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Fall starts the season for football, soccer, and rugby, followed by ice hockey and skiing—a time when head injuries may occur. “Mild” head injuries, also known as concussions, are common with these and other sports, as well as other situations in which falls occur (see below: “About Concussion”). When an athlete gets a concussion, a key question asked by parents, coaches, and medical personnel is, “When can he/she safely return to play?” Frequently, athletes return to play immediately after the injury without realizing that this may be a serious mistake. Neurologists have known for some time that a second concussion within days or weeks of a first can have catastrophic consequences. It is as if a second paper cut in a week could cause someone to bleed to death. Mindful of the dangers of this “second impact syndrome,” the American Academy of Neurology issued “Return to Play” guidelines.1New research, reported in this issue of Neurology , suggests that athletes with repeated concussions are more likely to have ongoing problems from their injury than those with a first-time concussion. Bruce et al.2 studied college athletes, playing a variety of sports, to understand the impact that one or more concussions may have in terms of long-term symptoms. A questionnaire was given to 433 male athletes at the beginning of the study to determine whether they had ever had a concussion and whether they had any current symptoms of concussion. During the study period, 57 athletes sustained concussions. Of these 57 athletes, 30 had a history of a previous concussion and the other 27 had not had …

“It’s just a ding, Coach; I can play”—But should he?