Signs, Symptoms, and Red Flags After a Concussion

What to watch for after a head injury in kids, teens, adults, and older adults in Washington County

A concussion can be hard to spot. Many people expect it to look serious right away. They think someone must pass out, throw up, or act confused at the scene. But most concussions do not look that way at first.

In Washington County and the West Metro Portland area, concussions often happen during sports games, bike rides, falls at home, car crashes, and work injuries. These are everyday events. Because of that, concussion symptoms are often missed, ignored, or brushed off as “no big deal.”

This article explains the signs and symptoms of concussion in a clear and simple way. It also explains when symptoms are normal, when they are not, and when someone needs urgent medical care.

Why Concussion Symptoms Can Be Delayed

One of the most confusing things about a concussion is timing.

Symptoms do not always start right away.

A person may feel okay at first. They may finish a game. They may go home after a fall. They may drive away after a car crash. Then later that day, or even the next day, symptoms begin.

This delay is normal.

After a concussion, the brain goes through changes over time. The injury does not always show itself right away. The brain’s energy systems get stressed slowly, not all at once.

Adrenaline also plays a role. After an injury, the body releases stress hormones. These can hide symptoms for hours. Once the adrenaline fades, symptoms become easier to notice.

Delayed symptoms are common after:

• Sports games

• Bike crashes

• Car accidents

• Falls during daily activities

A delay does not mean the injury suddenly appeared. It means the brain is struggling more as time passes.

Why Symptoms Can Change Day to Day

Concussion symptoms can change from one day to the next.

One day a person may have a headache. The next day they may feel dizzy instead. Another day they may feel tired or irritable.

This does not mean the injury is getting worse. It means different brain systems are being stressed in different ways.

Activities also matter. Symptoms often increase with:

• School work

• Job tasks

• Screens

• Driving

• Noise

• Bright lights

• Busy places

This pattern is expected after a concussion.

Common Symptom Categories After a Concussion

Concussion symptoms are usually grouped into categories. Not everyone has symptoms from every group.

Physical Symptoms

These affect the body.

Common physical symptoms include:

• Headache

• Dizziness

• Nausea

• Feeling sick to the stomach

• Sensitivity to light

• Sensitivity to noise

• Balance problems

• Feeling unsteady

• Visual strain

• Blurry vision

• Eye discomfort

Some people feel pressure in their head. Others feel sharp pain. Some feel motion sickness. All of these can be part of a concussion.

Cognitive Symptoms

These affect thinking.

Common cognitive symptoms include:

• Slower thinking

• Trouble focusing

• Trouble paying attention

• Forgetting things

• Losing track of tasks

• Feeling “foggy”

• Feeling confused

People often say they feel “off” or “not like themselves.” They may need more time to do simple tasks.

Emotional Symptoms

These affect mood and feelings.

Common emotional symptoms include:

• Irritability

• Anxiety

• Nervousness

• Sadness

• Low mood

• Crying more easily

• Big emotional reactions

These changes are not a personality flaw. They are part of how the injured brain handles stress.

Sleep Symptoms

These affect rest and sleep.

Common sleep symptoms include:

• Sleeping more than usual

• Sleeping less than usual

• Trouble falling asleep

• Waking up often

• Not feeling rested after sleep

Sleep problems are very common after concussion and can make other symptoms feel worse.

Not Everyone Has the Same Symptoms

Two people can have the same type of injury and feel very different.

One person may mostly have headaches. Another may mostly feel dizzy. Another may feel tired and emotional.

This does not mean one injury is real and the other is not. It means concussions affect people in different ways.

Age-Specific Concussion Symptoms

Concussion symptoms can look different depending on age.

Children

Young children may not have the words to explain how they feel.

Signs in children may include:

• Crying more than usual

• Being clingy

• Getting upset easily

• Changes in play

• Trouble at school

• Not wanting to do favorite activities

Parents may notice behavior changes before the child complains of pain.

Teens

Teens often hide symptoms.

