Diuretics make you urinate and can lead to dehydration. Don't miss your FREE gift. If you see someone pass out, make sure the person is breathing. A simple episode, also called a vasovagal attack or neurally-mediated syncope, is the most common type of fainting spell. Less commonly, orthostatic hypotension can be caused by a neurologic condition such as Parkinsons disease or multisystem atrophy, formerly known as Shy-Drager syndrome. Stimulants dry you out and raise your temperature. Verywell Health's content is for informational and educational purposes only. Another serious cause of a sudden loss of consciousness is a seizure, which is an abnormality of the brain, not related to blood pressure. Note carefully any symptoms you remember before or after you pass out. Da silva RM. how do i avoid fainting in gross anatomy? The worst experience and most embarassing faints for me was at this antique flea market that is in this really old huge building that can be really hot but has the coolest stuff. I am so sorry you have had to go through all of that!! If they were lying down, wait several minutes before asking them to sit up. Many patients come to me after trying many drugs and therapies from reputable clinics to help them with their problems fainting. American College of Emergency Physicians. Mayo Clinic does not endorse companies or products. Someone is considered to have syncope if they become unconscious and go limp, then soon recover. I've had an EEG and they've told me that it is not seizures. TalkTV's Kate McCann has returned to the network feeling a 'little embarrassed' after fainting live on air during the Tory leadership debate. Hi Elizabeth! it can be very scary as everyone here knows. When food enters the system, the vagus nerve directs blood to the stomach and intestines, pulling it from other body tissues, including the brain. If you feel like you are about to faint, you should sit down to prevent hitting your head when you fall. Find ways to distract yourself. When this nerve is overstimulated, a person may faint. It may also be called neurocardiogenic syncope. The vasovagal syncope trigger causes your heart rate and blood pressure to drop suddenly. Ask them to sit for several minutes before standing. It is most common in children and young adults. Also, try not to focus on the blood or whatever makes you feel faint. It is by far the most common form of reflex syncope. Before fainting, you may experience presyncope. 2007;93(1):130-6. doi:10.1136/hrt.2005.080713, Aydin MA, Salukhe TV, Wilke I, Willems S. Management and therapy of vasovagal syncope: A review. I actually was tempted to sit down during the ceremony when I felt dizzy but sensed that I would draw attention that way as everyone was standing up. I find that I can sometimes prevent them by lying down (Parma Airport in Italy being my most embarassing episode!). My life living with Multiple Chronic Illnesses. It's just become a part of me. This affects around 10 to 15% of patients that go to A&E. POTS generally appears in young women. I don't want it to be seizures. Some things make it work harder, such as bearing down to have abowel movementor vomiting. They were all super freaked out and didn't really know what to do. I do come very close to fainting in crowded rooms ,lots of heat and during strenuous excercise. Suggest that they sit forward and lower their head below their shoulders and knees. I wish I had been there like that for you.Drink lots of water - stay very hydrated. These kinds of fainting episodes commonly affect young people but can occur in older adults. It was already around 3 or 4 AM and I was too exhausted that I had fallen asleep at one of the couches in the club. One of the signs of CONCUSSION is unusual emotional reactions. He leads the established Imperial Syncope Diagnostic Service at Hammersmith Hospital and is frequently invited to national and international meetings to share his experience. A simple episode, also called a vasovagal attack or neurally-mediated syncope, is the most common type of fainting spell. Stimulation of the vagus nerve, which can cause the heart to slow and blood pressure to drop drastically, is one cause of fainting spells. Your insulin hypersensitivity idea is interesting. I'm a first year medical student and I am very happy in school. BONUS! Youll get guidance for monitoring symptoms, for sticking to your doctor's strategy, and for making heart-smart lifestyle changes. That made my primary care physician very doubtful it was NCS. I have NCS neurocardiogenic syncope, rather than vasovagel syncope, and you may as well. Like maybe my blood sugar spiked or my insulin went nuts. Although for my second fainting episode, at least I know what to expect now. I'd love to talk to you more. Orthostatic hypotension is defined as a fall in systolic blood pressure of 20 mmg Hg or more on standing, resulting in syncope or pre-syncope. Syncope. By clicking Accept All Cookies, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our marketing efforts. Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education. The Best Diets for Cognitive Fitness, is yours absolutely FREE when you sign up to receive Health Alerts from Harvard Medical School. The polyvagal theory suggests that the vagus nerve (part of your nervous system) can become very protective in certain situations, causing you to lose consciousness as a way to protect you from an observed threat. Fainting might have no medical significance. As blood flow to the brain slows, the brain stops sending signals to the muscle cells. This time they tried an electrophysiology test as well as a tilt-table test. Elevate the person's feet. