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Head Injury, Concussion & TBI

A bump, blow or jolt to the head can change how the brain works. Most people with a concussion feel better within a couple of weeks, but some injuries are serious. Know the danger signs, get checked, and give the brain time to heal.

Call 911 or go to the emergency department right away if, after a bump, blow or jolt to the head or body, someone has any of these danger signs (CDC HEADS UP, CDC):

  • one pupil (the black part in the middle of the eye) larger than the other;
  • drowsiness, or they cannot be woken up;
  • a headache that gets worse and does not go away;
  • slurred speech, weakness, numbness or decreased coordination;
  • repeated vomiting or nausea, convulsions or seizures (shaking or twitching);
  • unusual behavior, increased confusion, restlessness or agitation, or not recognizing people or places;
  • loss of consciousness (passed out or knocked out) — even a brief loss of consciousness should be taken seriously.

Babies and young children: also call 911 or go to the emergency department if they will not stop crying and cannot be consoled, or will not nurse or eat (CDC, CDC HEADS UP).

Blood thinners: these medicines may raise the risk of bleeding in the brain after a head injury (CDC). An older person who falls and hits their head should see a doctor right away, especially if they take a blood thinner (CDC), and the NHS advises anyone who takes a blood thinner to get urgent medical advice after a head injury (NHS). Get checked even if you feel fine.

In rare cases a dangerous blood clot can form and crowd the brain against the skull (CDC). Don’t try to judge how serious the injury is yourself (CDC HEADS UP), and don’t drive yourself to the hospital after hitting your head (NHS).

What is a traumatic brain injury?

A traumatic brain injury (TBI) is an injury that affects how the brain works, caused by a bump, blow or jolt to the head or by an object that pierces the skull. The three main types are mild TBI or concussion, moderate TBI and severe TBI (CDC). A concussion can also come from a hit to the body that snaps the head back and forth, making the brain bounce or twist in the skull. Most TBIs are mild — usually not life-threatening, but their effects can still be serious (CDC). You don’t have to be knocked out to have one (MSKTC).

Severity depends on how long a person is unconscious or confused and can’t form new memories, on brain scans and on the Glasgow Coma Scale, which runs from 3 (deepest coma) to 15 (fully alert) (MSKTC). In the VA/DoD guideline, a mild TBI means unconsciousness of up to 30 minutes and memory loss of up to a day; a severe TBI means unconsciousness for more than 24 hours or memory loss for more than 7 days (VA/DoD guideline, 2021).

Causes and how common it is

CDC counts about 214,110 TBI-related hospitalizations in 2020 and 68,663 TBI-related deaths in 2023 — more than 586 hospitalizations and 190 deaths a day — not counting the many TBIs treated only in emergency departments or clinics, or never treated. People 75 and older have the highest numbers and rates, and males are nearly twice as likely as females to be hospitalized and three times as likely to die from a TBI (CDC).

Signs and symptoms

Some symptoms appear right away, others hours or days later, and they change during recovery. They can be physical (headache, dizziness, nausea early on, tiredness, vision problems, sensitivity to light or noise), affect thinking (feeling foggy or slowed down, poor concentration or memory), emotions (irritability, sadness, anxiety) or sleep (more, less, or trouble falling asleep). People may not recognize their own problems (CDC).

In children, watch for changes. Babies and toddlers may cry more, want to be held, refuse to nurse or eat, lose interest in play or seem unsteady; older children may seem dazed, answer slowly, have trouble remembering, or change in mood or behavior (CDC HEADS UP).

How it’s diagnosed

Anyone with a possible concussion should see a health care provider — by telehealth if that’s the only option. Providers ask about symptoms and may use neuropsychological tests of memory, concentration and problem solving; a concussion can exist even if these tests are normal (CDC). Symptom checklists such as the Post-Concussion Symptom Scale help track recovery (CDC).

  • CT scans aren’t needed to diagnose a concussion but may be used for people at risk of bleeding (CDC). For adults, emergency physicians recommend the Canadian CT Head Rule, which considers features such as not reaching a full Glasgow Coma Scale score within two hours, signs of a skull fracture, vomiting more than once and age over 64 (ACEP clinical policy, 2023).
  • On blood thinners other than aspirin, these rules shouldn’t be used to skip a CT. If the first scan shows no bleeding and the exam is normal, routine admission isn’t needed, but you should be told the signs of rare, delayed bleeding (ACEP, 2023).
  • Children: CDC advises against routine CT or MRI; risk factors such as age under 2, repeated vomiting, loss of consciousness or a suspected skull fracture may point to a scan (CDC).