They may want to return to sports quickly. They may worry about missing games or letting teammates down.

Common teen behaviors after concussion include:

• Saying they feel “fine” when they are not

• Downplaying headaches

• Pushing through dizziness

• Getting frustrated easily

Adults should take teen symptoms seriously, even when teens minimize them.

Adults

Adults often notice problems at work or while driving.

Common adult symptoms include:

• Trouble concentrating at work

• Slower task completion

• Headaches after screen time

• Discomfort while driving

• Trouble handling busy environments

Adults may also feel pressure to keep working, even when symptoms increase.

Older Adults

Older adults are at higher risk after falls.

Symptoms in older adults may include:

• Confusion

• Balance problems

• Worsening memory

• Increased fall risk

Older adults may need closer monitoring because complications can be more serious.

Why Symptoms Matter Even When Imaging Is Normal

Many people are told their scan is normal and assume they should feel normal too.

This is a mistake.

Concussion symptoms are real even when CT or MRI scans look normal. These scans do not measure how the brain is working. They only show bleeding or structural injury.

Symptoms guide care, not scans.

Red Flags That Need Urgent Medical Care

Some symptoms are not normal for a simple concussion.

These are called red flags.

Go to a local emergency room or call emergency services right away if any of the following occur:

• Worsening headache

• Headache that keeps getting worse

• Repeated vomiting

• Seizure

• Slurred speech

• Weakness in arms or legs

• Numbness or tingling

• Severe confusion

• Trouble waking up

• Unequal pupil size

• Loss of consciousness that lasts

• Neck pain with neurologic symptoms

These signs may point to bleeding, swelling, or spinal injury. They need urgent care.

Why Early Recognition Matters

Ignoring concussion symptoms can slow recovery.

Playing sports while symptomatic increases risk. Working in dangerous settings increases risk. Driving with slowed reaction time increases risk.

Early recognition allows:

• Safer recovery

• Fewer setbacks

• Better long-term outcomes

Recognizing symptoms early is not being weak. It is being smart.

Watching Symptoms at Home

Many people can be safely observed at home after a concussion.

Key things to watch:

• Are symptoms staying the same or improving?

• Is the person acting normally?

• Are red flags appearing?

Families should receive clear instructions on when to seek help.

Questions to Ask Your Clinician

Which symptoms are expected and which are concerning?

Based on the current evidence, your clinician might say the following: symptoms like headache, light sensitivity, fatigue, dizziness, and trouble concentrating are common after a concussion, while symptoms that get worse over time, repeated vomiting, increasing confusion, or new neurologic problems are concerning and need urgent reassessment.

How long should someone be observed at home?

If referencing the most recent clinical practice guidelines as of the publication of this article your clinician might respond with something like: most people can be safely watched at home for the first 24 to 48 hours as long as symptoms are stable or improving and no red flags appear, with clear instructions about when to seek emergency care.

When is it safe to return to school or work tasks?

An evidence based clinician might answer this by saying the following: return to school or work usually starts with lighter mental tasks and temporary adjustments, and activities are slowly increased based on symptoms rather than waiting for all symptoms to be gone.

Frequently Asked Questions

Is headache always present after a concussion?

No. Some people mainly have balance problems, vision issues, or thinking difficulties instead of headaches.

Can symptoms get worse with screens?

Yes. Screens require eye movement and mental effort, which can increase symptoms for a short time.

Is it dangerous to sleep after a concussion?

No. Once serious injury is ruled out, sleep is safe and often helpful.

Why This Information Matters for Washington County Families

Concussions are common in this area because people are active. Kids play sports. Adults commute. Families bike and hike. Older adults experience falls.

Knowing the signs helps people act early and recover better.

Symptoms are not something to push through. They are signals from the brain asking for care.

Looking Ahead in This Series

This article focuses on recognizing concussion symptoms and red flags.

The next articles in this series will explain:

• How concussions are diagnosed

• What testing really means

• How recovery and return to daily life work