep hygiene
• Mindfulness meditation
• Melatonin
• Light therapy
• Acupuncture
• Psychological therapy
• Sleep study
• Other medications

Sleep hygiene is an important element to optimize immediately. Actions that can improve sleep include [7]:

• Keeping a regular bedtime schedule and routine
• Getting plenty of natural light
• Avoiding stimulants like caffeine and sugar, especially late in the day
• Eating light, protein-filled snacks in the evening if hungry
• Exercising during the day and not right before bed
• Keeping the bedroom dark, cool and comfortable
• Keeping electronics that may be distracting out of the bedroom
• No reading or working in bed
• Avoiding excessive alcohol

For more information about sleep and sleep hygiene, review the Vancouver Coastal Health concussion guidelines.

Fatigue

If your friend or family member feels tired a lot of the time, they may be experiencing fatigue. This is common after a concussion. A person can feel both mentally and physically tired, and it will affect daily activities and mood.

Fatigue usually improves over time but can get worse in some cases. It may help to track feelings of fatigue in a journal, so it is possible pinpoint when/why it happens.

You may feel fatigue as well if you’re taking on extra responsibilities associated with the person’s daily care. Ways you can help manage fatigue for both your loved one and yourself at home include [8]:

• Managing stress in a constructive way
• Exercise
• Consistent sleep schedules
• Pacing activities throughout the day
• Keeping track of daily activities to identify periods of fatigue

• More information on fatigue after a brain injury

Trouble focusing and paying attention

Any symptoms that affect memory, the ability to pay attention, learn and make decisions are called cognitive difficulties.

If your loved one is having trouble with any of these areas, talk to the doctor. They will complete tests to help figure out a treatment plan, how best to help your friend or family member, and provide information about their ability to function independently in their daily activities. They will also inform you of what you can expect should the person need extra assistant with cognitive tasks.

Some tips to help with cognitive difficulties include [9]:

• Keeping a physical schedule in a visible place
• Leaving notes for your friend or family member
• Setting reminders on their phone
• Proper sleep
• Management of fatigue

Dizziness

Problems with dizziness or balance (also called vestibular issues) are common after a concussion.

The episodes of dizziness or balance loss often don’t last long but can happen several times a day. This can be disruptive and distressing for both the person experiencing the episodes and you.

If this is happening, start tracking episodes of dizziness or balance loss. Write down what they were doing and ask them how they were feeling before the episode and share these notes with the doctor. They may want to complete tests to check balance, coordination, vision and hearing. Depending on the doctor’s findings, they may recommend some types of therapy or specific exercises.

Prolonged/persistent symptoms

If your friend or family member still has symptoms 1 month after the 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 they do have some symptoms after the 1-month period. Talk to the doctor about what symptoms they are experiencing.

Persistent symptoms include:

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

If the patient is experiencing seizures, slurred speech, or numbness you should consult with their doctor prior to the 1-month mark.

Prolonged symptoms can affect daily life and make it difficult to perform regular activities. The doctor may want to do more tests and check in more often if it turns out the patient has persistent symptoms. Their tests and medical investigations will tell them how best to manage symptoms. Check the Living Concussion Guidelines for more information on managing prolonged symptoms.

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 [10].

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

Concussion resources and awareness tools

Canada has many ongoing concussion campaigns and awareness organizations.

• See current statistics on concussion
• The Concussion Awareness Training Tool (CATT) is an online resource developed for multiple users to provide education, practical courses, and support resources surrounding concussion diagnosis and management. Individuals can choose to use the tool as a parent, a coach, a school professional, or as a person with a concussion. CATT is based upon the Consensus Statement on Concussion in Sport. They continuously make updates to their education modules as new information becomes available.
• The Canadian Concussion Centre is dedicated to research, education, diagnosis and treatment. The project is based at the Krembil Neuroscience Centre at the University Health Network’s Toronto Western Hospital. It is led by internationally acclaimed concussion expert, Dr. Charles Tator. The team includes world leaders in brain injuries, imaging, genetics, clinical care, neuropsychology, and psychiatry working together to determine how concussions could affect us all.
• The Concussion Legacy Foundation has a Post-Concussion Caregiver Guidebook
• For more information on coping with concussion, check out these tips.

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See sources

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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.