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. A concussion becomes a medical emergency with red flag symptoms (Patricios et al., 2023). Red flags include loss of consciousness over 1 minute, repeated vomiting (more than 2 episodes), severe or worsening headache, seizure, unequal pupil sizes, pupil non-reactivity to light, slurred speech, weakness in arms or legs, numbness in arms or legs, severe disorientation, confusion that worsens, difficulty waking from sleep, excessive sleepiness, clear fluid from nose or ears, Battle's sign (bruising behind ears), raccoon eyes (bruising around eyes), severe cervical spine pain, cervical spine instability, anticoagulant use with any head injury, symptoms worsening rapidly, and Glasgow Coma Scale less than 15. These signs may indicate intracranial bleeding (subdural hematoma, epidural hematoma, subarachnoid hemorrhage), brain swelling, skull fracture, or cervical spine injury requiring immediate intervention. Call 911 or go to ER immediately for any red flag. Do not drive to ER with severe symptoms; have someone else drive. Children, older adults, and patients on anticoagulants have lower threshold for emergency evaluation. When in doubt, seek emergency evaluation; brain injury safety paramount. Red flag symptoms indicate possible intracranial emergency. Red flags indicate emergencies. Call 911 or go to ER immediately for red flags. Call 911 for red flags. Brain injury safety paramount. Safety paramount. Loss of Consciousness Red Flag Loss of consciousness over 1 minute. LOC over 1 minute. Extended LOC concerning. Extended LOC concerning. Brief LOC less concerning. Brief LOC less concerning. LOC indicates more severe concussion. LOC indicates severity. Repeat LOC concerning. Repeat LOC concerning. Difficulty waking from sleep concerning. Difficulty waking concerning. Decreasing alertness concerning. Decreasing alertness concerning. Coma medical emergency. Coma medical emergency. Vomiting Red Flag Repeated vomiting (more than 2 episodes). Repeated vomiting. Projectile vomiting concerning. Projectile vomiting concerning. Vomiting with severe headache concerning. Vomiting with severe headache. Vomiting indicates increased intracranial pressure. Vomiting indicates ICP. Single vomiting episode less concerning. Single episode less concerning. Continued vomiting requires evaluation. Continued vomiting requires evaluation. Headache Red Flag Severe headache. Severe headache. Worsening headache. Worsening headache. Thunderclap headache. Thunderclap headache. Headache with vomiting. Headache with vomiting. Headache with neurological symptoms. Headache with neurological symptoms. Headache unrelieved by medication. Headache unrelieved by medication. Headache with stiff neck. Headache with stiff neck. Headache with fever after head injury. Headache with fever. Seizure Red Flag Seizure after head injury. Seizure after head injury. Generalized tonic-clonic seizure. Generalized seizure. Focal seizure. Focal seizure. Status epilepticus medical emergency. Status epilepticus emergency. Post-traumatic seizure indicates brain injury. Post-traumatic seizure indicates injury. Immediate ER evaluation. Immediate ER evaluation. Antiepileptic medication may be needed. Antiepileptic medication may be needed. Pupillary Red Flag Unequal pupil sizes. Unequal pupils. Pupil non-reactivity to light. Pupil non-reactivity. Fixed and dilated pupil. Fixed and dilated pupil. Indicates increased intracranial pressure. Indicates ICP. Indicates brain herniation. Indicates herniation. Medical emergency. Medical emergency. Immediate neurosurgical evaluation. Neurosurgical evaluation. Neurological Deficit Red Flag Weakness in arms or legs. Weakness. Numbness in arms or legs. Numbness. Slurred speech. Slurred speech. Facial drooping. Facial drooping. Difficulty understanding speech. Difficulty understanding. Difficulty walking. Difficulty walking. Loss of balance. Loss of balance. Vision loss. Vision loss. Double vision. Double vision. Indicates brain injury beyond concussion. Indicates brain injury beyond concussion. Mental Status Red Flag Severe disorientation. Severe disorientation. Confusion that worsens. Worsening confusion. Personality changes. Personality changes. Combative behavior. Combative behavior. Hallucinations. Hallucinations. Difficulty waking. Difficulty waking. Excessive sleepiness. Excessive sleepiness. Glasgow Coma Scale less than 15. GCS less than 15. Indicates significant brain dysfunction. Indicates brain dysfunction. Skull Fracture Signs Clear fluid from nose (CSF rhinorrhea). Clear fluid from nose. Clear fluid from ears (CSF otorrhea). Clear fluid from ears. Battle's sign (bruising behind ears). Battle's sign. Raccoon eyes (bruising around eyes). Raccoon eyes. Palpable skull deformity. Palpable