What to explain
Tell the clinician about the injury, later symptoms, mood changes, and repeated head impacts.
I would like to discuss whether my brain fog, headaches, dizziness, sleep, mood, balance, or vision changes may be related to a head injury or repeated head impacts. Some symptoms started right away, while others became noticeable hours or days later. My work, school, driving, exercise, or sport has also changed. I brought the dates and details I know, including whether I stopped the activity or continued after an injury. Please help me separate possible concussion effects from other causes. I also want to know whether I need mental health or rehabilitation support and what I can safely return to.
Questions to take in
Ask about recovery, mental health, repeated impacts, and future sport.
- Which problems are most likely connected to the concussion, including symptoms that appeared later, and which might have another cause?
- Can we review changes in my mood, sleep, anger, anxiety, substance use, behavior, and thoughts of suicide or self-harm? Do I need mental health treatment or a safety plan now?
- Does my history of repeated head impacts change the assessment, and what can and cannot be checked for CTE while I am alive?
- Does my injury history change whether I should return to contact sport, change how I play, or stop? Who should help make that decision?
- Do my dizziness, vision, balance, headache, neck, exercise, or standing symptoms need a specific examination or rehabilitation?
- Would a neuropsychological evaluation help explain the daily thinking problems or support work, school, or disability adjustments?
- Is there a specific reason for imaging or a blood or hormone test, and what decision would the result change?
- What can I safely do now for work, school, driving, exercise, and sport, and when should I see a concussion, brain-injury rehabilitation, or mental health specialist?
Concussion, balance, vision, sleep, and thinking assessments
Ask what each assessment can answer before it is ordered.
The clinician should first ask how the injury happened and check memory, speech, strength, feeling, coordination, balance, and eye movement. Other assessments should answer a specific question about symptoms, safety, treatment, work, school, driving, or sport.
SCOAT6 clinical concussion assessment
Reviews symptoms, how the injury happened, memory, thinking, balance, sleep, mental health, and daily activities. SCOAT6 is for an office visit after the first 72 hours of a sport-related concussion. It cannot explain persistent symptoms by itself.
Ask your doctorRivermead Post-Concussion Symptoms Questionnaire (RPQ)
Measures how strongly common post-concussion symptoms are affecting you and whether they change over time. A questionnaire does not diagnose the cause.
Ask your doctorVOMS vestibular and eye-movement assessment
Checks whether head or eye movement brings on dizziness, nausea, headache, or vision trouble, and whether the neck may contribute. It shows which movements bring on symptoms. It does not diagnose the cause.
Ask your doctorNeuropsychological evaluation
Measures several thinking abilities and considers education, earlier functioning, sleep, mood, pain, and medicine effects. It may help with rehabilitation or work and school adjustments when daily thinking problems continue.
Read the test guidePHQ-9 depression screening
Screens for depression during the past two weeks, including thoughts about death or self-harm. A concerning answer needs a direct conversation about safety; PHQ-9 alone is not a full suicide-risk assessment.
Read the test guideGAD-7 anxiety screening
Screens for common anxiety symptoms during the past two weeks. It can show whether anxiety needs a fuller assessment, but it does not ask about suicide or prove that concussion caused the anxiety.
Read the test guideOrthostatic vitals
Measures heart rate and blood pressure after lying down and standing. It's useful when standing causes lightheadedness, racing heart, weakness, or near-fainting. It isn't a routine test for everyone.
Read the test guideBrain MRI
Checks for bleeding or another change in the brain's structure when danger signs, an unusual recovery, or another condition is suspected. A normal CT or MRI does not confirm recovery, and special research scans are not routine tests for persistent symptoms.
Read the test guideTargeted blood or hormone tests
Checks another possible cause only when symptoms, injury severity, medicines, or medical history support it. A wide group of hormone blood tests is not needed after every mild concussion.
Ask your doctorBefore the appointment
Bring every known injury, delayed symptom, and change in daily life.
