The 411 on Concussions

You’re at the ice rink with your 12 year old daughter. She is racing down the ice for the puck when another player side swipes her. Her head hits the boards, and she falls to the ground. She doesn’t lose consciousness but seems wobbly when she skates to the bench. After 5 minutes, she says she feels better, gets back on the ice and plays the rest of the game. That night, she complained of a bad headache and vomited once. What are you supposed to do? Does she need to go to the ER? Does she have a concussion? 

Concussions, described as a mild traumatic brain injury, are caused by a direct or indirect blow to the head. They can be associated with a myriad of different symptoms. These include headache (the most common), dizziness, nausea, fogginess, light or noise sensitivity, blurry vision, double vision, exercise intolerance, sleep difficulties, fatigue, and cognitive difficulties. Most concussions resolve in 7-10 days, but the younger you are the longer it may take for symptoms to go away. 

While it might seem like each concussion is unique they do follow certain patterns.  

1. Vestibular concussions – affect balance 

2. Oculomotor concussions – affect eye tracking and balance 

3. Cervicogenic concussions – due to a whiplash injury 

4. Migraine variants – mostly headache 

5. Emotional – affect emotional state 

6. Exertional – affect exercise tolerance and heart rate 
   

While most concussions heal on their own, it’s important to be evaluated by a specialist or someone who is well versed in concussion, because the sooner you initiate treatment like physical therapy and light exercise, the faster you’ll recover. It’s important to realize that while rest is important, cocooning for more than 2 days can result in more prolonged symptoms. We recommend that students try to return to school after the first 2 days – even with a modified schedule.  

In the case of our young athlete, she should be checked out for a more serious brain injury like a bleed or a fracture. Concerning symptoms and signs include loss of consciousness, worsening headache, persistent vomiting, altered mental state, lethargy. In the ER, they might do a CT scan which can rule out more serious injuries. Just remember that concussions cannot be diagnosed by a CT scan or MRI. Concussed patients usually have normal CT scans and MRIs.  

Also, in the case of our young athlete, going back on the ice with a concussion is not a good idea. Playing with a concussion increases the risk of subsequent injury and another concussion. A second hit before the brain has had time to recover can have very serious consequences including prolonged recovery or in rare cases, severe disability or death. This is why we always say “if in doubt, sit it out”. 

Concussions are very common – 3.8 million cases are reported annually in the US alone. Most concussed individuals recover without any issues, but it’s important to be checked out to make sure you recover quickly and optimally and don’t face the risk of repeat injury before you’ve made a complete recovery.  

Dr. Audrey Paul is a distinguished physician with extensive training in pediatrics and pediatric emergency medicine. Her expertise lies in providing top-notch medical care to children and adolescents. Dr. Paul’s commitment to excellence and her passion for helping young patients have made her a respected figure in the medical community. As the medical director of Blue Wave Pediatric Walk-In Center and Blue Wave Concussion Center in Clearwater, Dr. Paul plays a vital role in offering comprehensive pediatric care and concussion treatment services.