Character Medical Advice: Concussions, Long-Term Effects

Reading time ~4 minutes

Your character got a bad knock on the head; happens to the best of us. Although tempting to write the following scenario, DON’T!

Your character is punched. They’re unconscious for several minutes before waking up with a headache, maybe a bit out of it/acting silly. A week later (or worse, later that day), they are back to their plucky selves, fighting crime, getting into mischief, what have you.*

Unfortunately, if you’re going for a realistic story, that ain’t happening.

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A few head injury key points:

  • Concussions are a form of traumatic brain injury, or ABI (acquired brain injury)
  • A secondary concussion while your character is currently concussed causes serious long-term effects, often permanent brain damage. If your character has a concussion, but just jumps right back into the fight and gets another bad knock on the head, be ready to write some long-term struggles!
  • Grade one concussions- no loss of consciousness, symptoms last 15 minutes
  • Grade 2 concussion- no loss of consciousness, symptoms last more than 15 minutes.
  • Grade 3 and 4 concussion- loss of consciousness, symptoms last much longer.
  • If your character is knocked out, it should only be for a few seconds to a couple of minutes. Longer than that, it’s a coma. It happens, but it’s rare. So your character really shouldn’t be unconscious for hours. Since this article is looking at long-term effects, we’ll focus on grade 4 concussions, If your character loses consciousness, long-term effects are expected.

alt text What your character will experience:


  • Confusion and Disorientation: they might not know where they are, what happened, or that they were even unconscious.
  • Pain: They may have a really bad headache, or they might not feel any pain.
  • Nausea: More serious head injuries can cause nausea. If its swelling or a bleed in the brain, your character will have projectile vomiting. IF your character has this symptom, they’ll need medical attention, or they could die. So, if you’re going for a serious head injury with a brain bleed, you better have a surgeon on hand. Please do NOT give them a brain bleed that magically resolves, unless they are superhuman, then go for it!
  • Balance issues
  • Speech and vision issues
  • Fatigue

alt text Long-term:

The long-term effects will depend greatly on the site of damage in the brain. Generally, they may experience:

  • Short-term memory loss is a common symptom. your character could have difficulty reading books, even if they’re a bookworm.
  • Exhaustion: it’s hard work, re-learning to do things and struggling with activities that used to be easy. Your character is going to be tired! Naps have officially been added to the agenda.
  • Light sensitivity: pupil dilation can be effected for quite a while, so light sensitivity can linger.
  • Frustration: It’s incredibly hard to struggle with things that used to be second nature. It’s a given that even the most level-headed character would be irritated by their difficulties.
  • Taste and smell aversions: Your character might suddenly hate the taste of eggs, or get sick from the smell of pistachios.
  • Speech and language issues: They might have trouble finding the word they’re looking for, or revert to their native language for easier communication.
  • Recovery isn’t linear. You can have regressions and huge leaps. This is normal. Symptoms can linger for a couple of years after a concussion, but they won’t be nearly as severe as initial effects (unless you’re dealing with multiple concussions). The short-term memory can be affected, ability to multi-task, etc.

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How long will it take to recover (grade 4 concussions):

Your character is looking at a few weeks of rest minimum before they should be doing any activities (although, your feisty character may ignore their doctor’s orders). They’ll be ordered to avoid physical activity even longer. Intense physical activity shouldn’t resume until other symptoms have resolved. This is especially important for ventures that could result in another concussion (sports, combat, etc.) Symptoms will persist for at least a couple of months but can last for years. Again, if there have been multiple concussions, damage may be permanent.

Today’s question comes from the lovely Alexandra, on Twitter. Thanks for the awesome topic idea!

I try to make these post general enough to give writers an overview, but if you want more specific information, hit me up in the comments, or Facebook/Twitter


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