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. Fainting occurs when your brain temporarily doesn't receive enough blood supply, causing you to lose consciousness. Dr Boon Lim is one of London's leading cardiologists and electrophysiologists. What to do after fainting. I didn't even know ms1 were in the hospital until third year. It connects thedigestive systemto the brain, and its job is to manage blood flow to the stomach. This content does not have an English version. When I come to my best friend was holding a bottle of orange juice to my mouth. It's frustrating because I'm unconscious for over an hour, to as long as 3 hours. In movies, the classic melodramatic faint comes with a gasp, a hand to the forehead, and a dramatic fall. I have had episodes of passing out on the toilet, getting a massage, and my most embarrassing moment, at work. We've all been there, but some people get lightheaded more easily than others. First Aid/CPR/AED participant's manual. When you know what causes your fainting spells, you can take steps to avoid them. Some seizures produce dramatic shaking movements and loss of consciousness for longer than most fainting spells. Triggers include: Pressure on the chest after exertion or exercise, Urinating (post-micturition syncope: occurs in men while standing to urinate), Blowing a brass instrument or lifting weights. If the person doesn't regain consciousness within one minute, call 911 or your local emergency number. I was put on a medication SO many years ago that was salt based, before my NCS diagnosis, and I lost so much weight I went down to 80 pounds - so not a good idea for me.Interesting you bring up nitrate/glycerin - I was doing some research and there have been some studies that say that people with NCS may have "insulin hypersensitivity" during an episode. Masks are required inside all of our care facilities. Someone is considered to have syncope if they become unconscious and go limp, then soon recover. Certain medications such as diuretics (water pills), calcium channel blockers and angiotensin-converting enzyme (ACE) inhibitors (often used for. It's harmless and rarely requires medical treatment. Some types of fainting seem to run in families. Every fainting passenger did so publicly, in front of dozens of people. This condition is so random I think I tend to look desperately for any correlation to anything so that I can hope by avoiding that thing I can avoid the episodes. To make an appointment to see Dr Lim, go his Top Doctors profile. I have also suffered from migraines since the age of 13 and I also suffer from vitiligo. Fainting is essentially caused by two things: low blood pressure and a low heart rate. It turns out they could have skipped the tests and just showed me the medical bill I'd get, that would have made me pass out too. To reduce the chance of fainting again, don't get the person up too quickly. Someone who faints should be moved so they are lying down to allow blood to flow to the brain. Orthostatic (upright) hypotension (low blood pressure when standing) can also cause fainting because blood has trouble going against gravity to reach the brain. You certainly have had some interesting fainting episodes.It is great that you can keep a sense of humor about it all. Advertising on our site helps support our mission. Thank you. and tilting me up on the table. Within 2 or 3 minutes I told them "Yup, I'm going to pass out". Get the latest in health news delivered to your inbox! I also have Vasovagal Snyncope. He is an attending emergency medicine physician at White Plains Hospital in White Plains, New York and also works at an urgent care center and a telemedicine company that provides care to patients across the country. He specialises in heart rhythm disturbances, pacing and syncope at Imperial College and at his Harley Street clinic. The national anthem was sung, prayers were read, etc. Other times, it will require more testing. We had to wait, standing, under the sun for a good 45 minutes before going into the gym where the ceremony would be held. Ah yes, the salt treatment. Good to know someone does. Also, let the phlebotomist know if you're prone to fainting. Call your healthcare provider to let them know you had a fainting episode. Once a person loses consciousness, the person's heart begins to speed up to counteract the low blood pressure. Shock is a life-threatening emergency that usually comes from bleeding, but can also come from severe allergy (anaphylaxis) or severe infection. But the longer I deal with NCS, the longer I'm getting the idea that what I have to avoid is "Any situtation that puts you in even mild discomfort that you can not immediately remove yourself from." I was trying to find if either could be linked to Vasovagal when I came across your post. Control bleeding with direct pressure. This reduces the amount of blood that returns to the heart and which thereafter can be pumped to your brain. :-)Thanks for sharing some of your stories. I've had infrequent migraines since 2001, but also have problems with dehydration and kidney stones.A really sharp internist put all of these together, and did a thyroid test, which may be the root cause of all of these problems. It comes on suddenly, only lasts for a short time and you recover fully within a short time. It was past 11 pm and the place I was, was very cold. Before fainting, you might feel: Cold and clammy. My first question to myself would have been, "Did I drink THAT much?" I think I got up too quickly and started feeling dizzy. While a fainting spell usually doesn't last for long, the trick is learning to distinguish it from a life-threatening event, like a heart attack. I was mortified! I don't remember any of this katie they're mom showed me the video when i came to i was laying on a bed and katie was sitting next to me.Neeedless to say inever went back there again i was so embarassed, Thank you so much for sharing your experiences. information