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Commotio cerebri
A concussion needs no loss of consciousness — and no second one while the first is still healing.
Also known as: concussion · mild traumatic brain injury · mTBI · post-concussion syndrome · sports concussion
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
A concussion is a temporary disturbance of brain function after a blow to the head or body — and the key sentence is this: loss of consciousness is not required. Most concussions happen without any blackout at all. Typical features are feeling dazed or in a fog, headache, nausea, dizziness, sensitivity to light and noise, slowed thinking, irritability and a memory gap around the event. Because this is a disorder of function rather than a visible injury, CT and MRI scans are normally clear. That does not make the symptoms less real — it only shows that imaging is looking for something else, namely a bleed. On recovery, current thinking is that after one to two days of rest, light activity below the symptom threshold helps more than complete dark and quiet, which is now outdated. The way back is stepwise, and it is return to learn before return to play: concentration at school or work should hold up again before playing resumes. While symptoms last, no sport with a risk of falling or contact — because the real danger is a second concussion before the first has healed. If headache, concentration problems, sensitivity, dizziness or exhaustion persist for weeks, this is called post-concussion syndrome. People are then often told there is nothing wrong — which is untrue and hurtful. Targeted treatment helps, and the great majority recover fully.
If concussion is suspected, play stops — not until half-time, not for the final. When in doubt, sit them out.
One to two days of rest, then light activity just below the symptom threshold. Weeks in a dark room are outdated.
School or work must hold up first — start reduced, build in breaks, then increase. Sport comes after that.
A second concussion before the first has healed is the real risk — recovery then takes far longer.
Short blocks with breaks, brightness down. Total isolation from friends and phone harms mood more than it helps.
A steady sleep rhythm and enough fluids speed recovery; alcohol delays it and raises fall risk.
Worsening headache, repeated vomiting, drowsiness, seizure, one-sided weakness: call 144 — see traumatic brain injury.
Neck and balance physiotherapy, headache assessment, vision check and psychological support all help — the symptoms are real.
Nine out of ten adults are symptom-free again after two weeks; children and teenagers often need four. The biggest mistake is complete rest: after one to two days of taking it easy, a step-by-step return helps more than lying in the dark.
There is no drug for concussion. Painkillers are given sparingly, because daily use beyond ten days creates a lasting headache of its own — that is what lies behind part of the long courses. What applies today has changed: not weeks in a dark room, but one to two days of rest and then a stepwise return to load, physical and mental, up to just below the symptom threshold. Full contact sport waits at least a week after symptoms have gone.
The commonest sign of all — and it needs no second of unconsciousness.
Usually start at once or within hours. If they keep worsening, this is no longer concussion but an emergency.
The playground, the open-plan office or the screen suddenly become exhausting.
Repeating questions, losing the thread, needing longer than usual — in sport often what teammates notice first.
Children and teenagers often just seem difficult or lazy — that is the injury, not the character.
Headache, concentration, sensitivity and dizziness over weeks: post-concussion syndrome is real and treatable.
The decisive value after a blow to the head: under blood-thinning treatment imaging is considered even with mild courses and a good general state.
Shows the platelets. If they are low, the same caution applies as under blood thinning.
Belongs alongside when it is unclear whether the fall was the cause or the consequence.
Without B12 the insulating layer of the nerves is not maintained. A lack causes tingling, numbness and unsteadiness in the dark — and it is one of the few reasons for nerve trouble that can be fully undone if found early.
The nerves cover their energy needs through thiamine. It runs short with alcohol, after stomach operations, with long-lasting vomiting and under water tablets.
Here both count: a lack harms the nerves, and too high an intake over months harms them as well. Supplements therefore belong taken in a dose that has a reason.
Works together with B12. Given alone, folate can improve the blood count while the B12 deficiency goes on damaging the nerves — which is why both are looked at together.
Studied in animals and small athlete trials — 2–3 g a day. No benefit is proven in humans, and the one measure with a clear effect remains the pause: no second blow before the first has settled.
In the first days sleep is what helps most. Caffeine borrows alertness against exactly that sleep — and the withdrawal headache then looks like the syndrome itself.
Clearly worthwhile and well supported when deficient — vegan, older adults, certain drugs. No energy boost without a deficiency.
In pregnancy clearly established against neural-tube defects, otherwise mainly with deficiency. Can mask a B12 deficiency — watch both.
The pituitary sits in a bony hollow and hangs from a thin stalk — both make it vulnerable to a jolt. A growth hormone deficiency is a known late consequence and one of the few treatable explanations for lasting exhaustion.
Sleep problems are among the most common complaints afterwards, and sleep is at the same time what carries the recovery most. In small studies in children melatonin was tested for this, with mixed results.
After a head injury the water balance can go off in both directions: too much ADH with falling sodium, or too little with large amounts of urine and strong thirst. Both are treatable and easily missed.
After a concussion the brain needs rest; alcohol disturbs sleep and recovery and lengthens the complaints. At least 2 weeks without is usual, longer with lasting symptoms.
Headache after a concussion is markedly worsened by lack of fluid and skipped meals. Both are easy to fix and often overlooked.
Sleep is the most important recovery in the first days — complete shielding from stimuli, by contrast, delays it.
Light movement after two days shortens the course; strict rest was the old advice.