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A brain injury caused by a blow to the head or a violent shake. Most people recover fully within a few weeks — faster with a plan than without one. The risks are missing a bleed underneath it, and going back too soon.
Any of these after a head injury means bleeding or swelling inside the skull must be excluded today — not tomorrow, and not at a clinic.
Seeming fine at first does not rule this out. With some bleeds a person is lucid for hours before deteriorating — which is exactly why worsening symptoms after a head injury are treated as urgent rather than reassuring.
Call 995Concussion is a traumatic brain injury caused by a blow to the head, or by the head and upper body being shaken violently. The brain moves inside the skull, and its function is temporarily disrupted.
It is often called mild traumatic brain injury, which is accurate in the medical sense and misleading in the everyday one. The effects are usually temporary, but they are real, and how the first fortnight is handled makes a considerable difference to how long they last.
You do not have to be knocked out to have a concussion. Most people are not. That misunderstanding is the commonest reason a concussion goes unrecognised.
Symptoms may appear immediately or emerge over hours or days. They tend to fall into four groups.
The emotional and sleep symptoms are the ones most often missed, particularly in children and teenagers, because they are attributed to something else.
Rest matters, but complete rest in a dark room is no longer the advice. Extended total rest tends to prolong recovery rather than shorten it. The approach is a short period of relative rest, then gradual reintroduction of activity guided by symptoms — and, increasingly, controlled exercise used as active treatment rather than something to wait for.
Relative rest. Limit screens, reading and anything demanding concentration. Avoid alcohol. Someone should stay with you overnight after a significant head injury.
Walking, light household tasks, short periods of reading or screen use. If a symptom appears, stop, rest, and try a shorter period later.
Often part-time first, with breaks. Reduced screen time and extra time for tasks help. Tell someone at work or school what has happened.
Stationary cycling or brisk walking, nothing with any risk of contact or falling. Symptoms should stay settled throughout.
Drills and skills without contact, then with contact, each stage only once the previous one has been completed symptom-free.
Competition and full contact. For anyone under 18, this stage should follow medical clearance rather than personal judgement.
A second head injury while still recovering from the first can cause rapid, severe brain swelling. It is uncommon, it is most often described in adolescents and young adults, and the consequences are serious enough that the rule in sport is simple and absolute: if in doubt, sit out.
No single game is worth it, and a player who returns a week late loses nothing that matters.
Most people recover from a concussion without seeing a specialist, and it would be dishonest to suggest otherwise. But there are four situations where being assessed at a concussion clinic in the first week or two changes the outcome rather than merely confirming what you already suspect.
The same impact commonly injures the neck and the balance system. Those produce headache, dizziness and fogginess that look exactly like concussion but need different treatment — and starting that treatment early is considerably more effective than starting it at three months. Separating them is an examination, not a scan.
Controlled aerobic exercise speeds recovery, but only within a fairly narrow band: too little achieves nothing, too much sets you back. That threshold is measured rather than guessed, and it is the single most useful thing a first appointment produces.
Some people are more likely to have a prolonged recovery — a history of previous concussions, of migraine, of anxiety or sleep problems, or a heavy symptom load in the first days. Where those apply, active management from the start is better than discovering at week six that rest alone was not going to work.
Return to contact sport should follow medical clearance, particularly for anyone under 18. Schools, employers, coaches and insurers frequently want a documented assessment and a staged plan rather than a verbal assurance.
The commonest story we see is not a dramatic one. Someone has a knock, is told to rest, does exactly that, and is still not right three months later — by which point the neck problem, the disturbed sleep and the deconditioning have compounded each other. Almost all of it is treatable, and most of it is avoidable with a plan in the first fortnight.
Assessment begins with what happened — the mechanism of injury, whether consciousness was lost, what you remember before and after — followed by a neurological examination covering:
A scan is not routine. Concussion does not show on CT or MRI — the injury is functional rather than structural. Imaging is used to answer a different question: whether there is bleeding, swelling, a skull fracture or a cervical spine injury underneath. That is what a neurosurgical assessment is for, and it is why symptoms that worsen rather than settle change the plan.
There is no medication that treats a concussion itself, which is why the advice so often stops at rest. That undersells what can be done — particularly once the first week has passed.
Relative rest and graded return, as above. For headache, paracetamol is generally preferred early on; anti-inflammatories and aspirin are usually avoided in the first days because of bleeding risk. Check with a doctor rather than assuming.
Alcohol and anything else that clouds assessment are best avoided while symptoms are settling.
This is the part that has changed most, and it surprises people. Light aerobic exercise kept deliberately below the level that provokes symptoms — a stationary bike or brisk walk at a measured intensity — is now used as active treatment rather than something to wait for.
Introduced early and at the right intensity, it is associated with faster recovery than rest alone. The intensity matters: too much sets things back, which is why it is prescribed rather than guessed at.
Symptoms continuing beyond a month rarely have one cause, and each contributor is treated in its own right:
Where headache persists after a head injury and has not responded to medication, treatment can be directed at the nerves carrying the pain. Dr Tung's practice includes occipital nerve treatments, pulsed radiofrequency and neuromodulation.
This is the option most often missing from post-concussion care, and the reason a headache still present three months after the injury is worth bringing in rather than enduring.
Most people are back to normal within a month. Where symptoms continue beyond that, it is worth reassessing rather than waiting it out — because by then the problem is usually no longer the original injury but the things it set off, and those are treatable.
In older adults, a delayed decline after even a minor knock deserves particular attention. Bleeding can accumulate slowly over weeks between the brain and its covering, showing up as confusion, unsteadiness or personality change rather than as an obvious head injury problem. It is very treatable once identified.
Yes, and most people do. Loss of consciousness happens in a minority of concussions. Confusion, headache, dizziness or feeling "off" after a blow to the head is enough to take it seriously.
Usually not. Concussion does not appear on CT or MRI. Imaging is used where there is concern about bleeding, swelling, a fracture or a neck injury — not to diagnose the concussion itself.
That advice is outdated for most cases, and broken sleep hinders recovery. What matters is that someone is with you for the first night and knows the warning signs above. If you are worried enough to be considering hourly checks, you should be at an emergency department instead.
Only after progressing through the stages above symptom-free, and for anyone under 18, with medical clearance. Children and adolescents are given more time, not less, than adults.
Yes. The same impact frequently injures the jaw joint, neck muscles and upper spine. Pain from those structures is often mistaken for the concussion itself — and unlike the concussion, it is directly treatable.
No. You can book directly. Bring any scans from the emergency department, and a note of when the injury happened and how symptoms have changed since.
Headaches (all types) · Dizziness and vertigo · Neck pain · Whiplash injury · Cervicogenic headache · Brain aneurysm · Neurosurgery
Recently had a knock and want a plan rather than guesswork? Still not right weeks later? Need clearance before going back to sport? All three are worth an appointment.
