Head Injuries on the Trail — Concussion Protocol
Slips on wet rocks, falls on steep descents, motorbike accidents, and even head bumps on low teahouse doorframes cause concussions we treat regularly. The problem on the trail is that concussion symptoms — headache, nausea, dizziness — overlap with altitude sickness. A missed concussion + continued altitude = dangerous combination.
Concussion Signs — Check After Any Head Impact
- Headache — worsening, not improving over time
- Nausea/vomiting — especially if it appears 30min–2h after the hit
- Dizziness/balance problems — worse than altitude dizziness, doesn't improve with rest
- Memory gap — can't remember the fall or what happened immediately before/after
- Sensitivity to light or sound — normal teahouse noise becomes painful
- Confusion or "foggy" thinking — slower processing, can't follow conversations
- Pupil changes — unequal pupils or sluggish response to light = EMERGENCY
- Drowsiness beyond normal fatigue — hard to wake, extremely sleepy
Concussion vs. Altitude Sickness — The Overlap
- Concussion: follows a specific head impact, symptoms appear within minutes–hours, doesn't improve with descent
- Altitude sickness: develops gradually over hours–days, improves with descent and rest, no specific injury event
- Both: a fall could cause both — hit your head AND trigger AMS; treat the head injury first, it's more dangerous
The 24-Hour Rule
- Stop immediately — no trekking, no strenuous activity for 24h after ANY head impact with symptoms
- Monitor overnight — someone should check on you every 2–3h; worsening = evacuate now
- Don't take aspirin or ibuprofen — they increase bleeding risk; Paracetamol only for pain
- Don't sleep for the first few hours — someone needs to confirm you can be roused normally
- If symptoms worsen at any point: headache gets worse, vomiting, confusion, drowsiness — descend to medical care immediately
Return-to-Trek Protocol After a Head Injury
- 48h minimum symptom-free — before any exertion; symptoms under exertion mean restart the clock
- Easy half-day first — flat or gentle walking, no heavy pack, no altitude gain
- Graduated return — each day adds load only if the previous day stayed symptom-free
- No solo trekking for 72h — someone must be able to check on you
- Second-hit rule — any new head impact during recovery ends the trek; second-impact syndrome is rare and catastrophic
What We Check at the Clinic
- Neurological exam — pupils, coordination, memory recall, gait — objective scoring of whether a concussion exists
- Symptom tracking — the pattern over hours matters more than any single reading; we log the trajectory
- Cervical spine check — falls that hit the head often injure the neck too
- Imaging referral when indicated — CT/MRI coordination at partner hospitals if the picture is intracranial bleeding
- Clearance decision — a written statement on whether and when return to trekking is safe
Common Questions
The Head Injury Assessment
Concussion — traumatic brain injury — on trek comes from falls (the commonest cause), rockfall, or collision. The assessment: loss of consciousness (even brief), confusion, memory gap for the event, headache, nausea, vomiting, or the feeling of being dazed. Any of these after head impact = concussion until proven otherwise; the assessment happens now, not when it is convenient.
The Trekking Decision
Suspected concussion on trek means stop — do not continue ascending; the symptoms can evolve and the remote location complicates evacuation. Descend if possible, monitor for worsening (worsening headache, repeated vomiting, increasing confusion, weakness — signs of bleeding needing emergency care). The concussion managed at altitude with continued ascent is the dangerous error.
The Head Injury on Trail
Concussion — the mild traumatic brain injury — from the fall on the trail, the rock impact, or the collision. The symptoms: headache, confusion, memory disturbance (the gap in memory for the event), dizziness, nausea, the cognitive fog. The head injury that produces the loss of consciousness or the worsening symptoms needs the evaluation.
The Post-Concussion Protocol
If concussion suspected — stop trekking, monitor (the 24-hour observation for the worsening symptoms that indicate more serious injury), avoid the exertion (physical and cognitive — the screens and the concentration worsen the symptoms), and the descent if symptoms worsen. The concussion that is ignored and continues trekking risks the second-impact syndrome (the second concussion before the first resolves — rare but catastrophic).
