Signs and Symptoms of Concussion

  • George G. A. Pujalte
  • Timothy M. Dekker
  • Andre A. AbadinEmail author
  • Trisha E. Jethwa


It is the responsibility of every healthcare provider who could potentially care for someone who sustains a concussion to recognize the most common signs and symptoms. Some are present immediately after the injury, but many may evolve with time. The American Medical Society for Sports Medicine’s most recent position on concussions breaks down the symptoms into six domains: headache-migraine, cognitive, anxiety/mood, ocular, fatigue, and vestibular. Many of these symptoms are generalizable, cross domains, and evolve throughout the process of the condition. Moreover, many of these symptoms can be present prior to the onset of the concussion. This can confound the clinical picture. Therefore, it is essential for clinicians to clarify symptoms with their patients, compare symptoms to the patient’s baseline, and converse with athletic trainers, friends, or family members. Thorough follow-up with these patients is crucial to assess progression during recovery. The diagnosis of concussion can be elusive, therefore it is imperative for primary care providers to be aware of the constellation of signs and symptoms that can present with concussions.


Concussion domain Concussion symptoms Concussion signs Cognitive domain Emotion domain Athletic injuries Vestibular symptoms 


  1. 1.
    Harmon KG, Clugston JR, Dec K, et al. American Medical Society for Sports Medicine position statement on concussion in sport. Clin J Sport Med. 2019;29:256.CrossRefGoogle Scholar
  2. 2.
    Davis GA, Makdissi M, Bloomfield P, et al. International consensus definitions of video signs of concussion in professional sports. Br J Sports Med. 2019;53:1264–7.CrossRefGoogle Scholar
  3. 3.
    Hunt AW, Paniccia M, Reed N, Keightley M. Concussion-like symptoms in child and youth athletes at baseline: what is “typical”? J Athl Train. 2016;51:749–57.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Moser RS, Schatz P. Increased symptom reporting in young athletes based on history of previous concussions. Dev Neuropsychol. 2017;42:276–83.CrossRefGoogle Scholar
  5. 5.
    Macartney G, Simoncic V, Goulet K, Aglipay M. Concussion symptom prevalence, severity and trajectory: implications for nursing practice. J Pediatr Nurs. 2018;40:58–62.CrossRefGoogle Scholar
  6. 6.
    Junn C, Bell KR, Shenouda C, Hoffman JM. Symptoms of concussion and comorbid disorders. Curr Pain Headache Rep. 2015;19(9):46.CrossRefGoogle Scholar
  7. 7.
    Bressan S, Babl FE. Diagnosis and management of paediatric concussion. J Paediatr Child Health. 2016;52:151–7.CrossRefGoogle Scholar
  8. 8.
    Eisenberg MA, Meehan WP, Mannix R. Duration and course of post-concussive symptoms. Pediatrics. 2014;133:999–1006.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Grace MT. Concussion in the pediatric patient. J Pediatr Health Care. 2013;27:377–84.CrossRefGoogle Scholar
  10. 10.
    Halstead ME, Walter KD. Sport-related concussion in children and adolescents. Pediatrics. 2010;126:597–615.CrossRefGoogle Scholar
  11. 11.
    McCrory P, Meeuwisse W, Dvorak J, et al. Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med. 2017;51:838–47.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Mccrory P, Meeuwisse W, Aubry M, et al. Consensus statement on concussion in sport—the 4th international conference on concussion in sport held in Zurich, November 2012. Clin J Sport Med. 2013;23:89–117.CrossRefGoogle Scholar
  13. 13.
    Chandran A, Elmi A, Young H, Dipietro L. Determinants of concussion diagnosis, symptomology, and resolution time in U.S. high school soccer players. Res Sports Med. 2019:1–13.Google Scholar
  14. 14.
    Harriss AB, Abbott KC, Humphreys D, Daley M, Moir ME, Woehrle E, et al. Concussion symptoms predictive of adolescent sport-related concussion injury. Clin J Sport Med. 2019;