Recovery and persisting symptoms

Most people with a mild TBI or concussion feel better within a couple of weeks (CDC); most children within 2 to 4 weeks (CDC HEADS UP). Recovery may be slower in older adults, young children and people with past concussions. Some people have symptoms for months or longer: talk with your provider if symptoms last beyond 2 to 3 weeks or worsen when you return to activities (CDC). Common lasting problems include:

Moderate and severe TBI

A moderate or severe TBI may cause lifelong problems that have been compared to a chronic disease. Among people 16 and older who had inpatient rehabilitation, five years later 22% had died, 30% were worse, 22% were the same and 26% had improved (CDC). Lasting effects can include trouble thinking and learning, weakness, poor coordination, hearing and vision problems, and changes in mood and behavior (CDC HEADS UP). A severe injury can cause a coma — see our Coma guide. Recovery can continue for months or years (MSKTC).

About 1 in 10 people hospitalized for a TBI will have seizures, most in the first days or weeks (MSKTC); TBI is a known cause of epilepsy (CDC). See our Epilepsy guide for seizure first aid. Having two or more TBIs may raise the risk of Parkinson’s and Alzheimer’s disease later in life (VA).

CTE

Chronic traumatic encephalopathy (CTE) is a brain disease linked to long-term exposure to repeated hits to the head, as in some contact sports. There is no strong evidence that one or more concussions lead to it. CTE can currently be confirmed only by examining the brain after death, its symptoms are uncertain, and it is likely very rare. If you are worried about memory or mood changes, see a doctor: treatments can help with many of these symptoms (CDC).

Older adults and blood thinners

Older adults are more likely than any other age group to be hospitalized for or die from a TBI, yet their injuries may be missed because the symptoms overlap with conditions such as dementia. CDC asks providers to check for TBI after any fall or car crash, especially in people taking anticoagulants (such as warfarin, rivaroxaban or apixaban) or antiplatelet medicines (such as clopidogrel or aspirin) (CDC). Never stop a blood thinner on your own.

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Emergency evaluation and CT when decision rules call for it; brief rest, then a gradual return to activity; symptom care (pain relievers by class, with caution), vestibular therapy, cognitive rehabilitation and mental health care; for moderate or severe TBI, rehabilitation with physical, occupational and speech therapy, and seizure care when needed. Emergency care and CT: cost estimate being researched. Physical therapy: about $50–$350 or more a session without insurance (cost guide); Medicare Part B: 20% of the approved amount after the deductible. Most people with a concussion feel better within a couple of weeks. Some have symptoms for months; moderate and severe injuries may bring long-term or lifelong effects, with recovery continuing for years.
Chiropractic Some chiropractors treat neck-related (cervicogenic) symptoms after a concussion, such as neck pain, headache and dizziness, usually as part of wider care. Cost estimate being researched. Limited, mostly small studies. The VA/DoD guideline found insufficient evidence and judged that harms may slightly outweigh benefits. Never before medical clearance; neck manipulation carries rare serious risks.
Acupuncture Studied for persisting post-concussion symptoms, post-traumatic headache and sleep problems; offered in some VA and DoD settings. Cost estimate being researched. Some small trials report benefits, but the VA/DoD guideline found the evidence insufficient to recommend for or against it. Low risk with a qualified practitioner.
Herbal medicine No herb or supplement is proven to heal a brain injury. Omega-3s and some other supplements are under study only. Not applicable. Ginkgo may raise bleeding risk with blood thinners, and supplements can interact with medicines. Talk to your doctor before taking anything.
Massage therapy Gentle massage may ease neck tension or headache later in recovery, once a doctor has cleared you. Cost estimate being researched. Comfort, not a cure. We found little research beyond a single case study.
MBHA Wellness Coach Recovery routines: sleep, screen time and pacing, return-to-school and work plans, no alcohol, driving only when cleared, injury prevention, and caregiver support. Cost estimate being researched. Supports — never replaces — your medical team, and helps you and your family follow the plan.

Approach 1 of 6

Conventional medicine (AMA)

We name treatments but never doses — your care team tailors them.

Emergency care and imaging

Doctors examine the person and use decision rules to decide on a CT scan (ACEP, 2023). After a moderate or severe TBI, the hospital team works to prevent further injury, such as from swelling that raises pressure inside the skull (MSKTC). Most people with a concussion can recover at home after a check-up (CDC).

