10 Warning Signs and Red Flags of Concussion
Dr. Mark discusses the 10 warning signs of concussion and the 10 critical red flags you should never ignore. Learn how to spot these life-threatening symptoms early and take action to protect athletes and loved ones. Subscribe here.
Let’s jump in!
Hey there! I’m Dr. Mark, and as a concussion specialist with years of experience dealing with athletes of all levels, I want to dive into something crucial today: recognizing the warning signs of a concussion. Concussions can happen to anyone, from professional athletes to kids playing in the backyard. Understanding the signs can be the difference between a quick recovery and serious complications.
What is a Concussion?
A concussion, also known as a mild traumatic brain injury (mTBI), occurs when a force causes the brain to move rapidly within the skull. This sudden movement can disrupt brain function, leading to various symptoms. While most concussions are not life-threatening, some can be, and that’s where knowing the red flags comes into play.
Understanding Red Flags
In medical terms, a "red flag" indicates something serious may be occurring. After a concussion, certain signs could suggest a more severe injury, such as brain swelling, spinal cord injury, or intracranial bleeding. Recognizing these signs and acting quickly is essential.
10 Critical Warning Signs You Should Never Ignore
Loss of Consciousness: If someone loses consciousness, even briefly, it’s a serious matter that requires immediate medical attention.
Severe Headache: A persistent or worsening headache following a head injury can indicate serious complications.
Repeated Vomiting: Vomiting can be a sign of increased pressure in the brain; it’s not something to ignore.
Double Vision: If someone sees double, this could indicate a serious issue that needs to be evaluated.
Increased Confusion: Worsening confusion or disorientation is a clear red flag that something is wrong.
Weakness or Numbness: If a person experiences weakness or tingling in their limbs, it could point to a spinal injury.
Seizures: Any seizure activity following a concussion is a medical emergency.
Visible Deformity: A noticeable change in the shape of the skull can indicate a fracture.
Agitation or Combative Behavior: Increased restlessness or irritability can suggest serious brain injury.
Neck Pain or Tenderness: This can point to potential spinal injuries and should be evaluated immediately.
What to Do If You Notice These Signs
If you observe any of these signs, it's crucial to act quickly. Call 911 or take the person to the nearest emergency room. Quick action can prevent long-term damage or even save a life.
Tools for Recognition
Having resources on hand as a coach, parent, or athlete is vital. The Concussion Recognition Tool 6 (CRT 6) is a fantastic resource that provides a list of symptoms to watch for. It’s a simple checklist that can help you determine if someone needs medical attention.
Additionally, I recommend using the Concussion Tracker App. This free app allows athletes to take a post-injury assessment, helps track symptoms, and connects you with concussion specialists in your area.
Final Thoughts
Remember, when in doubt, sit them out. Concussions are serious, and recognizing the warning signs early can make all the difference. If you found this information helpful, please share it with others. The more we spread awareness, the safer we can keep our athletes.
For more insights on concussion care and recovery, check out my blog on sleep after a concussion and alcohol consumption post-concussion.
Thanks for reading, and stay safe!
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Life's big question: How long after a concussion can you drink alcohol?
It all begins with an idea.
How long after a concussion can you drink...?
... Is a question that I get from a lot of athletes. Surprised?
Many folks want to know when they can enjoy a beer on Sunday or drinks (plural) on their night out. And, while I think many folks already know the answer, everyone asks anyway: "Hey doc, when would it be safe to have alcohol again?"
The concise (and often reluctantly received) answer is: “You should not drink alcohol after a concussion until you are 100% cleared. Even then, take it easy on the bottle there, pal.”
That said, there are no guidelines that say what I just said to you right there. So, why do I say that then? Because I've got good reason to - follow me on this.
OTHER COMMON QUESTIONS:
How long should you stay awake after a mild traumatic brain injury/concussion?
Can you take Ibuprofen for a concussion?
Do you have to avoid coffee and caffeine after a concussion?
What do the concussion guidelines say?
I just picked two relatively recent sport concussion statements to illustrate my point: there is no mention of alcohol use after concussions.
This (very major) guideline only mentions that we should be sure that your acute concussion symptoms are not coming from alcohol intoxication. There's no mention of alcohol, good or bad, in your recovery.
