What You Should Know About Concussions

By USPHS CAPT Tricia Booker
Traumatic Brain Injury Center of Excellence

Having your bell rung. Getting knocked out. Seeing stars.

You might use one of those terms to describe a hard hit to your head. But your doctor might call it something else: a possible traumatic brain injury.

TBI is the disruption (often temporary) of normal brain function caused by a jolt or blow to the head, and the military population is especially susceptible. Nearly 459,000 service members worldwide were diagnosed with a first-time TBI from 2000 through the first quarter of 2022, according to the Department of Defense. Concussion—also known as mild TBI—accounts for over 80% of these, making it by far the most common type of active-duty TBI.

But a diagnosis requires a medical exam. With a population that has volunteered to put their lives on the line to protect and defend, it may be tempting to prioritize the mission over medicine, downplaying or ignoring any symptoms. Retired U.S. Marine Corps Capt. William Greeson, who was treated for brain injury at the end of a long military career, says this attitude is especially true for what he calls “military alphas.”

“[Their attitude is] ‘I’m going to go out front, I’m going to lead, I’m going to get it done, and we'll talk about this later,’ ” he said. “And then later never comes.”

At the Military Health System’s Traumatic Brain Injury Center of Excellence, we believe later should come sooner. With that in mind, let’s clear up some myths about the most common type of TBI. Can you separate fact from fiction in the following statements?

Concussions only happen on the battlefield.
False. About 8% of active-duty concussions are from battle injuries, and only 20% happen during deployment. The rest are sustained while doing things like playing contact sports, participating in military training, or crashing a vehicle.

You don’t have to get “knocked out” to have a concussion.
True. Concussions temporarily change how the brain works. This can be a brief loss of consciousness. More often, consciousness is altered, such as, being dazed or seeing stars, or unaffected.

You can have a concussion even without a blow to the head.
True. A concussion may be caused by a sudden increase or decrease in speed, even if the head doesn’t strike anything. For example, the external forces present in cases of whiplash or blast injury may be strong enough to shake the brain, causing it to hit the skull and leading to potential damage.

If you don’t have a headache, you’re fine.
False. A headache is the most common symptom of concussion, but it’s just one of many. Concussion symptoms can be physical, cognitive, or emotional, causing a wide variety of issues such as irritability, fatigue, balance difficulties, sleep disturbance, dizziness, ringing in the ears, blurred vision, and concentration or memory difficulties. Some symptoms are warrant a trip to your local emergency department. These include:

• Worsening headache
• Slurred speech or difficulty speaking
• Unsteadiness on feet
• Seizures
• Double or blurred vision
• Weakness or numbness anywhere in your body
• Decreasing levels of alertness
• Disorientation (not knowing where you are, difficulty recognizing people or places)
• Any unusual behavior (such as increased aggression, anger, irritability, or crying)
• Repeated vomiting
• Feeling that something “just isn’t right”

Symptoms of a concussion appear immediately after the injury.
False. Concussion symptoms can start immediately after the injury—or gradually over the next 48 hours. The good news is that they often resolve within days or weeks.

Most people fully recover from a concussion, particularly if it’s their first. Service members can usually return to full duty in 2–4 weeks.
However, the time it takes to heal depends on the individual, the nature of the injury, any history of concussions or migraines, and associated conditions such post-traumatic stress disorder, depression, anxiety, and substance-use disorder.

You should seek medical care and follow your doctor’s progressive return to activity guidance because a concussion can impact memory, concentration, coordination, reaction time, and other areas—that may affect job performance or unit readiness and safety. This is also why you must be medically cleared before picking up that basketball or your car keys; otherwise, symptoms like dizziness, balance problems, and fatigue can put you at risk of re-injury.

Visit https://rly.pt/TBICoE for more information about all types of TBI, as well as provider resources and support for service members, veterans, families, and caregivers.