Concussion Signs and Symptoms

Sign and Symptom Clusters

Concussion signs (those noticed by coaches, parents and teammates) and symptoms (feelings or problems experienced by the athlete) fall into five "clusters":

       1. Symptoms

           a. somatic (headache, nausea, vomiting, dizziness, visual problems, sensitivity to light/noise,  balance problems);

           b. cognitive (feeling mentally "foggy," feeling slowed down, difficulty concentrating and remembering);

           c. emotional (involuntary crying or uncontrollable episodes of crying and/or laughing)

       2. Physical signs (loss of consciousness (LOC), amnesia, unsteadiness, vacant or blank stare)


       3. Behavioral changes (irritability, sadness, nervousness, more emotional, depression)


       4. Cognitive impairments (slowed reaction time)


       5. Sleep disturbance (insomnia, drowsiness, sleeping less than usual, sleeping more than usual)

Despite widespread concerns about chronic under-reporting by athletes, assessing their symptoms remains a critical component of concussion diagnosis and management.

Concussion Symptoms


1. Headache (reported as symptom by 94.2% of high school athletes)      

2. Dizziness (75.6%)

3. Difficulty concentrating (54.8%)

4. Light sensitivity (36%)

5. Nausea  and vomiting (31.4%)

6. Balance problems         

7. Fatigue         

8. Trouble falling asleep         
9. Sleeping more than usual         
10. Sleeping less than usual         
11.  Drowsiness         

12. Noise sensitivity         
13. Irritability         
14. Sadness         
15. Nervousness         
16. Feeling more emotional         
17. Numbness or tingling         
18. Feeling slowed down         
19. Feeling mentally "foggy"         
21. Difficulty remembering         
22. Visual problems

In diagnosing concussion, the treating doctor will consider both the number of symptoms the athlete reports and their severity  on a 6-point scale, in which 0 means the symptom is not present and 6 being unbearably bad. 


Not always sign of concussion


Because the list includes symptoms that are not specific to concussion, some non-injured athletes may report symptoms.  Student-athletes with pre-injury depression, sleep disturbances, and/or attention-deficit/hyperactivity disorder should not be expected to have a total score of 0 on the symptom scale before they are medically cleared for a return to play because of their elevated baselines.  As a result, the generally accepted threshold total symptom score for return to play is 7.

Mobile phone apps/pocket CRT help

Remembering this list of symptoms is difficult for any parent, coach or player.  As Dr. Joseph Congeni says in The Smartest Team, after he and Dr. Rosemarie Moser tick off most of the 22 symptoms from this list, “There' so many different ways concussion can present that it’s very hard to tell a kid, a coach or parent … this is the one symptom to look for because there’s all these symptoms.  Are you kidding me?”

Fortunately, there are a number of helpful smartphone apps which list the symptoms so that they are at a parent, coach's or player's fingertips. In addition, concussion experts have developed a Pocket Concussion Recognition Tool to help identify concussion, which is freely available for download and printing from the Internet.