American Medical Society for Sports Medicine position statement on concussion in sport
This guideline, again, reminds us that your symptoms should be checked against alcohol intoxication. Additionally, they mention (among many things) that alcohol use may be associated with chronic traumatic encephalopathy (CTE). But no advice on alcohol in acute or PCS recovery.
So, what's the deal with alcohol and mTBI, anyway? It's complicated.
While there are no standardized guidelines on approaching alcohol after a concussion (mTBI), there are quite clear correlations with alcohol being involved in the mTBI injury itself.
For example, it's estimated that up to 50% of US and 65% of UK head injuries are alcohol-related injuries. And, we know that among university athletes, alcohol consumption is associated with concussion risk. That risk also carries down to younger adolescents who engage in "risky behaviors" (e.g., alcohol consumption).
It's complicated, though, because alcohol may or may not confer some protection in more severe TBI forms. In a few studies, folks who were intoxicated on their day of injury were found to have better recovery outcomes. The alcohol (ETOH) may inhibit the NMDA receptor involved in TBI excitotoxicity, which explains the potential benefit of same-day inebriation. Other research has not necessarily found alcohol to be a protective predictive factor.
Context check: These folks still experienced a TBI and had to go through the injury, symptoms, and recovery. Before you think, "alcohol sounds like a potentially good thing here." Remember, alcohol may have promoted the damage and offered mild-to-no benefits after the fact - just like your high school boyfriend/girlfriend.
Is there research for alcohol impacting recovery?
I actually did a post all about that (video above) where I reviewed a study that looked at cannabis, alcohol, and cigarettes in concussion recovery.
The takeaway was that alcohol consumption neither hurt nor helped the recovery in concussion patients.
Where do I get off telling you not to drink alcohol?
THERE ARE TWO BIG REASONS:
Alcohol increases your risk of concussion. Repeat concussions pose significant risks.
Alcohol is just not good for you. I'll discuss more how that can impact your overall health and recovery below.
Alcohol increases your risk of concussion.
As stated above, alcohol consumption is correlated with concussions. Alcohol may impair normal inhibition, alter motor control, impair normal sleep, and - bing, band, boop - your concussion risk goes up.
A STANDARD CONCUSSION TIMELINE LOOKS SOMETHING LIKE THIS:
Injury day.
About 3-5 days later, your symptoms reach their peak (worst).
Within 7-10 days, your symptoms should be resolving.
Then, within 21-33 days, your brain metabolism should be back to normal.
The redline is a look at what your brain metabolism would look like if you sustained a second concussion early (5-6 days) after your first injury.
Symptom recovery does not equate to metabolic recovery in mTBI. A second, concussive impact before full metabolic recovery could lead to more severe damage (e.g., second-impact syndrome) and significantly delay your recovery. Whether you're an athlete looking to return to your teammates or a mother merely looking to return to everyday work and family life, you want to optimize a healthy recovery.
Alcohol is not a part of the optimal recovery plan.
Alcohol is just not good for you.
Even 1-2 drinks per day can increase how fast your brain atrophies (shrinks). Is that what we want when we're still unsure about the correlations between concussion and chronic traumatic encephalopathy (CTE)? Probably not.
More and more research is showing that no amount of alcohol intake is "safe." And before you say, "Well, I don't drink every day. I save my drinks for the weekend." Understand that consuming 4-5 drinks in a confined period is considered "binge drinking." Binge drinking is associated with high blood pressure, high cholesterol, atrial fibrillation, stroke, cancer, etc...
From a more functional perspective, chronic alcohol intake (dependence) is associated with a "leaky gut" and persistent inflammation. Suppose you've followed my social media or blog over the past year. In that case, you'll have heard me discuss the significant role that your gut-brain axis likely plays in your concussion/PPCS recovery. Alcohol also disrupts normal blood sugar regulation and regular sleep cycles. None of this is "good" for your recovery.
I don't want to keep belaboring this. Still, I do hope that it's clear at this point: alcohol is not going to promote optimal health and recovery for you following a concussion.
Wrapping it all up.
HOW LONG AFTER A CONCUSSION CAN YOU DRINK?
It's up to you. There's no strong argument that alcohol is genuinely beneficial for you, and it's a coin toss as to whether it will directly impact your concussion recovery or not.
If you ask the "doctor who treats concussions for a living" for advice... I'd say: “Do not drink alcohol during your concussion rehab and minimize your alcohol intake after recovery. Your brain and your body will thank you.”