deformity. Open skull wound. Open skull wound. Indicates skull fracture. Indicates skull fracture. Risk of meningitis. Risk of meningitis. Immediate ER evaluation. Immediate ER evaluation. Cervical Spine Red Flag Severe cervical spine pain. Severe cervical pain. Cervical spine instability. Cervical instability. Weakness below injury level. Weakness below injury. Numbness below injury level. Numbness below injury. Loss of bowel or bladder control. Loss of bowel or bladder control. Difficulty breathing. Difficulty breathing. Immediate cervical spine immobilization. Immediate immobilization. Imaging required. Imaging required. Spine specialist evaluation. Spine specialist evaluation. Anticoagulant Considerations Anticoagulant use with head injury. Anticoagulant use. Warfarin (Coumadin). Warfarin. Direct oral anticoagulants (Eliquis, Xarelto, Pradaxa). DOACs. Antiplatelet medications (Plavix, aspirin). Antiplatelets. Increased bleeding risk. Increased bleeding risk. Lower threshold for ER. Lower threshold for ER. CT scan required. CT scan required. Reversal agents available. Reversal agents available. Specialist consultation. Specialist consultation. Children Red Flags Lower threshold for emergency. Lower threshold. Children under 2 years particularly important. Children under 2. PECARN pediatric head injury rules. PECARN rules. Persistent crying. Persistent crying. Refusal to eat or drink. Refusal to eat. Decreased responsiveness. Decreased responsiveness. Bulging fontanelle (infants). Bulging fontanelle. Repeated vomiting. Repeated vomiting. Behavioral changes. Behavioral changes. Pediatric emergency. Pediatric emergency. Older Adults Red Flags Lower threshold for emergency. Lower threshold. Anticoagulant use common. Anticoagulant use common. Subdural hematoma risk increased. Subdural hematoma risk increased. Delayed symptom onset common. Delayed onset common. Comprehensive imaging warranted. Comprehensive imaging warranted. Lower symptom threshold for ER. Lower symptom threshold. Fall prevention assessment. Fall prevention. Geriatric specialist consultation. Geriatric specialist. What to Do for Red Flag Symptoms Call 911 immediately. Call 911 immediately. Do not drive yourself. Do not drive yourself. Do not move if cervical injury suspected. Do not move if cervical injury. Maintain airway. Maintain airway. Stop bleeding if external. Stop bleeding. Keep patient calm. Keep patient calm. Observe consciousness. Observe consciousness. Note time of symptoms. Note time of symptoms. Bring medication list to ER. Bring medication list. Bring identification to ER. Bring identification. Supporting Mobility Routine These exercises support recovery after concussion 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 Emergencies Not recognizing red flag symptoms. Red flag recognition. Driving with severe symptoms. Driving with severe symptoms. Delaying emergency evaluation. Delaying evaluation. Not recognizing delayed onset of red flags. Delayed red flags. Not seeking evaluation for anticoagulant patients. Anticoagulant patients. What concussion symptoms require calling 911? 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, rapidly worsening symptoms. Call 911 immediately for any red flag. How do I know if my concussion is causing brain bleeding? Red flag symptoms may indicate brain bleeding including loss of consciousness over 1 minute, repeated vomiting, severe headache, seizure, unequal pupils, slurred speech, weakness, severe disorientation, difficulty waking. CT scan diagnoses brain bleeding. Anticoagulant use increases bleeding risk. ER evaluation essential for red flags. Can a concussion become an emergency days later? Yes. Delayed deterioration possible especially in older adults and anticoagulant patients. Subdural hematoma may develop hours to days after injury. Worsening symptoms after initial improvement concerning. Repeat ER evaluation if symptoms worsen. Older adults and anticoagulant patients require extended monitoring. What is Battle's sign? Battle's sign is bruising behind the ears indicating basilar skull fracture. Often appears 1-3 days after head injury. Indicates significant injury. Associated with cerebrospinal fluid leak risk. Risk of meningitis. Immediate ER evaluation. Imaging required. Specialist consultation. Often associated with raccoon eyes (bruising around eyes). Should children with concussion always go to ER? Children should have lower threshold for ER. Children under 2 years particularly important. PECARN rules guide pediatric ER evaluation. Persistent vomiting, decreased responsiveness, severe headache, seizure, behavioral changes, bulging fontanelle in infants, and refusal to eat warrant emergency evaluation. When in doubt, take child to ER. 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