The Short Answer Educational content only. Any suspected concussion warrants medical evaluation. Red flag symptoms warrant emergency evaluation. Consult treating providers including concussion specialists for individualized guidance. Go to the ER for concussion symptoms with any red flag signs (Silverberg et al., 2020). Red flags include loss of consciousness over 1 minute, repeated vomiting (more than 2 episodes), severe or worsening headache, seizure, unequal pupil sizes, slurred speech, weakness or numbness, severe disorientation, difficulty waking, clear fluid from nose or ears, Battle's sign (bruising behind ears), raccoon eyes (bruising around eyes), anticoagulant use (blood thinners), symptoms worsening rapidly, and severe cervical spine pain or instability. Standard concussion symptoms without red flags warrant primary care or urgent care evaluation. ER evaluation includes neurological examination, imaging (CT typically), and specialist consultation when indicated. Concussion specialist follow-up supports treatment after ER evaluation. Children, older adults, and patients on anticoagulants have lower threshold for ER evaluation. When in doubt, seek emergency evaluation; brain injury safety paramount. Red flag symptoms warrant immediate ER evaluation. Red flags warrant ER. Standard concussion symptoms without red flags warrant urgent care or primary care. Standard symptoms warrant urgent care. When in doubt, seek emergency evaluation. When in doubt, ER. Red Flag Symptoms Requiring ER Loss of consciousness over 1 minute. Extended LOC. Repeated vomiting (more than 2 episodes). Repeated vomiting. Severe headache. Severe headache. Worsening headache. Worsening headache. Seizure. Seizure. Unequal pupil sizes. Unequal pupils. Pupil non-reactivity to light. Pupil non-reactivity. Slurred speech. Slurred speech. Weakness in arms or legs. Weakness. Numbness in arms or legs. Numbness. Severe disorientation. Severe disorientation. Confusion that worsens. Worsening confusion. Difficulty waking from sleep. Difficulty waking. Excessive sleepiness. Excessive sleepiness. Clear fluid from nose or ears. Clear fluid from nose or ears. Battle's sign (bruising behind ears). Battle's sign. Raccoon eyes (bruising around eyes). Raccoon eyes. Severe cervical spine pain. Severe cervical pain. Cervical spine instability. Cervical instability. Anticoagulant use with any head injury. Anticoagulant use. Symptoms worsening rapidly. Rapid worsening. When Standard Concussion Symptoms Warrant Urgent Care Headache without red flags. Headache without red flags. Dizziness without red flags. Dizziness without red flags. Nausea without repeated vomiting. Nausea without repeated vomiting. Light sensitivity. Light sensitivity. Sound sensitivity. Sound sensitivity. Brain fog. Brain fog. Word-finding difficulty. Word-finding difficulty. Memory difficulty. Memory difficulty. Concentration difficulty. Concentration difficulty. Mood changes. Mood changes. Sleep disruption. Sleep disruption. Mild balance difficulty. Mild balance difficulty. Mild vision changes. Mild vision changes. Higher Threshold for ER Children with any concussion symptoms. Children with any symptoms. Children under 2 years old. Children under 2 years. Older adults (65+). Older adults. Anticoagulant use (blood thinners). Anticoagulant use. Bleeding disorders. Bleeding disorders. Multiple concussions. Multiple concussions. Recent concussion. Recent concussion. Severe initial injury mechanism. Severe mechanism. Concussion specialist unavailable. Specialist unavailable. When in doubt. When in doubt. ER Evaluation Components Neurological examination. Neurological examination. Mental status examination. Mental status examination. Cranial nerve examination. Cranial nerve examination. Motor examination. Motor examination. Sensory examination. Sensory examination. Reflex examination. Reflex examination. Cerebellar examination. Cerebellar examination. Glasgow Coma Scale. GCS. Cervical spine examination. Cervical spine examination. CT scan when indicated. CT when indicated. Specialist consultation when indicated. Specialist consultation. Observation period. Observation period. Discharge instructions. Discharge instructions. Follow-up arrangements. Follow-up arrangements. CT Scan Indications Red flag symptoms. Red flag symptoms. Loss of consciousness. Loss of consciousness. Repeated vomiting. Repeated vomiting. Severe headache. Severe headache. Seizure. Seizure. Glasgow Coma Scale less than 15. GCS less than 15. Anticoagulant use. Anticoagulant use. Older adults with head injury. Older adults. Suspected skull fracture. Suspected skull fracture. Battle's sign or raccoon eyes. Battle's sign or raccoon eyes. Clear fluid from nose or ears. Clear fluid. Focal neurological deficit. Focal neurological deficit. Mechanism severity. Mechanism severity. What CT Scan Identifies Skull fracture. Skull fracture. Intracranial bleeding. Intracranial bleeding. Subdural hematoma. Subdural hematoma. Epidural hematoma. Epidural hematoma. Subarachnoid hemorrhage. Subarachnoid hemorrhage. Intracerebral hemorrhage. Intracerebral hemorrhage. Brain swelling. Brain swelling. Cerebral contusion. Cerebral contusion. Penetrating injury. Penetrating injury. CT does not show concussion. CT does not show concussion. Normal CT does not rule out concussion. Normal CT does not rule out concussion. After ER Evaluation Discharge home with monitoring. Discharge