Thanks to public awareness campaigns, most people are aware of the seriousness of traumatic brain injuries (TBIs), especially concussions. A concussion can result from a jolt to the head from a fall, accident, or collision on the playing field. But it may not take an obvious incident to cause a problem: Sometimes a simple jerk of your head that you may not even remember can causes symptoms later on. Here’s what to look for any time you bump your noggin, plus strategies to stay safe in the first place.

It’s not all in your head

We think of the brain as being well protected inside the skull, but it can be shaken within that space. During a jolt, your brain can hit against the skull, and that can cause bruising, bleeding, and/or swelling, which may not have any outward signs.

The severity of symptoms and how quickly they start typically indicate the severity of the brain injury and the kind of action you need to take. This is important because the downsides of ignoring symptoms and a delay in getting needed medical attention include the risk of the injury becoming more severe over time, not recovering as well as you could have, experiencing persistent symptoms, having an increased risk of neurodegenerative diseases like Alzheimer’s, and even death.

Mild injury. With a mild TBI, such as a concussion, symptoms might not start for hours, even up to 72 hours later. Why the delay? One scenario is if you have a small bleed that doesn’t reabsorb on its own, it can start to pool over time and not cause symptoms until it gets to a certain size. That’s why you want to stay vigilant.

Signs to look for include headache, dizziness, sensitivity to sound or light or other visual disturbances, nausea, and changes in your demeanor, your balance and even your appetite. If you’re having any of these symptoms and they don’t go away or get worse, or if you simply don’t feel like yourself, call your health-care provider.

Moderate to severe injury. With a moderate or severe TBI, symptoms will show up rapidly. Most obvious is a prolonged loss of consciousness, which can be for 30 minutes or more. You may experience severe confusion, weakness or a loss of sensation in your limbs, seizures, vomiting, and/or a headache that gets progressively worse. These are emergencies requiring immediate attention. Tests such as a computed tomography (CAT) scan will look for bleeding and other signs of injury, which will, in turn, determine the best treatment.

Factors that increase risk

It’s important to note that not every time you walk into a door or hit your head on a shelf will result in a concussion, even if you experience a mild headache from it. It takes a certain amount of force to jolt your brain—for instance, it’s more likely to happen if you ran into that door.

On the other hand, some factors make a concussion more likely, such as having a history of concussions and, surprisingly, having Lyme disease. Research shows that Lyme can make you more prone to concussion, and there’s crossover in the symptoms, too. Both are reasons to call your primary care provider right away so that he or she can determine whether you need to be seen. Here are other circumstances that should prompt you to call:

  • If you’re on a blood thinner, such as an anticoagulant or an antiplatelet medication. Taking these drugs increases the risk of internal bleeding from a head injury.
  • If you have mild cognitive impairment or dementia. Their symptoms overlap with those of a concussion, and your doctor will need to discern what is causing your symptoms.
  • If you have chronic vision problems. Be especially aware of any worsening in eyesight and report changes to your health-care provider.
  • If you have orthostatic hypotension. This form of low blood pressure, which is relatively common in the general population, can also occur after a head injury. Don’t chalk up any symptoms, like balance issues, to that condition. They could also be from a concussion.

Brain injury prevention

Many brain injuries are the result of a fall or a car accident, and there are effective strategies to help you avoid both.

Work on fall prevention. Falls are, by far, the most common cause of TBIs, especially as we age. Even if you’ve exercised throughout your life, fall prevention courses can help you maintain balance and mobility to avoid falls. Tai chi and other exercise disciplines that include balance are helpful, but if you have any existing equilibrium issues, seek out a physical or occupational therapist working in a safe supervised environment, such as rehab center. The movements you’ll practice should be challenging. If they’re too easy, you won’t be motivated to improve.

Be an even safer driver. Adjust your seat and all mirrors every time you get in the car so that so you can easily see your surroundings, including pedestrians and other cars. Contact your doctor, AAA, or even your car insurance company to ask about a senior driver class to brush up on your driving skills. If you don’t feel comfortable driving at night because of diminished night vision, call an Uber instead. Don’t chance it. Above all, be honest with yourself: If you’re concerned that your reaction time or reflexes aren’t what they used to be, it might be time to hang up the keys. It’s a hard decision, but one that could save not only your own life, but those of others too.

Stay up to date with eye doctor appointments. Sounds obvious, but make sure your eyeglasses and contact lens prescriptions are up to date so you can clearly see where you’re going. Vision checks at a yearly exam are especially important if you are still driving.

Schedule a review of your medications. If any of your prescriptions have the potential to cause dizziness—and thereby increase the likelihood of a fall—ask your provider if there are alternatives. Any medical conditions that could have the same effect, like orthostatic hypotension, should be treated and monitored.

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