A list of every known head injury. Add the date, what hit your head or body, and whether you blacked out or lost memory. Note if another injury happened before you recovered.
For sports or other repeated exposure, list the sport or activity, years played, position, diagnosed concussions, and whether you stopped or continued after any blow that caused symptoms. If you can't remember the number of impacts, say so.
Emergency department notes, discharge instructions, and the full report from any CT or MRI. Bring the report. A message saying the scan was normal isn't enough.
A timeline showing what started immediately, what appeared hours or days later, what continues now, and what is improving or getting worse.
Three real examples of tasks you cannot do as before, such as reading, using a screen, working, studying, shopping, cooking, driving, or exercising.
Changes in sleep, anxiety, sadness, anger, impulse control, alcohol or drug use, interest in usual activities, suicidal thoughts, or self-harm thoughts. Include what a family member, friend, teammate, coach, teacher, or coworker has noticed.
Your current work, school, driving, exercise, and sport restrictions, plus any return plan you have.
Your medicine and supplement list, plus any history of migraine, sleep problems, anxiety, depression, learning or attention problems, neck injury, fainting, balance trouble, or vision treatment.
CT and MRI look for structural problems such as bleeding. Concussion is usually judged from the injury, symptoms, examination, and recovery. Bring the full report so the clinician can see what was scanned and what the radiologist found.
How the doctor assesses this
Details that help the clinician judge whether concussion is involved
- Thinking, sleep, balance, vision, headache, mood, or behavior changed after the injury, even if nobody noticed until later.
- Someone close to you noticed a change that you did not recognize at first.
- There was another concussion before recovery, or years of repeated head impacts during contact sport or another activity.
Details that need another explanation or urgent assessment
- The current problems were present before the injury and did not change afterward.
- The timing fits another cause more closely, such as migraine attacks, severe sleep loss, a new medicine, neck pain, fainting, substance use, or a separate illness.
- New or rapidly worsening neurological symptoms need urgent assessment for bleeding or another serious problem. Treat them as urgent, not as ordinary concussion recovery.
- A normal CT or MRI does not confirm or rule out concussion. The history and examination still need to show whether concussion, another cause, or both best explain the symptoms.
- Depression, anger, impulsive behavior, memory trouble, or suicidal thoughts need care. On their own, these symptoms do not show that a person has chronic traumatic encephalopathy (CTE).
What to understand before choosing care
Questions that decide which treatment, safety plan, or referral is needed.
- Please ask me directly about depression, anxiety, anger, impulsive behavior, substance use, suicidal thoughts, self-harm thoughts, and whether I feel safe today.
- Please review every known concussion and my years of repeated head impacts, including sport, work, military service, falls, or violence. I may not know the number of impacts that caused no immediate symptoms.
- I need a written plan for returning to work, school, driving, exercise, and sport because these activities are still difficult or may be unsafe.
- If I play a contact or collision sport, please explain whether my injury history changes the safest position, level of play, return date, or decision to stop.
- If rehabilitation may help, I want to know which symptom it is meant to treat and how we will measure whether it is helping.
What the research found
What studies show about delayed symptoms, mental health, repeated impacts, and CTE.
CDC states that some concussion symptoms appear immediately, while others are first noticed hours or days later. A week or two later, a person may notice more emotional changes or sleep trouble. A delayed symptom is worth reporting, but timing alone does not prove concussion caused it.
A 2025 combined analysis included 15 studies and 592,406 adults. It reported that up to 30% of adults can have persistent symptoms. It linked early trouble concentrating, loss of consciousness, a memory gap, and a history of anxiety, depression, or sleep disorders to higher odds. These factors cannot predict one person's recovery.
A 2026 study followed 106 of 150 emergency department patients to one month. Under the study's definition, 34 people, or 32.1%, had persistent symptoms. Female sex, a memory gap after the injury, and higher early symptom scores were associated with persistence. This was one hospital study with missing follow-up, so 32.1% is not a universal rate.
