Causes And Symptoms Of Concussion

Introduction

Concussions are a common injury following a blow to the head, commonly associated with sport-related injuries. However, it is not only sports that can result in concussions, nor is it only a blow to the head that can cause them. Understanding the multiple causes and symptoms of concussions is essential for the diagnosis and management of the injury. 

This article aims to outline and discuss the causes and symptoms of a concussion for your benefit. The earlier a concussion is diagnosed, the more effective the treatment.  

What is a concussion?

Concussions are traumatic injuries to the brain that can affect brain function. They can be diagnosed by a variety of symptoms, which can differ from case to case. The effects are often short term but if concussions are repeated, they can have longer-term effects. 

They are caused by a sudden blow to the head or body which results in the brain moving quickly inside the skull. The rapid movement can change the shape of the brain tissue by stretching and damaging brain cells and blood vessels within the brain. The damage also causes chemical changes within these cells, making it harder for them to communicate and function normally.

It is vital to understand the symptoms of concussions as they can have serious consequences. Concussions can lead to mental health symptoms, particularly in younger people.¹ Recognising a concussion can sometimes be difficult due to the symptoms sometimes only appearing after a few days and varying in subtlety.  However, identification is critical to the management and prevention of further injury.

Symptoms

It is important to remember that not all individuals suffering from a concussion will go unconscious. Concussions are sometimes hard to diagnose as some symptoms may present themselves instantaneously whereas others sometimes take a few days.

No form of medical imaging including X-rays and CT scans can detect a concussion nor are there objective tests, such as blood or urine tests that can be used for a diagnosis.² 

Instead, symptoms are assessed by a medical professional to make the diagnosis. A physical exam and neurological assessment may be performed, involving balancing tests as this is commonly affected by a concussion. Common symptoms of concussion include:

• Headaches
• Nausea/Vomiting
• Dizziness
• Sensitivity to light and sound 
• Confusion 
• Memory problems 
• Difficulty concentrating 
• Irritability 
• Anxiety 
• Depression

Symptoms in children sometimes differ from those in adults. Ensure you keep an eye out for any of these symptoms, in addition to the adult symptoms, after your child has had a head injury: ³

• Dazed appearance
• Fatigue
• Irritable
• Loss of balance or unsteady when walking
• Excessive crying
• Change in sleeping patterns
• Lack of interest in usual favourite toys

Causes

Concussions can occur via direct impact (i.e., a hit to the head), or indirect impact, in which the concussion isn’t caused by a hit to the head.

Direct impact

Sporting injuries 

High-impact sports including football, hockey, and boxing pose a huge risk of concussion due to the increased potential for collisions with opponents and equipment. Improper technique and lack of protective gear increase the likelihood of concussion.

Vehicle accidents 

Head injuries are frequently associated with vehicle accidents, including concussions. Sudden braking can cause passengers to force their heads into other surfaces, resulting in concussions.

Falls

Falls are the leading cause of concussions, with the majority occurring in children and the elderly. Slippery surfaces or uneven terrain can also increase your risk of concussion.

Home accidents

Your home may be full of potential obstacles for falls. In particular, children and the elderly, are likely to have home accidents. Tables, chair legs and slippery surfaces may cause falls and head injuries. 

Assaults 

Physical assaults, whereby an individual is hit, kicked or punched in the head.

Indirect impact

Whiplash 

Direct impact to the head is not required to result in a concussion. A concussion can occur with a blow to the chest, causing a whiplash effect on the brain.⁴

Blast waves 

These are associated with explosive events performed in military combat. The rapid and intense air pressure changes generated by explosions can cause concussions. The sudden release of energy generates a blast wave that propagates outwards from the epicentre of the explosion. The wave consists of a shock wave of high pressure, followed by low pressure, which creates a force that can impact nearby objects, including the human body.

Shaken baby syndrome 

This is a severe form of abusive head trauma that occurs when a caregiver forcefully shakes an infant, causing rapid back-and-forth movement of the brain within the skull. This can lead to concussion through the forces inflicted on the infant’s delicate brain tissue or can be more serious with brain bleeds or bruising.

What should I do if I have a concussion?

If your symptoms are pointing towards a concussion, there is no strict treatment to be followed. Symptoms should resolve themselves within a few days without medical attention. However, it is still important to:^5,6

• Rest well for 1-2 days before returning to gradual physical and mental activity 
• Remain in the presence of a responsible adult
• Don’t drive
• Avoid medications, such as non-steroidal anti-inflammatory drugs (NSAIDs, e.g., ibuprofen and aspirin), and sedating pain medicines
• Consult with your doctor first before taking any medications

Children should remain home from school and avoid any form of screen time. 

If symptoms do persist or worsen, visit a medical professional. They may perform tests to see whether a more serious brain injury has occurred. 

Rarely, individuals may experience symptoms for longer than 3 months, known as persistent post-concussive syndrome. This is common with stronger blows to the head and is more common in people assigned female at birth (AFAB) and elders.⁷

Risk factors 

Many different factors can put you at greater risk of sustaining a concussion, such as:

Age 

Children and the elderly are more susceptible to concussions due to the fragility of their brains. Additionally, they are naturally at greater risk of falls due to their lack of balance, which commonly leads to concussions. 

The young brain has been discovered to be more susceptible to concussion and may take a longer time to recover from the trauma. 

Gender 

People with AFAB often report more symptoms when suffering from a concussion. In support of this, recent evidence has indicated that people with AFAB may be more susceptible to a concussion than those assigned male at birth (AMAB).⁸

Previous concussions 

After suffering from an initial concussion, an individual is more likely to suffer from them thereafter. Subsequent concussions can occur from less force and take longer to ease symptoms. 

Certain sports 

These include contact sports, such as football, rugby, American football, hockey etc. 

Naturally, playing a sport that involves contact, makes you more likely to suffer from a concussion than those that don’t. You are therefore more likely to suffer multiple concussions, which puts you at greater risk of re-injuring yourself.

Occupation 

Multiple occupations put you at greater risk of a concussion than others. These include the military (from blows) and construction in which helmets should always be worn to minimise risks. This also includes being a professional athlete partaking in a high-impact sport as mentioned previously.

Prevention

It is important that prevention strategies are put in place if you have previously suffered a concussion or if you believe you are at risk.

Protective gear 

This is important in both high-risk jobs such as construction, where knocks to the head are common, and in contact sports.

Training and education

Through following adequate training, individuals using larger equipment such as forklifts, for example, will have greater control when operating. 

Avoidance of high-risk activities

If you are repeatedly suffering from concussions, it may be sensible to remove yourself from these positions. If you have implemented preventative steps such as wearing more protective gear and having sufficient training, with no improvements noted, a lifestyle change may be in order. Changing roles within an occupation or positions within a sporting team may be a good start.

Summary 

• Concussions are traumatic head injuries with both physical and mental symptoms
• Many people may go unconscious, however, many symptoms may take a few days to present
• Symptoms include memory loss, light sensitivity, impaired vision, and lack of sleep
• Symptoms will resolve themselves within around 2 weeks, with rest being the best medicine
• If symptoms persist after 2 weeks, see your doctor 
• Your doctor will likely refer you to further scans to rule out any more serious head injuries