It is usually an unremarkable moment. A helmet-to-helmet hit that looked like a hundred others, a slip on a wet floor, a low door frame. Someone gets up, says they are fine, and then asks the same question twice. If you are reading this at eleven at night trying to decide whether to wait until morning, you are asking exactly the right question.
Here is what most people do not expect. There is no procedure that fixes a concussion. No cast, no stitches, nothing that makes it go away faster. Treatment is assessment, ruling out the dangerous thing, and a recovery plan that fits the person.
At Arlington ER we assess head injuries every day and night of the year, with a GE VCT 64-slice CT scanner on site for the cases that need one. We are open at 2am on a Saturday, which is when most of these injuries actually happen.
The Short Answer: Assessment Is the Treatment
A concussion is diagnosed and managed, not repaired. What happens at an emergency room is a careful examination to answer one question: is this a concussion, which recovers on its own, or is there bleeding inside the skull, which will not.
Once that is settled, the rest is a recovery plan and clear instructions about what would mean coming back.
What a Concussion Actually Does to the Brain
A concussion happens because the brain sits in fluid inside the skull. A blow to the head, or a movement violent enough to shift the head sharply, causes the brain to strain against that fluid. The injury is functional rather than structural. Cells are disrupted, brain chemistry is temporarily altered, and for a while the brain does not do everything it normally does.
That explains why the symptoms are so varied. Headache is the obvious one, but so are nausea, sensitivity to light and noise, trouble concentrating, poor balance, unusual irritability, and sleeping far more or far less than usual. People often describe feeling slightly behind everything.
You Do Not Have to Be Knocked Out
Most concussions happen without any loss of consciousness. This is the single most common misunderstanding we see, and it is the reason people delay coming in.
Someone who stayed on their feet, walked off the field, and answered questions can still have a concussion. Confusion, repeating themselves, or no memory of the moment itself matters far more than whether they blacked out.
Waking Someone Every Hour Is Outdated Advice
Current guidance is to let them sleep. The CDC no longer recommends waking someone hourly. The old advice to keep someone awake, or wake them hourly through the night, came from a reasonable fear that a bleed might go unnoticed. The response was wrong. Sleep is part of how the brain recovers, and disrupting it makes the following days worse rather than safer.
What matters is whether the person can be roused normally. If you check on them and they wake the way they usually would, that is reassuring. If they cannot be woken properly, or seem confused when they are, call 911. That is not a situation for watchful waiting.
| What to do on the first night Let them sleep. Have someone in the house who can check on them. Rouse them once or twice to confirm they wake normally, not to keep them awake. Keep the lights low and screens off. Call 911 for any of the warning signs listed further down. |
What Happens When You Arrive at the Emergency Room
The examination is more thorough than people expect for an injury with nothing to see.
A physician takes a careful account of what happened, because the mechanism of injury matters: how the head was struck, whether consciousness was lost, and whether memory of the event is intact. Then comes a neurological examination covering eye movements, pupil response, coordination, balance, strength, reflexes, memory, and orientation. Blood pressure and pulse are checked as well, since a rising blood pressure alongside a falling pulse is a specific warning sign.
All of it exists to separate a concussion from a bleed. Learn more about our concussion and head injury emergency care and what the assessment involves.
Why Not Every Concussion Needs a CT Scan
A CT scan does not diagnose a concussion. It rules out bleeding. The scan of a genuinely concussed person is usually completely normal, because a concussion leaves no structural mark.
Physicians use established criteria to decide who needs imaging, based on age, how the injury happened, whether there was vomiting or a seizure, whether the person takes blood-thinning medication, and how the examination went. If those criteria are not met, a scan adds radiation without adding information.
Being told your child does not need a scan is not being brushed off. It is usually the better outcome. When a scan is warranted we read it here rather than sending images away and waiting. Our emergency CT imaging services explain what a head CT shows and how the decision is made.
How Long Concussion Recovery Takes
Most concussions resolve within one to four weeks, and recovery is not a straight line. Almost nobody is warned about the second part, and it causes a great deal of unnecessary worry.
People feel better on day three, decide they are fine, return to a full day of school, work, or screens, and feel considerably worse on day four. That is not a relapse or a sign something was missed. It is a brain being asked to do too much too soon.
Complete rest in a dark room beyond the first day or two actually slows recovery. What works is a short period of genuine rest, then a gradual return to normal activity, stopping just short of whatever brings symptoms back. If twenty minutes of reading brings on a headache, read for fifteen, then build from there.
Return to Sport Is Stricter Than Return to School
Nobody should return to contact sport until symptoms have gone completely and they have been cleared to do so. This is not a decision to make on the sideline, and it is not one for the athlete to make about themselves.
The reason is a second impact before the first injury has healed, which is the scenario every brain injury guideline in the country is written to prevent. Texas requires school districts to follow a return-to-play protocol for exactly this reason.
Warning Signs That Mean Come Back Immediately
Most people who are sent home keep improving. Some do not. Any of the following means being seen again rather than waiting:
- A headache that keeps getting worse rather than easing
- Repeated vomiting
- Confusion, unusual drowsiness, or difficulty waking
- Weakness or numbness down one side, or slurred speech
- A seizure
- Clear fluid or blood coming from the nose or ears
- In a young child, persistent crying that cannot be settled, or refusing to feed
If someone is difficult to wake or is having a seizure, call 911 rather than driving them.
A Note for Arlington Parents of Student Athletes
Football practice in Texas starts in August, and the opening weeks of the season are when most head injuries in young athletes happen. For families across Arlington, Pantego, and Dalworthington Gardens, two things are worth knowing.
First, teenagers routinely underreport concussion, because reporting it means coming off the field. If your child seems different after a game, quieter, slower, or unusually irritable, take that seriously even if they insist nothing happened.
Second, a young brain takes longer to recover than an adult one. The pressure to get back quickly is strongest in exactly the group that should take the longest.
Frequently Asked Questions
Most resolve within one to four weeks. Symptoms often improve and then briefly return when activity increases, which is normal rather than a setback.
Come in if there was confusion, vomiting, memory loss, or worsening headache, or if the person takes blood-thinning medication. If you are unsure, being assessed and told it is minor is a good outcome.
Yes. A movement violent enough to shake the head sharply, such as whiplash in a car accident, can cause one without any direct blow.
Yes, once someone has been assessed and nothing dangerous was found. Sleep helps recovery. What matters is that they can be roused normally.
Only after symptoms have fully resolved and a clinician has cleared them. Returning early risks a second injury before the first has healed.
No. A CT scan looks for bleeding, and the scan of a concussed person is usually normal. The diagnosis is made from the examination, not the image.