  15. 15.
    Bigler ED. Neuropsychology and clinical neuroscience of persistent post-concussive syndrome. J Int Neuropsychol Soc. 2008;14:1–22.CrossRefGoogle Scholar
  16. 16.
    Couch JR, Bearss C. Chronic daily headache in the Posttrauma syndrome: relation to extent of head injury. Headache. 2001;41:559–64.CrossRefGoogle Scholar
  17. 17.
    Jensen OK, Nielsen FF. The influence of sex and pre-traumatic headache on the incidence and severity of headache after head injury. Cephalalgia. 1990;10:285–93.CrossRefGoogle Scholar
  18. 18.
    Choe M, Barlow KM. Pediatric traumatic brain injury and concussion. Continuum (Minneap Minn). 2018;24(1):300–11.Google Scholar
  19. 19.
    Theeler BJ, Erickson JC. Mild head trauma and chronic headaches in returning US soldiers. Headache: J Head Face Pain. 2009;49:529–34.CrossRefGoogle Scholar
  20. 20.
    Defrin R. Chronic post-traumatic headache: clinical findings and possible mechanisms. J Man Manip Ther. 2013;22:36–44.CrossRefGoogle Scholar
  21. 21.
    Xiong K, Zhu Y, Zhang Y, Yin Z, Zhang J, Qiu M, Zhang W. White matter integrity and cognition in mild traumatic brain injury following motor vehicle accident. Brain Res. 2014;1591:86–92.CrossRefGoogle Scholar
  22. 22.
    Vanderploeg RD, Curtiss G, Belanger HG. Long-term neuropsychological outcomes following mild traumatic brain injury. J Int Neuropsychol Soc. 2005;11:228–36.CrossRefGoogle Scholar
  23. 23.
    Wilson JT, Teasdale GM, Hadley DM, Wiedmann KD, Lang D. Post-traumatic amnesia: still a valuable yardstick. J Neurol Neurosurg Psychiatry. 1994;57:198–201.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Flynn FG. Memory impairment after mild traumatic brain injury. Continuum (Minneap Minn). 2010;16:79–109.PubMedGoogle Scholar
  25. 25.
    Stuss DT, Alexander MP. Executive functions and the frontal lobes: a conceptual view. Psychol Res. 2000;63(3–4):289–98.CrossRefGoogle Scholar
  26. 26.
    Riechers RG. Rehabilitation in the patient with mild traumatic brain injury. Continuum (Minneap Minn). 2010;16:128–49.PubMedGoogle Scholar
  27. 27.
    Ellis MJ, Ritchie LJ, Koltek M, Hosain S, Cordingley D, Chu S, et al. Psychiatric outcomes after pediatric sports-related concussion. J Neurosurg Pediatr. 2015;16:709–18.CrossRefGoogle Scholar
  28. 28.
    Lincoln AE, Caswell SV, Almquist JL, Dunn RE, Norris JB, Hinton RY. Trends in concussion incidence in high school sports. Am J Sports Med. 2011;39:958–63.CrossRefGoogle Scholar
  29. 29.
    Covassin T, Swanik CB, Sachs ML. Sex differences and the incidence of concussions among collegiate athletes. J Athl Train. 2003;38(3):238–44.PubMedPubMedCentralGoogle Scholar
  30. 30.
    Schmelzer K, Ditzen B, Weise C, Andersson G, Hiller W, Kleinstäuber M. Clinical profiles of premenstrual experiences among women having premenstrual syndrome (PMS): affective changes predominate and relate to social and occupational functioning. Health Care Women Int. 2014;36:1104–23.CrossRefGoogle Scholar
  31. 31.
    Brown DA, Elsass JA, Miller AJ, Reed LE, Reneker JC. Differences in symptom reporting between males and females at baseline and after a sports-related concussion: a systematic review and meta-analysis. Sports Med. 2015;45:1027–40.CrossRefGoogle Scholar
  32. 32.
    Max JE. Neuropsychiatry of pediatric traumatic brain injury. Psychiatr Clin North Am. 2014;37:125–40.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Max JE, Pardo D, Hanten G, et al. Psychiatric disorders in children and adolescents six-to-twelve months after mild traumatic brain injury. J Neuropsychiatry Clin Neurosci. 2013;25:272–82.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Hazrati L-N, Tartaglia MC, Diamandis P, Davis KD, Green RE, Wennberg R, et al. Absence of chronic traumatic encephalopathy in retired football players with multiple concussions and neurological symptomatology. Front Hum Neurosci. 2013;7:222.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Lehman EJ, Hein MJ, Baron SL, Gersic CM. Neurodegenerative causes of death among retired National Football League players. Neurology. 2012;79:1970–4.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Master CL, Scheiman M, Gallaway M, Goodman A, Robinson RL, Master SR, Grady MF. Vision diagnoses are common after concussion in adolescents. Clin Pediatr. 2015;55:260–7.CrossRefGoogle Scholar
