How long after hitting your head can concussion symptoms start?
How long after hitting your head can concussion symptoms start?
The short answer: Symptoms may begin at the moment of the injury up until 48hrs after the injury.
Because of the pathophysiology of a concussion, it is doubtful that symptoms presenting after 48hrs are related to the mechanical and metabolic injury that is "a concussion." Symptoms that present days to weeks later are much more likely related to a cervical ("whiplash") injury than a concussion.
Why do symptoms typically present within 48hrs?
Because a concussion is a neurometabolic injury - it's both mechanical and metabolic. For a concussion to occur:
Your nerve cells stretch and shear, causing electrolytes and neurotransmitters to go everywhere.
These electrolytes and neurotransmitters cause your nerve cells to fire indiscriminately - called "excitotoxicity."
This process results in brain blood flow dysregulation and a brain energy deficit that lasts 21-30 days.
By days 2-3, mechanical and metabolic damage is done, and recovery is underway. A "textbook" concussion timeline goes as follows:
Day 0: Injury
Days 3-5: Symptoms are at their worst.
Days 5-10: Symptoms resolve.
Days 21-30: Metabolism returns to baseline/normal.
But, what about me and my delayed symptoms?
Suppose you're an individual who endured an impact or injury that involved the head/neck, and your symptoms presented days to weeks later. In that case, it is far more likely you sustained a cervical ("whiplash") injury. In that scenario, a concussion is not impossible. However, it is far more likely that you're dealing with an orthopedic injury or something "not a concussion."
How would we know if you had a concussion (or not)?
Diagnosis of a concussion comes down to a quality physical exam. There are three big categories that your provider needs to assess:
Autonomic (exercise) tolerance
Visual/Vestibular function
Cervical spine function
At this time, we know that ~90% of folks with a concussion will have an oculomotor ("eye movement") deficit. Most will present with exercise intolerance that shows up during or after physical activity. In addition, to these two systems, your provider should assess your cervical spine function to differentiate concussion vs. whiplash.
In my practice, I offer in-person care here in Arizona and virtual programs for folks outside the state and abroad. Over the course of three visits, we dive deeply into each of the systems mentioned above and assess metabolic/hormonal and psychological function. By completing this comprehensive assessment in a matter of 2-3 weeks, patients are provided with a comprehensive rehab plan that can shave months off their recovery times.
For your very own consultation to begin working together, request an appointment below.