Concussion Symptoms You Can’t Ignore – When to Go to the ER
A brain injuryy can be mild and manageable—or it can signal something much more serious. The challenge? Knowing the difference.
Many concussion symptoms are expected—headache, dizziness, feeling “off.” But some symptoms? They’re red flags for a more severe brain injury. If you experience any of these, you don’t wait, you don’t sleep it off—you go to the ER.
So let’s break down the concussion symptoms you can’t afford to ignore, why they matter, and what they could mean.
Red Flags – Get to the ER Immediately
These symptoms aren’t up for debate—they indicate a potentially life-threatening issue like brain bleeding, swelling, or skull fractures. If you or someone else is experiencing any of these, drop everything and get to the ER.
1. Glasgow Coma Scale (GCS) < 13/15
The Glasgow Coma Scale (GCS) is a neurological scoring system used by medical professionals to assess brain function. A normal score is 15—anything below 13 signals significant brain dysfunction.
What it looks like: Extreme confusion, difficulty staying awake, inability to respond appropriately.
Why it matters: A low GCS score means the brain isn’t functioning properly, possibly due to swelling, bleeding, or severe trauma.
2. Loss of Consciousness
Even brief blackouts after a concussion are not normal. Losing consciousness, even for a few seconds, means your brain took a hard hit and could be experiencing more than just a mild concussion.
What it looks like: Passing out immediately after the injury or moments later.
Why it matters: Loss of consciousness suggests significant trauma to the brain, and in some cases, internal bleeding.
3. Seizure or Convulsions
If someone has a seizure after a concussion, that’s a major emergency. A seizure is caused by disrupted brain activity and could mean serious damage, swelling, or bleeding in the brain.
What it looks like: Body stiffening, jerking movements, loss of awareness.
Why it matters: Indicates abnormal electrical activity in the brain, often linked to a more severe injury.
4. Skull or Facial Deformity
If something feels off when you touch your head or face—like a dent, swelling, or misalignment—it may be a skull fracture.
What it looks like: Obvious bumps, depressions, or asymmetry in the skull.
Why it matters: A fractured skull can lead to serious complications, including brain bleeding or infection.
5. Blood or Clear Fluid Coming from the Ears or Nose
If you notice blood or a clear, watery substance leaking from the nose or ears, it could be cerebrospinal fluid (CSF)—a sign of a skull fracture.
What it looks like: Unexplained bleeding or clear fluid dripping from the nose or ears.
Why it matters: A skull fracture with CSF leakage puts the brain at high risk for infection and pressure buildup.
6. Unequal Pupil Size (One Pupil Larger Than the Other)
The pupils should always be equal in size and respond the same to light. If one pupil suddenly becomes noticeably larger than the other, it’s a major red flag for brain pressure or nerve damage.
What it looks like: One eye appears “blown out” or reacts differently to light than the other.
Why it matters: Could indicate pressure on the brainstem, often from bleeding or swelling.
7. Severe or Worsening Headache
A headache after a concussion is normal—a headache that keeps getting worse is not. If the pain intensifies over time, it could signal brain swelling or internal bleeding.
What it looks like: Pain that starts mild but progressively worsens despite rest and hydration.
Why it matters: Increased intracranial pressure (swelling or bleeding) can lead to permanent brain damage or death if untreated.
8. Repetitive Vomiting
A single episode of nausea? Fairly normal. Vomiting over and over? Not normal.
What it looks like: Throwing up more than once after the head injury.
Why it matters: Could indicate brain trauma, increased pressure, or an injury to the vestibular system (which controls balance and coordination).
9. Extreme Drowsiness or Worsening Confusion
Feeling tired is expected after a concussion—but if someone becomes harder and harder to wake up, that’s a big problem.
What it looks like: Difficulty staying awake, extreme grogginess, struggling to respond to questions.
Why it matters: Could signal brain swelling or worsening neurological dysfunction.
Orange Flags – Symptoms That Need Medical Attention
Unlike red flags, orange flags don’t necessarily mean a trip to the ER—but they shouldn’t be ignored either. These symptoms mean something is still wrong, and if they persist or get worse, you need to see a doctor ASAP.
persistent Headache
A lingering headache after a concussion isn’t just an annoyance—it’s a sign your brain is still struggling to recover. If it won’t go away or gets worse, it’s time to get checked out.
Nausea or Vomiting
Feeling queasy after a concussion is common, but if the nausea sticks around or you start throwing up repeatedly, your brain might be telling you something more serious is going on.
Sensitivity to Light or Noise
If normal lighting feels like a police interrogation and everyday sounds hit like a rock concert, your brain’s sensory processing may be out of whack. This is a common post-concussion symptom, but severe cases should be evaluated.
Difficulty Concentrating or Memory Problems
Struggling to focus or forgetting things you normally wouldn’t? Your brain’s energy crisis post-concussion can make even simple tasks feel like solving quantum physics—if this doesn’t improve, get it checked out.
Fatigue or Sleep Disturbances
Can’t keep your eyes open or suddenly feel like an insomniac? Your brain regulates sleep, so when it takes a hit, your rest cycle can go off the rails. If it’s interfering with daily life, don’t ignore it.
Neck Pain or Tenderness
Whiplash often tags along with concussions, leaving your neck stiff and sore. But if the pain is severe, persistent, or radiates down your arms, it could be more than just a strain.
Dizziness or Balance Issues
If walking across the room feels like trying to stand on a boat in a storm, your vestibular system (which controls balance) might be affected. This is common post-concussion, but if it’s severe or long-lasting, you’ll want an expert to assess it.
Final Thoughts: What Should You Do Next?
Bottom Line: If you have red flag symptoms, get to the ER immediately. If you have orange flag symptoms, monitor closely and see a doctor if they persist or worsen.
The difference between a mild concussion and a medical emergency comes down to recognizing the right symptoms. If you’re unsure what to do next, I’ve put together a FREE Concussion Recovery Guide that walks you through the essential steps to avoid common mistakes and heal faster. And if you would like to chat with me personally click the button below to schedule your free phone consult.