A 2025 analysis combined 18 studies with 13,483,226 participants, including 650,465 people with a concussion history. It linked concussion history to higher odds of suicidal thoughts or a suicide plan (both 1.35), a suicide attempt (1.66), and death by suicide (1.90). These results show a link. They don't prove concussion caused any one person's thoughts or behavior, or predict one person's risk.
The 2023 Amsterdam consensus uses the term persisting symptoms when symptoms last more than four weeks. It recommends a clinical assessment that covers several possible contributors because no single test can show why the symptoms continue.
Repeated head impacts include blows that cause no immediate concussion symptoms. CDC reports an association between CTE and long-term exposure to repeated head impacts, but no strong evidence that one or more concussions or occasional blows cause CTE. For now, only a brain examination after death can confirm CTE.
A 2025 Nature study examined donated brain tissue from 28 men younger than 51. Eight had no repeated head impacts. Nine played contact sport but did not have CTE. Eleven had early-stage CTE. The researchers reported about 56% fewer cells of one nerve-cell type near the brain's surface in people exposed to repeated impacts. This selected study of donated brain tissue cannot estimate risk for a living athlete, women, or the general population.
A 2024 combined analysis found small improvements in some dizziness and symptom scores after balance and eye-movement rehabilitation. The evidence was low certainty, and the review did not show a clear improvement in return to sport or daily function.
Several kinds of tailored support may help adults return to work after concussion, a 2025 systematic review found. Options included rehabilitation, psychological support, ways to work around a difficulty, and help from the workplace or a vocational service. The review did not identify one program that works for everyone.
How age, sex, disability, earlier health, work, school, and sport affect the plan.
Children and teenagers need an age-appropriate assessment and a written return-to-school plan. Symptoms and behavior changes may go unnoticed for hours or days. Returning to school and usual activities comes before unrestricted contact practice or competition.
Return-to-sport rules differ by age, level of play, sport, and country. Children, teenagers, community athletes, and professional athletes may have to stay away from contact sport for different lengths of time. Follow the rule that applies to you, not a professional athlete's timeline.
Working-age adults may need shorter days, fewer screens or meetings, rest breaks, different duties, transport help, or a gradual return to work.
Older adults may recover more slowly. Falls, blood-thinning medicine, and other health problems can also change the risk after a blow to the head, so get new thinking problems checked instead of blaming age.
A 2025 combined analysis of adults linked female sex to a greater chance of lasting symptoms. It's an average finding. It doesn't predict one person's recovery, and it's no reason to give that person different treatment without assessing them.
Female and para-athletes may need assessment and return plans that account for sex, disability, communication, equipment, and the demands of their sport. These factors do not make the symptoms less serious.
Health before the injury matters. Tell the clinician about earlier concussions and any condition or substance use that affected thinking, sleep, mood, learning, attention, balance, vision, or headaches before the latest injury.
If the answer is no
If your doctor will not order a routine brain scan after concussion
A CT or MRI scan is not usually needed to identify a mild brain injury or concussion. CDC says scans are used when bleeding or another injury is a concern. Symptom, memory, focus, and problem-solving checks can show how the concussion affects you.
What changes the answer
- Bring the injury and symptom timeline. Include the mechanism, loss of consciousness or amnesia, symptoms that appeared later and how school, work, driving or exercise now affects them.
- Ask whether you need imaging, and why. Request an explanation of the examination and the clinical decision rules used to assess risk of bleeding or another urgent injury.
- Ask for cognitive and functional assessment. Memory, concentration, learning and problem-solving tests can document difficulties even when imaging is not needed or is normal.
- Request a recovery and escalation plan. Ask about return to work, study, sport and driving, plus the symptoms or failure to improve that should trigger follow-up or specialist referral.
United States, United Kingdom, and Australia
Concussion care and sports guidance.
US United States
Ask for a full concussion review. Bring every known injury, repeated head impacts, delayed symptoms, mood or behavior changes, and difficult tasks. Ask which assessment, safety support, or referral you need now.