Concussion care

CDC’s guideline advises 1 to 2 days of rest, then light activity, then a gradual return to activities that don’t make symptoms much worse (CDC). Complete rest is not recommended (MSKTC).

Symptom care

Rehabilitation, seizures and mental health

What it costs

  • Emergency care, CT, neuropsychological testing and inpatient rehabilitation: cost estimate being researched.
  • Physical therapy: about $50–$350 or more a session without insurance, or a $10–$75 copay or 10%–50% coinsurance with it (cost guide: CostHelper). Medicare Part B covers medically necessary outpatient therapy; you pay 20% of the Medicare-approved amount after the deductible (Medicare.gov).

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Some chiropractors, osteopaths and physical therapists use hands-on neck treatment after a concussion (scoping review, 2025), because an injured neck can cause headaches that start in the neck and back of the head (MSKTC).

Never before medical clearance. Anyone with a head injury needs a health care provider first (CDC). A neck injury can hide behind concussion symptoms: one report describes an unstable neck fracture found weeks after a surfing injury that looked like a concussion (case report, 2019). Neck manipulation has been linked to rare artery tears that can cause a stroke (NCCIH).

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

Acupuncture has been studied for lasting symptoms after a concussion. The evidence is growing but limited.

Complications are uncommon, but improper acupuncture can cause infections or organ and nerve injury (NCCIH). Tell your acupuncturist about any blood thinner.

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

No herb or supplement has been proven to heal a brain injury. For people on prescribed medicines after a concussion, the VA/DoD guideline advises avoiding supplements such as “energy” products, some of which react with medicines (VA/DoD guideline, 2021).

Approach 5 of 6

Massage therapy

Massage is not a treatment for brain injury, but MSKTC lists self-massage and therapeutic massage among options for headaches after TBI (MSKTC). The VA/DoD guideline found no qualifying studies of massage after a mild TBI (VA/DoD guideline, 2021); we found only one case study (case study, 2015). Wait for medical clearance, ask for gentle work around the neck, and mention any blood thinner: rare serious problems such as blood clots or nerve injury have been reported, some with vigorous massage (NCCIH).

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

An MBHA Wellness Coach can help with the daily routines of recovery — alongside, never instead of, your medical team.

Another approach

Concussion recovery: rest, then gradual return

  1. First few days: rest, when symptoms are usually worst; choose relaxing activities like reading or a short walk.
  2. After one or two days: ease back into regular activities even with mild symptoms; cut back on anything that makes them worse.
  3. When symptoms are nearly gone: return to most activities. Recovery means doing your usual activities without symptoms.

Avoid activities that risk another head injury, and stay connected with family and friends (CDC). Don’t keep a child in a dark room or in bed all day (CDC HEADS UP). Many symptoms are a normal part of healing (MSKTC), but tell your provider if you are not getting better (CDC).

Another approach

Children and sports: HEADS UP

Suspect a concussion? Remove the young athlete from play for the rest of the day, get them checked, and allow a return only with permission from a provider experienced in concussion (CDC HEADS UP).

Return to learn: most children can go back to school within 1 to 2 days, and doing so can shorten recovery. Ask the provider for CDC’s HEADS UP Letter to Schools; supports may include rest breaks, extra test time and a quiet space, and a 504 Plan or IEP if problems last (CDC HEADS UP).

Return to play follows six steps, each usually taking at least 24 hours: regular activities, light aerobic activity, moderate activity, heavy non-contact activity, full-contact practice, then competition. Move on only without new symptoms (CDC HEADS UP).

Why a second hit is dangerous: a repeat concussion while the brain is still healing can be very serious, affect a young person for a lifetime and even be fatal (CDC HEADS UP). Though rare, teens are at greater risk of a severe brain injury when this happens (CDC). There is no concussion-proof helmet (CDC HEADS UP).

Another approach

Service members and veterans

Most military TBIs are mild, and most service members with a mild TBI return to full duty within 10 to 14 days (Department of Defense). The VA’s Polytrauma System of Care treats veterans with TBI, which can occur with PTSD, depression or substance use (VA). Veterans in crisis can call 988 and press 1, or text 838255 (CDC).

Another approach

Preventing head injuries

Member stories

Living with Head Injury, Concussion & TBI? Share your experience

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Sources

This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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