When to See a Doctor After a Concussion

What is a concussion?

A concussion is a mild traumatic brain injury caused by a direct or indirect force to the head that disrupts brain function. Concussions do not require a loss of consciousness — the vast majority occur without any loss of consciousness at all 1Ref 1Harmon KG, Clugston JR, Dec K, Hainline B, Herring SA, Kane SF, Kontos AP, Leddy JJ, McCrea MA, Poddar SK, Putukian M, Wilson JC, Roberts WO (2019).American Medical Society for Sports Medicine position statement on concussion in sport.Supports concussion definition, symptom categories, same-day removal from play, graduated return-to-sport protocol, second-impact syndrome risk, and specialist evaluation requirements.

The injury is functional, not structural: standard CT scans and MRIs typically appear normal, because the problem is disrupted brain chemistry and communication rather than visible tissue damage. Symptoms reflect this disruption: headache, fogginess, slowed processing, balance problems, light and noise sensitivity, sleep changes, and emotional symptoms are all common.

What are the symptoms of a concussion?

Concussion symptoms fall into several categories 1Ref 1Harmon KG, Clugston JR, Dec K, Hainline B, Herring SA, Kane SF, Kontos AP, Leddy JJ, McCrea MA, Poddar SK, Putukian M, Wilson JC, Roberts WO (2019).American Medical Society for Sports Medicine position statement on concussion in sport.Supports concussion definition, symptom categories, same-day removal from play, graduated return-to-sport protocol, second-impact syndrome risk, and specialist evaluation requirements2Ref 2Centers for Disease Control and Prevention (2025).Signs and Symptoms of Concussion.Supports symptom recognition across physical, cognitive, emotional, and sleep domains; emergency warning signs requiring immediate care:

Physical - Headache or pressure in the head - Dizziness or balance problems - Nausea or vomiting (once or twice — repeated vomiting is a red flag) - Sensitivity to light (photophobia) or noise (phonophobia) - Blurred or double vision - Feeling slowed down

Cognitive - Feeling mentally foggy or "not right" - Slowed reaction time - Difficulty concentrating or remembering - Memory gap around the event (retrograde or anterograde amnesia)

Emotional / behavioral - Irritability or emotional lability - Feeling more anxious or sad than usual

Sleep - Sleeping more or less than usual - Difficulty falling asleep

Symptoms typically begin within minutes to hours of the injury and usually resolve within days to weeks in most cases.

Emergency symptoms: when to go to the ER immediately

Certain symptoms after a head injury suggest a more serious injury — such as a skull fracture, brain bleed, or significant swelling — that requires immediate imaging and emergency care 2Ref 2Centers for Disease Control and Prevention (2025).Signs and Symptoms of Concussion.Supports symptom recognition across physical, cognitive, emotional, and sleep domains; emergency warning signs requiring immediate care:

• Headache that is worsening over time, rather than staying stable or improving
• Repeated vomiting (more than 1–2 times)
• Seizure after the head injury
• Loss of consciousness lasting more than a minute, or any loss of consciousness that is not immediately resolved
• Weakness, numbness, or coordination problems on one side of the body
• Slurred speech
• Confusion or agitation that is worsening, not improving
• One pupil larger than the other
• Worsening drowsiness — unable to be roused normally

If any of these are present, call 911 or get to an emergency department immediately. Do not drive yourself.

Who should evaluate a sports concussion?

For symptoms that are stable or mildly improving (not the emergency red flags above), a concussion evaluation should be done by a clinician with training in concussion management 1Ref 1Harmon KG, Clugston JR, Dec K, Hainline B, Herring SA, Kane SF, Kontos AP, Leddy JJ, McCrea MA, Poddar SK, Putukian M, Wilson JC, Roberts WO (2019).American Medical Society for Sports Medicine position statement on concussion in sport.Supports concussion definition, symptom categories, same-day removal from play, graduated return-to-sport protocol, second-impact syndrome risk, and specialist evaluation requirements. This may include:

• A sports medicine physician — many are specifically trained in concussion assessment and return-to-play protocols
• A primary care physician familiar with sports concussion guidelines
• A neurologist or concussion specialist — for persistent symptoms, multiple prior concussions, or complex presentations
• An emergency medicine physician — appropriate when symptoms need urgent evaluation and the above specialists are not immediately available

Some athletic programs and schools require evaluation by a licensed healthcare provider before any athlete may return to practice or competition. Gale's clinicians can perform initial concussion evaluations and help coordinate specialist referral when needed.

What happens at a concussion evaluation?

A concussion evaluation typically includes:

1. Symptom inventory — how many symptoms are present and their severity 2. Cognitive testing — orientation, immediate recall, concentration, and short-term memory 3. Neurological exam — cranial nerve function, coordination, balance (often using BESS or similar balance assessment) 4. Review of prior concussion history — each concussion slightly extends recovery in some athletes 5. Imaging decision — CT or MRI is not routinely required for most sports concussions but is ordered if there are red flags

The goal is to establish a baseline for recovery tracking and to ensure the person is safe.

When can an athlete return to play after a concussion?

No athlete should return to contact sport on the same day as a concussion 1Ref 1Harmon KG, Clugston JR, Dec K, Hainline B, Herring SA, Kane SF, Kontos AP, Leddy JJ, McCrea MA, Poddar SK, Putukian M, Wilson JC, Roberts WO (2019).American Medical Society for Sports Medicine position statement on concussion in sport.Supports concussion definition, symptom categories, same-day removal from play, graduated return-to-sport protocol, second-impact syndrome risk, and specialist evaluation requirements3Ref 3McCrory P, Meeuwisse W, Dvorak J, Aubry M, et al. (2017).Consensus statement on concussion in sport — the 5th international conference on concussion in sport held in Berlin, October 2016.Supports graduated return-to-sport protocol and no same-day return to play after concussion. The consensus approach uses a graduated return-to-sport (GRTS) protocol:

1. Symptom-free rest — until no symptoms at rest 2. Light aerobic exercise — walking, swimming, or stationary cycling below symptom threshold 3. Sport-specific exercise — drills without contact 4. Non-contact training drills — more complex drills; coordination exercises 5. Full-contact practice — only after medical clearance from a trained clinician 6. Return to competition

Each step takes at least 24 hours, and if symptoms recur, the athlete drops back a step. The total minimum recovery timeline is typically one week for uncomplicated concussions in adults, but many athletes take longer.

Returning to play before full recovery risks second-impact syndrome — a rare but potentially catastrophic condition occurring when a second concussion happens before the brain has fully recovered from the first 1Ref 1Harmon KG, Clugston JR, Dec K, Hainline B, Herring SA, Kane SF, Kontos AP, Leddy JJ, McCrea MA, Poddar SK, Putukian M, Wilson JC, Roberts WO (2019).American Medical Society for Sports Medicine position statement on concussion in sport.Supports concussion definition, symptom categories, same-day removal from play, graduated return-to-sport protocol, second-impact syndrome risk, and specialist evaluation requirements.