- Start with a primary care, sports medicine, rehabilitation, or concussion clinician who can review the full injury and symptom history.
- CDC advises contacting a healthcare professional when symptoms have not gone away within two to three weeks or get worse after returning to regular activities.
- A suspected sports concussion means leaving play immediately. Return to practice only with healthcare approval and supervision, using a step-by-step plan.
UK United Kingdom
Book a GP review for ongoing symptoms. Explain every known injury, what appeared later, what has not improved, and how mood, work, study, driving, sleep, movement, or sport is affected. Ask which local service can assess each problem.
- NICE NG232 replaced the older CG176 head-injury guideline in 2023.
- Use 999 or A&E for danger signs after a recent injury. A GP can review ongoing symptoms and decide whether you need help for dizziness, vision, headaches, thinking, mental health, or brain-injury rehabilitation.
- Bring the discharge letter and full scan report, even if the scan was reported as normal.
AU Australia
Ask who should treat the problem that limits you most. Bring every known injury, repeated-impact history, scan reports, delayed symptoms, mood changes, and unsafe activities. Ask which rehabilitation or specialist assessment you need.
- Start with a GP or clinician who can review the injury, current symptoms, daily function, and need for rehabilitation.
- For people under 19 in community sport, national guidance requires 14 days without symptoms at rest before contact training. It also requires at least 21 days after the concussion before competitive contact sport.
- Ask for a plan that covers school or work, mental health, repeated concussions, and the decision about future contact sport.
Safety
Use a written plan for daily life, mental health, and return to sport.
- After the first one or two days, prolonged complete rest is usually not recommended. Follow a clinician's gradual plan and reduce an activity if it clearly brings symptoms back or makes them worse.
- Leave play immediately after a suspected sports concussion. Do not return to the same game or practice, even if you begin to feel better.
- Return to sport one step at a time with healthcare approval and supervision. CDC's six-step progression usually takes at least 24 hours per step, and symptoms returning means stop and contact the clinician.
- Ask for written adjustments if reading, screens, noise, meetings, travel, or long work or school days bring symptoms back.
- Do not drive if dizziness, blurred or double vision, slower reactions, poor attention, or fatigue makes driving unsafe. Ask when it is safe to restart.
- Treat sleep, pain, depression, anxiety, anger, substance use, and suicidal or self-harm thoughts as real parts of recovery. Ask who will help with each one instead of waiting for every symptom to disappear on its own.
Source checked
Sources behind this handout.
- 01
CDC, What to Do After a Mild TBI or Concussion (2025)
Source - 02
CDC, Symptoms of Mild TBI and Concussion (2025)
Source - 03
CDC HEADS UP, Managing Return to Activities (2025)
Source - 04
CDC HEADS UP, Returning to Sports (2025)
Source - 05
CDC, About Repeated Head Impacts (2024)
Source - 06
CDC, Safety Guidelines for Pediatric Mild TBI (2025)
Source - 07
Patricios et al., Amsterdam Concussion Consensus (2023)
DOI - 08
Living Concussion Guidelines, Mental Health Symptoms (updated 2025)
Source - 09
McIntosh et al., JAMA Network Open systematic review and meta-analysis (2025)
DOI - 10
McIntosh et al., Neurology Open Access prospective study (2026)
DOI - 11
Liao et al., concussion and suicidal behaviors systematic review and meta-analysis (2025)
DOI - 12
Butler et al., repeated head trauma in young athletes (2025)
DOI - 13
Aljabri et al., vestibular rehabilitation systematic review and meta-analysis (2024)
DOI - 14
Ethier-Gagnon et al., return-to-work systematic review (2025)
DOI - 15
NICE NG232, Head injury: assessment and early management (2023)
Source - 16
American College of Radiology, Appropriateness Criteria for Head Trauma
Source - 17
NSW Agency for Clinical Innovation, concussion guidance (reviewed 2025)
Source - 18
Australian Concussion and Brain Health Position Statement (2024)
Source