Mild traumatic brain injury

When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Last reviewed: 4 Jun 2025
Last updated: 03 Jul 2025

Summary

Definition

History and exam

Key diagnostic factors

  • direct blow to the head or deceleration of the head from an impulsive force
  • previous brain trauma, substance use, or alcohol misuse
Full details

Other diagnostic factors

  • headache
  • feeling foggy/slow
  • dizziness/balance problems
  • memory difficulties
  • vomiting/nausea
  • neck pain
  • normal physical neurologic exam
  • abnormalities on neuropsychological testing
Full details

Risk factors

  • head injury
  • previous brain trauma
  • alcohol and drug misuse
  • poor neck strength
Full details

Diagnostic tests

1st tests to order

  • clinical diagnosis
Full details

Tests to consider

  • CT head
  • MRI head
Full details

Emerging tests

  • PET, single-photon emission CT (SPECT) of head
  • multimodal MRI technologies
Full details

Treatment algorithm

ACUTE

confirmed mild traumatic brain injury

Contributors

Expert advisers

Luke C. Henry, PhD

Assistant Professor

Department of Neurological Surgery

Senior Clinical Neuropsychologist

University of Pittsburgh

Pittsburgh

PA

Disclosures

LCH declares that he has no competing interests.

Maria Twichell, MD

Assistant Clinical Professor

Director

General Rehabilitation Unit

UPMC Physical Medicine and Rehabilitation

University of Pittsburgh Medical Center

Pittsburgh

PA

Disclosures

MT declares that she has no competing interests.

Acknowledgements

Dr Luke C. Henry and Dr Maria Twichell would like to gratefully acknowledge Dr Jeffrey Bazarian and Dr Maryse Lassonde, previous contributors to this topic.

Disclosures

JB has been reimbursed by Roche, the manufacturer of an automated assay for serum S-100B, to attend a conference, and has been reimbursed by Banyan Biomarkers and Neuren Pharmaceuticals to help develop their research protocols. JB is also an author of a reference cited in this topic. ML is an author of several references cited in this topic.

Peer reviewers

Eirik Helseth, MD, PhD

Professor and Consultant

Department of Neurosurgery

Ulleval University Hospital

Oslo

Norway

Disclosures

EH declares that he has no competing interests.

Margot Putukian, MD

Director of Athletic Medicine

Princeton University

Princeton

NJ

Disclosures

MP is an author of a reference cited in this topic.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Maas AIR, Menon DK, Manley GT, et al. Traumatic brain injury: progress and challenges in prevention, clinical care, and research. Lancet Neurol. 2022 Nov;21(11):1004-60.Full text  Abstract

Harmon KG, Clugston JR, Dec K, et al. American Medical Society for Sports Medicine position statement on concussion in sport. Br J Sports Med. 2019 Feb;53(4):213-25.Full text  Abstract

Patricios JS, Schneider KJ, Dvorak J, et al. Consensus statement on concussion in sport: the 6th International Conference on concussion in sport-Amsterdam, October 2022. Br J Sports Med. 2023 Jun;57(11):695-711.Full text  Abstract

American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Mild Traumatic Brain Injury; Valente JH, Anderson JD, Paolo WF, et al. Clinical policy: critical issues in the management of adult patients presenting to the emergency department with mild traumatic brain injury - approved by ACEP Board of Directors, February 1, 2023, clinical policy endorsed by the Emergency Nurses Association (April 5, 2023). Ann Emerg Med. 2023 May;81(5):e63-105.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Mild traumatic brain injury images
  • Differentials

    • Moderate/severe traumatic brain injury (TBI)
    • Depression
    • General trauma or injury to the body not involving the head
    More Differentials
  • Guidelines

    • Living guideline for pediatric concussion
    • Living concussion guidelines: guideline for concussion and prolonged symptoms for adults 18 years of age or older
    More Guidelines
  • Calculators

    Glasgow Coma Scale

    Canadian Head CT Rule for Minor Head Injury

    More Calculators
  • Patient information

    Concussion (mild traumatic brain injury)

    More Patient information
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer