If you think you have a concussion, your first step depends on how severe your symptoms are. Most concussions can be evaluated by a primary care doctor or an urgent care clinic within a day or two of the injury. But certain warning signs mean you should skip the office visit and go straight to an emergency room.
When to Go to the Emergency Room
Some symptoms after a head injury signal a potentially serious brain bleed or swelling that needs immediate attention. Call 911 or get to an ER if you or someone with you notices any of the following:
- Seizures or convulsions
- One pupil larger than the other, or double vision
- Repeated vomiting (more than twice)
- A headache that keeps getting worse and won’t go away
- Slurred speech, weakness, numbness, or loss of coordination
- Loss of consciousness, increasing drowsiness, or inability to stay awake
- Inability to recognize people or places
- Unusual behavior, growing confusion, restlessness, or agitation
These are danger signs identified by the CDC, and they apply to adults and children alike. You don’t need to have all of them. Even one is enough to warrant an emergency visit. The ER team can perform a CT scan to check for bleeding, skull fractures, or brain swelling. Doctors use specific clinical criteria to decide whether imaging is needed, including factors like vomiting more than twice, being over 65, memory loss lasting more than 30 minutes before the impact, or not returning to full alertness within two hours.
What the ER Can and Cannot See
A CT scan is fast and effective at catching the dangerous stuff: skull fractures, blood collecting between the brain and skull, and bruising on the brain’s surface. But here’s something many people don’t realize. A CT scan will almost always look completely normal after a concussion. That’s because concussions involve disrupted brain function, not the kind of structural damage that shows up on standard imaging. A normal scan doesn’t mean you’re fine. It means you don’t have a life-threatening bleed.
MRI is more sensitive and can detect subtle injury to the brain’s white matter connections, which is the most common type of damage in a concussion. But MRI is rarely ordered in the acute setting because both the American Academy of Neurology and the American Medical Society for Sports Medicine recommend against routine imaging for concussions due to low diagnostic yield. A concussion is primarily diagnosed through clinical evaluation, not a scan.
When Urgent Care or Your Doctor Is Enough
If you hit your head and have symptoms like a headache, feeling foggy, dizziness, or sensitivity to light, but none of the emergency red flags listed above, you likely don’t need the ER. Your primary care doctor, a pediatrician (for kids), or an urgent care center can evaluate you. The cost difference is significant: an ER or urgent care evaluation for a concussion averages around $688, but the ER visit itself is the single biggest driver of total concussion care costs, adding roughly $500 to your overall bill compared to starting with a doctor’s office.
A doctor diagnosing a concussion will check your symptoms, test your memory and concentration, assess your balance and coordination, and look at how your eyes track movement. These are the same core elements used in the standardized assessment tools that sideline doctors use for athletes. There’s no blood test or single scan that confirms a concussion. The diagnosis comes from putting together your symptoms, the mechanism of injury, and how you perform on these clinical tests.
For Children: Start With the Pediatrician
If your child hits their head and doesn’t show emergency warning signs, take them to their regular pediatrician within 24 hours. Pediatricians have enough specialized experience to diagnose and manage most concussions. They’ll set a treatment plan and give you a timeline for when symptoms should start improving.
If your child’s symptoms aren’t improving within that expected window, schedule a follow-up. Persistent symptoms that don’t respond to standard care are the signal to ask for a referral to a pediatric neurologist, who has specialized training in children’s nervous system issues and can order more advanced testing if needed.
When to See a Concussion Specialist
Most concussions resolve within a few weeks with proper rest and a gradual return to activity. But roughly 10 to 30 percent of people develop persistent symptoms, sometimes called post-concussion syndrome, that linger for months. When that happens, care costs jump dramatically, averaging around $2,580 compared to about $608 for a straightforward recovery.
Specialized concussion clinics bring together a team that can address the full range of lingering problems. These clinics typically include neurologists, physical therapists, vestibular therapists (for dizziness and balance issues), athletic trainers, and access to neuropsychological testing. That testing uses computerized assessments of memory, learning, multitasking, and concentration to create a detailed picture of how your brain is functioning and what needs targeted rehabilitation.
You should consider a concussion clinic if your symptoms haven’t improved after two to three weeks, if you’re having trouble returning to work or school, or if you’ve had multiple concussions in the past. Your primary care doctor can refer you, or many concussion clinics accept self-referrals.
What to Expect After Your Visit
Regardless of where you’re evaluated, the initial treatment is the same: a brief period of relative rest followed by a gradual return to normal activities. The old advice of lying in a dark room for days has been replaced by a more active approach. After a short rest period, you’re encouraged to slowly reintroduce light activity as tolerated.
For athletes, the return to sports follows a structured six-step progression developed from international concussion guidelines. Each step takes a minimum of 24 hours, and you only move forward if symptoms don’t return. It starts with getting back to regular daily activities like school or work, then progresses through light aerobic exercise (5 to 10 minutes of walking or stationary biking), moderate activity with more head and body movement, heavy non-contact drills like sprinting and full weightlifting, controlled practice with full contact, and finally competition. A healthcare provider needs to clear you before you begin this progression and should be supervising throughout.
For non-athletes, the same principle applies in a less structured way. You gradually increase your mental and physical workload, backing off if symptoms flare. Screen time, reading, driving, and exercise all get reintroduced in stages. Most people return to full activity within two to four weeks.