home with monitoring. Wake every 2-3 hours initially. Wake every 2-3 hours initially. Observe for worsening symptoms. Observe for worsening. Return to ER if worsening. Return to ER if worsening. Rest 24-48 hours. Rest 24-48 hours. Avoid screens initially. Avoid screens initially. Avoid alcohol. Avoid alcohol. Avoid driving until cleared. Avoid driving. Primary care follow-up. Primary care follow-up. Concussion specialist follow-up. Specialist follow-up. Return-to-activity protocols. Return-to-activity protocols. Concussion Specialist Follow-Up Concussion specialist evaluation. Concussion specialist. Comprehensive evaluation. Comprehensive evaluation. Vestibular assessment. Vestibular assessment. Vision assessment. Vision assessment. Cervical spine evaluation. Cervical spine evaluation. Neuropsychological testing. Neuropsychological testing. Multidisciplinary treatment. Multidisciplinary treatment. Return-to-activity guidance. Return-to-activity guidance. Symptom management. Symptom management. Recovery monitoring. Recovery monitoring. Pediatric ER Considerations Lower threshold for ER in children. Lower threshold in children. Children under 2 years particularly important. Children under 2. PECARN pediatric head injury rules. PECARN rules. Pediatric concussion evaluation. Pediatric concussion evaluation. Pediatric concussion specialist. Pediatric concussion specialist. School concussion protocols. School protocols. Return-to-learn protocols. Return-to-learn. Return-to-play protocols. Return-to-play. Pediatric imaging considerations. Pediatric imaging considerations. Older Adult ER Considerations Lower threshold for ER in older adults. Lower threshold in older adults. Anticoagulant use common. Anticoagulant use common. Subdural hematoma risk increased. Subdural hematoma risk. Fall mechanism most common. Fall mechanism. Comprehensive imaging. Comprehensive imaging. Geriatric concussion specialist. Geriatric concussion specialist. Fall prevention assessment. Fall prevention assessment. Medication review. Medication review. Supporting Mobility Routine These exercises support recovery through nervous system regulation. JME 155 Diaphragmatic breathing supports vagal tone and parasympathetic regulation during early concussion recovery. 10 breaths every 60-90 minutes. JME 14 Chin tucks reduce upper cervical tension common in concussion injury. 10 repetitions with 5-second holds. JME 1 Cervical rotation supports cerebral blood flow and nervous system regulation. 10 repetitions each direction. JME 150 Thoracic rotation restores breathing depth shallow during concussion recovery. 8 repetitions per direction. Start your 3-day free trial for joint-specific mobility programs that support nervous system regulation through concussion recovery. Common Mistakes With Concussion ER Decisions Not going to ER for red flag symptoms. Red flags require ER. Not seeking evaluation for standard symptoms. Evaluation important for symptoms. Driving to ER with severe symptoms. Have someone else drive. Ignoring symptoms after ER discharge. Monitor after discharge. Not following up with concussion specialist. Specialist follow-up important. What concussion symptoms are emergencies? Loss of consciousness over 1 minute, repeated vomiting, severe or worsening headache, seizure, unequal pupils, slurred speech, weakness or numbness, severe disorientation, difficulty waking, clear fluid from nose or ears, Battle's sign, raccoon eyes, anticoagulant use, and rapidly worsening symptoms. Any red flag warrants immediate ER evaluation. Can I go to urgent care instead of the ER? Urgent care appropriate for concussion symptoms without red flags. Urgent care evaluates headache, dizziness, nausea, light sensitivity, brain fog, mild balance difficulty, and mood changes. Red flag symptoms require ER. When in doubt, go to ER. Urgent care can refer to ER if red flags identified during evaluation. What does the ER do for concussion? Neurological examination, mental status examination, Glasgow Coma Scale, cervical spine examination, CT scan when indicated, specialist consultation when indicated, observation period, discharge instructions, follow-up arrangements. ER rules out brain bleeding and other emergencies. Concussion specialist follow-up supports treatment after ER. Does a normal CT scan mean I do not have a concussion? No. CT scan identifies brain bleeding, skull fracture, and other emergencies but does not show concussion. Normal CT does not rule out concussion. Concussion diagnosis based on symptoms and clinical evaluation, not imaging. Most CT scans normal in concussion. Concussion specialist evaluation supports diagnosis. How long should I be monitored after a head injury? Wake every 2-3 hours initially for first 24 hours. Observe for worsening symptoms over 24-72 hours. Return to ER if worsening. Track symptoms for 1-2 weeks after injury. Concussion specialist follow-up. Return-to-activity protocols guide return. Most symptoms resolve in 2-4 weeks; persistent symptoms warrant specialist evaluation. References Patricios, J. S., et al. (2023). Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport, Amsterdam, October 2022. British Journal of Sports Medicine, 57(11), 695-711. PubMed Silverberg, N. D., et al. (2020). Management of concussion and mild traumatic brain injury: a synthesis of practice guidelines. Archives of Physical Medicine and Rehabilitation, 101(2), 382-393. PubMed