Hit Your Head? Concussion Signs in Adults and When to Go to the ER

You stood up into a kitchen cupboard, slipped on the stairs, took an elbow in a football match or had a minor car crash. There's a headache and a lump is coming up, and the question in your head is: is this normal, or do I need the ER? In adults, most bumps really are minor. But there are clear signs that decide who needs to be checked today, and some of them have nothing to do with how hard you hit your head, such as your age or the blood thinner you take. This guide is for adults, teenagers and older people. If the person who was hurt is a child, see our guide to head injuries in children and when to go to the ER.

What are the symptoms of concussion in adults?

Concussion is a mild brain injury that temporarily affects how the brain works. It follows a blow or a hard jolt to the head, and you don't have to be knocked out to have one. Symptoms can show up straight away or hours later. The common ones are:

• Headache or a feeling of pressure in the head.
• Dizziness or balance problems.
• Nausea, and sometimes vomiting early on.
• Feeling foggy, dazed or slowed down.
• Trouble concentrating, or gaps in your memory around the injury.
• Sensitivity to light or noise, or blurred vision.
• Tiredness, irritability, mood changes, or sleeping more or less than usual.

Symptoms of a minor head injury usually improve within about two weeks. Any concussion is worth a same-day medical check, and urgent care is fine if there are no warning signs. For a headache that changes or keeps building, see our guide to when a headache is serious.

I hit my head. When should I go to the ER?

These lists are based on the UK NICE head injury guideline (NG232) and NHS advice, the same criteria doctors use to decide who needs urgent assessment.

Call 911 straight away for

• Being knocked out and not waking up, or not being able to stay awake or keep the eyes open.
• A seizure (fit) after the injury.
• New weakness or numbness in part of the body, problems walking, balancing, speaking or understanding, or slurred speech.
• Clear fluid or blood coming from the nose or ears, or bruising behind the ears.
• A visible dent in the skull, or a wound with something stuck in it.
• Confusion that is getting worse, strange behaviour, or not recognising people or places.
• A high-energy injury with neck pain, such as a car crash or a fall from height.

Go to the ER now for

• Any loss of consciousness from the injury, even if you came round quickly and feel fine.
• Any vomiting since the injury.
• A headache that has been there since the bump, or is getting worse.
• Not remembering what happened before or after the blow.
• Being 65 or over, with anything more than a trivial bump.
• Taking blood thinners (anticoagulants or antiplatelets), or having a bleeding or clotting disorder.
• Previous brain surgery.
• Having been drinking alcohol or taking drugs, which can hide warning signs.
• A high-energy injury: a car crash, being hit by a car as a pedestrian or cyclist, or a fall from more than about 1 metre or 5 stairs.

Same-day urgent care for

• Mild concussion symptoms (mild headache, dizziness, feeling a bit foggy) with none of the signs above.
• A scalp cut that may need stitches or won't stop bleeding with pressure.
• Not being sure whether it's safe to stay at home.

Home care is usually fine for

• A minor bump with only a lump or local soreness, and no loss of consciousness, vomiting or memory loss.
• Feeling completely like yourself, with another adult around for the first 24 hours.

If the person is unconscious or having a seizure, don't drive them yourself: call 911 and stay with them. If you've been told to go to the ER, don't drive yourself there. For more, see our guide to emergency numbers in Jordan.

Head injury on blood thinners or over 65: why the bar is lower

As we age, the brain shrinks slightly, which stretches the small veins between it and its outer covering and makes them easier to tear. Blood thinners such as warfarin, apixaban and rivaroxaban, and antiplatelet medicines such as clopidogrel, let any small bleed keep going for longer. That is why bleeding inside the head can follow a blow that seems trivial, like a fall from standing at home.

If you take a blood thinner, or your mother or father is over 65 and has fallen and hit their head, the safest course is an ER check the same day, even if everything seems normal. Don't stop the medicine on your own, and bring its name and dose with you. Aspirin on its own may carry less risk, but always ask a doctor. And if the fall itself happened because of dizziness or a faint, that needs assessing too; see our guide to fainting and dizziness: when to go to the ER.

Can concussion symptoms show up days later?

Yes. Concussion symptoms can appear or get worse over the first day or two, which is why another adult should stay with you for the first 24 hours. Rarer and more serious is a chronic subdural haematoma: a slow bleed between the brain and the skull that can go unnoticed for days, with symptoms that build gradually over weeks. It is more common in older people, people on blood thinners, people who drink heavily over the long term, and people who fall repeatedly.

In the weeks after any head injury, even one that seemed minor, watch for: a headache that keeps getting worse and isn't eased by painkillers, new confusion or forgetfulness, personality changes, drowsiness, vomiting, weakness on one side, or repeated falls. Any of these means the ER. Often a family member notices the change before the injured person does.

Sudden weakness on one side or slurred speech can be a bleed or a stroke, and both need 911 straight away. Learn the stroke symptoms and the FAST test.

Concussion or something more serious?

This table is a rough guide, not a substitute for an examination:

A big fall with neck pain: don't move them

A hard blow to the head can injure the neck too. If someone has fallen from height, dived into shallow water or been in a car crash, and has neck pain, tingling, or weakness in the arms or legs, don't move them and don't try to sit them up or lift their head. Call 911, keep their head and neck still and in line with the body, and only move them if there is immediate danger such as fire or traffic.

Can I sleep after hitting my head?

This is one of the most common myths. If you have no warning signs, or a doctor has assessed you, and you were talking and acting normally, there's no need to keep you awake all night. The NHS says you don't need to stay awake if you're tired, and sleep is part of the rest your brain needs to recover. What matters is:

• Another adult stays with you for at least the first 24 hours.
• They check on you and make sure you wake easily and act normally.
• You don't take sleeping tablets unless a doctor advises it.
• If you are hard to wake, or wake up confused or with muddled speech, they call 911.

If you live alone, ask a family member or friend to stay with you that night, or stay with them.

How do I recover from a concussion?

• Relative rest for a day or two: cut back on physical and mental effort, but you don't need days of complete rest in a dark room. Gentle walking and light activities are fine if they don't make symptoms worse.
• Gradual return: build up step by step. If symptoms come back or get worse, ease off a little, then try again.
• Screens: cut down phone and computer time in the first days, and take frequent breaks if they bring on headache or tiredness.
• Pain: paracetamol is safe for most people for a concussion headache; check with a pharmacist. A cold pack wrapped in a cloth on the lump for a few minutes helps.
• Alcohol and drugs: avoid them until you have fully recovered; they slow recovery and mask warning signs.
• Driving: don't drive until you feel fully recovered and your concentration and reactions are back to normal.
• Work and study: go back when you feel better, and consider shorter days or lighter tasks at first.
• Sport: no contact sport for at least 3 weeks, and never go back on the same day as the injury.

For a safe, step-by-step path back to the pitch, see our guide to returning to sport after an injury. If symptoms last more than two weeks, or you're unsure when it's safe to drive, work or play again, see a doctor.

What about a cut on the scalp?

The scalp has a rich blood supply, so even a small cut can bleed a lot and look frightening. Press on it with a clean cloth firmly for several minutes without lifting it to check. If it won't stop bleeding, or the edges gape apart, it may need stitches. See our guide to whether your cut needs stitches, and remember that a cut doesn't replace watching for signs of concussion.

Urgent care or the ER? What happens when you arrive

With mild concussion symptoms and no warning signs, urgent care sees walk-ins around the clock. With any loss of consciousness, vomiting, memory loss, a worsening headache, blood thinners or age 65 and over, go straight to the emergency department. If you're unsure, our guide to ER vs urgent care explains the difference.

The doctor asks how the injury happened, whether you were knocked out and what medicines you take, then checks your alertness, memory, eyes, nerves and neck. Using national guideline criteria, the doctor assesses whether you need a brain scan. Most adults with a minor bump don't. If you do need a scan, the team will tell you where and arrange the next step. If a cut needs closing, that is dealt with at the same visit.

Sources

• NHS — Head Injury and Concussion
• NICE — Head Injury: Assessment and Early Management (NG232)
• CDC HEADS UP — Signs and Symptoms of Concussion
• NHS — Subdural Haematoma
• MedlinePlus — Subdural Hematoma