  37. 37.
    Luo TD, Clarke MJ, Zimmerman AK, Quinn M, Daniels DJ, Mcintosh AL. Concussion symptoms in youth motocross riders: a prospective, observational study. J Neurosurg Pediatr. 2015;15:255–60.CrossRefGoogle Scholar
  38. 38.
    Rosenfield M. Computer vision syndrome (a.k.a. digital eye strain). Optom Pract. 2016;17:1–10.Google Scholar
  39. 39.
    Antonioli M, Rybka J, Carvalho LA. Neuroimmune endocrine effects of antidepressants. Neuropsychiatr Dis Treat. 2012;8:65–83.PubMedPubMedCentralGoogle Scholar
  40. 40.
    Centofanti SA, Dorrian J, Hilditch CJ, Banks S. Do night naps impact driving performance and daytime recovery sleep? Accid Anal Prev. 2017;99(Pt B):416–21.CrossRefGoogle Scholar
  41. 41.
    Schmidt MH. The energy allocation function of sleep: a unifying theory of sleep, torpor, and continuous wakefulness. Neurosci Biobehav Rev. 2014;47:122–53.CrossRefGoogle Scholar
  42. 42.
    Mosti C, Spiers MV, Kloss JD. A practical guide to evaluating sleep disturbance in concussion patients. Neurol Clin Pract. 2016;6:129–37.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Oyegbile TO, Delasobera BE, Zecavati N. Gender differences in sleep symptoms after repeat concussions. Sleep Med. 2017;40:110–5.CrossRefGoogle Scholar
  44. 44.
    Botchway EN, Godfrey C, Nicholas CL, Hearps S, Anderson V, Catroppa C. Objective sleep outcomes 20 years after traumatic brain injury in childhood. Disabil Rehabil. 2019:1–9.Google Scholar
  45. 45.
    Mollayeva T, Mollayeva S, Shapiro CM, Cassidy JD, Colantonio A. Insomnia in workers with delayed recovery from mild traumatic brain injury. Sleep Med. 2016;19:153–61.CrossRefGoogle Scholar
  46. 46.
    Hoffer ME, Gottshall KR, Moore R, Balough BJ, Wester D. Characterizing and treating dizziness after mild head trauma. Otol Neurotol. 2004;25:135–8.CrossRefGoogle Scholar
  47. 47.
    Mollayeva T, Mollayeva S, Colantonio A. Traumatic brain injury: sex, gender and intersecting vulnerabilities. Nat Rev Neurol. 2018;14:711–22.CrossRefGoogle Scholar
  48. 48.
    Kontos AP, Deitrick JM, Collins MW, Mucha A. Review of vestibular and oculomotor screening and concussion rehabilitation. J Athl Train. 2017;52:256–61.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Mcleod TCV, Hale TD. Vestibular and balance issues following sport-related concussion. Brain Inj. 2014;29:175–84.CrossRefGoogle Scholar
  50. 50.
    Leddy JJ, Baker JG, Merchant A, Picano J, Gaile D, Matuszak J, Willer B. Brain or strain? Symptoms alone do not distinguish physiologic concussion from cervical/vestibular injury. Clin J Sport Med. 2015;25:237–42.CrossRefGoogle Scholar
  51. 51.
    Lau BC, Kontos AP, Collins MW, Mucha A, Lovell MR. Which on-field signs/symptoms predict protracted recovery from sport-related concussion among high school football players? Am J Sports Med. 2011;39:2311–8.CrossRefGoogle Scholar
  52. 52.
    Brent DA, Max J. Psychiatric sequelae of concussions. Curr Psychiatry Rep. 2017;19(12):108.CrossRefGoogle Scholar
  53. 53.
    Mcallister TW, Wall R. Neuropsychiatry of sport-related concussion. Handb Clin Neurol. 2018;158:153–62.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • George G. A. Pujalte
    • 1
  • Timothy M. Dekker
    • 2
  • Andre A. Abadin
    • 2
    Email author
  • Trisha E. Jethwa
    • 2
  1. 1.Department of Sports Medicine and Family MedicineMayo Clinic FloridaJacksonvilleUSA
  2. 2.Department of Family MedicineMayo Clinic FloridaJacksonvilleUSA

Personalised recommendations