The Red Flag Symptoms
Post-head-injury red flags: the worsening headache, the repeated vomiting, the seizure, the confusion that persists or worsens, the slurred speech, the weakness or numbness, the unequal pupils, and the loss of consciousness. The red flags indicate the intracranial injury that requires the urgent evaluation.
The Return-to-Activity
The concussion protocol: the rest (physical and cognitive), the graduated return (the staged activity increase as tolerated), and the symptom monitoring that identifies the post-concussion syndrome. For the trekker who sustained the head injury, the return to the trek requires the symptom resolution and the medical assessment.
The Recovery Protocol
Concussion recovery: the cognitive rest (the screen avoidance, the mental activity limitation), the physical rest (the gradual return to the activity), and the symptom monitoring (the headache, the dizziness that is tracked). For the trek with the concussion, the rest that precedes the resumption.
The Second Impact
Second impact syndrome — the second concussion before the first resolves is dangerous. For the trek with the concussion history, the activity that is resumed cautiously to prevent the second injury.
The Recovery
Concussion recovery — the brain rest that is recommended (the limited screen, the limited reading, the limited exertion), the symptom monitoring, and the gradual return to the activity. For the concussion, the return that is gradual.
The Second Impact
Second impact syndrome — the rare but catastrophic swelling if the second concussion occurs before the first heals. For the concussion that is not fully recovered, the activity that is avoided.
The Second Impact
Concussion second impact — the return to the activity before the full recovery that risks the catastrophic injury. For the concussion, the premature return that is dangerous.
The Recovery
Concussion recovery — the physical and the cognitive rest that is needed, the gradual return that is staged, and the symptoms that are monitored.
The Second Impact
Concussion second impact — the catastrophic (the brain that is still vulnerable). For the post-concussion, the activity that is restricted.
The Recovery
Concussion recovery — the rest (the physical + the cognitive that is reduced), the gradual return that is supervised.
The Evaluation Cost
Concussion evaluation cost — the consultation (~$10-25) + the CT if indicated (~$50-150). For the head injury, the assessment that is affordable.
The Observation
Concussion observation — the monitoring (the clinic or the hospital that is used). For the deteriorating symptom, the evaluation that is immediate.
The Observation Cost
Concussion observation — the ~$30-80 (the monitored that watches the deterioration). For the head injury, the overnight that is the safe.
The Severe Escalation
Concussion escalation — the CT/imaging + the possible evacuation (the worsening that costs more). For the red-flag sign, the imaging that is done.
The Observation Cost
Concussion observation — the ~$40-150 (the monitored that is the safe). For the head-hit, the watched that is the protocol.
The Imaging
Concussion CT — the ~$100-250 (the indicated that is the escalation). For the red-flag, the scanned that is the rule.
I hit my head but feel fine — do I still need to stop?
Yes if you have any symptom — headache, nausea, dizziness, memory gap, foggy thinking, light sensitivity. "Feeling fine" after a real head impact is not the same as no concussion; symptoms can be delayed by hours. The rule is 24 hours of no exertion after any head impact with symptoms.
How is concussion different from altitude sickness?
Concussion follows a specific impact event and does not improve with descent; AMS develops gradually and improves with rest and descent. The trap on the trail is assuming headache and nausea are altitude — if you hit your head in the last 24 hours, treat it as concussion first. A head injury is the more dangerous of the two.
Can I take painkillers for the headache?
Paracetamol only. Do not take aspirin or ibuprofen for the first 24–48 hours — both thin the blood and worsen any internal bleeding risk. If the headache needs stronger than paracetamol, that is itself a signal to get assessed.
When does a head injury become an evacuation emergency?
Worsening headache, repeated vomiting, increasing confusion, drowsiness that is hard to reverse, unequal pupils, weakness on one side, seizure, or clear fluid from nose or ear. Any of these means the brain is swelling — this is helicopter evacuation, not clinic.
When is it safe to trek again after a concussion?
A minimum of 24–48 hours completely symptom-free, then a graduated return: half-day easy walk before any summit or high-pass day. A second concussion before the first resolves is exponentially more dangerous — do not rush the return.