and will only use or disclose that information as set forth in our notice of Anyway, end result of all this has been the cardiologist telling me it would be a good thing for me to increase my "salty snack intake". They didn't seem to find much of interest with the EP test, so then it was on to the tilt-table. By Rod Brouhard, EMT-P Stay on top of latest health news from Harvard Medical School. There are some dangerous conditions that can cause fainting. Get useful, helpful and relevant health + wellness information. The American Journal of Emergency Medicine,33(8), 998-1001. Listen to Dr Lim speaking to the BMJ student group here. These include bradyarrhythmias (the heart beats too slowly) and tachyarrhythmias (the heart beats too fast). I worked through a similar issue earlier in the earlier parts of surgical rotations. You must call this clinic to make an appointment, Subscribe to our Newsletter to stay up to date on the latest news, TOP DOCTORS | 85 Tottenham Court Road, London, W1T 4TQ. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. But it can also have an emotional trigger such as seeing blood ("fainting at the sight of blood"). All of this information will help the doctor help you. The Merck Manual Professional Edition. When discussing syncope with your doctor, you should note episodes of pre-syncope as well. Yes, my heart races. Stimulation of the vagus nerve, which can cause the heart to slow and blood pressure to drop drastically, is one cause of fainting spells. If you are a Mayo Clinic patient, this could Find more COVID-19 testing locations on Maryland.gov. Parents don't always realize that their teen is suicidal. And I didn't have the tools I have now so I had some really embarrassing moments and didn't know how to handle people surrounding me.I know the feeling of guilt when you feel like you are "stealing" the spotlight. I have learned that all effect each other as I manage each one and my life. I don't remember drinking that night so it didn't make sense. How can you prevent fainting when getting your blood drawn? Vomiting and diarrhea, specifically, stimulate the vagus nerve. The condition is called vasovagal syncope (SIN-cope-ee). http://www.emergencycareforyou.org/EmergencyManual/WhatToDoInMedicalEmergency/Default.aspx?id=240. Like shock, losing consciousness due to alcohol is not technically considered fainting, but it may or may not be cause for concern. I have fainted twice in my whole life but I'm pretty scared that it'll happen to me againThe first time was last 2009. It can happen in otherwise healthy people. Today has not been a really great day. The Embarrassment Of The Aftermath 1 Return to school as soon as possible. "The problem is that you can't evaluate yourself, and you should let a physician determine if fainting is worrisome or not," says Dr. Shamai Grossman, an associate professor of emergency medicine at Harvard Medical School, who has conducted 20 studies on fainting. But understanding fainting is half the battle in preventing it. Find the best specialist in Cardiology in your location: Situational syncope: why do we faint under stress? I noticed that one prevention method they often failed to stick to is drinking enough water. I don't have any seizure like symptoms i always do the dead faint they always tell me i start turning pale and becoming weak my eyes roll back in my head and im out before i hit the floor and im completely out for 5 to 10 minutes everytime i have fainted at the video store i come to and mrs lewis is holding my feet and her daughter is fanning me and i have to lay there for 30 to 45 minutes before they will let me get up but not everybody is that understanding. To read more about him and the conditions he specialises in, you can also visit his website. How do you cope and not get panic attacks? That's the only time I've passed out cold. Sounds like you need to firm up that 'ole constitution of yours. He has a special interest in the mapping and ablation of atrial fibrillation (AF) and is highly-skilled at using modern 3-D m This reduces the perfusion of blood and oxygen to the brain and leads to a transient loss of consciousness. Lightheaded. During that brief drop, the brain does not get the blood flow that it needsand you lose consciousness. But my doc said that I probably had vasovagal syncope ,and in that your heart slows down. He is very actively engaged in all aspects of research with a particular interest in developing the best techniques for treating atrial fibrillation. A person may feel faint and lightheaded (presyncope) or lose consciousness (syncope). Shift work can harm sleep and health: What helps? Medications, especially blood pressure drugs, often cause orthostatic hypotension. Yes, it is a serious subject. You may suffer from a simple fainting spell due to anxiety, fear, pain, intense emotional stress, hunger, or use of alcohol or drugs. Opiates slow breathing while lowering blood pressure. The embarrassed individual becomes conscious of a real (or imagined) failure to comply with social norms and fears that others won't view them as highly as a result. If the feeling doesn't pass in a few minutes, or you begin to experience chest pain or shortness of breath, call 911. I would suggest getting checked out if you have not already gone to the doctor after fainting. I think after a while we figured that one out! In Heart Failure: Understanding the condition and optimizing treatment, youll learn the mechanics of the heart, the symptoms and warning signs of heart failure, and the keys to an effective treatment plan. I feel awful the rest of the day and end up getting panic attacks from this. Accessed Oct. 1, 2014. Tips to Help You Think Clearly, How to handle fainting at the sight of blood. I have had some success with compression stockings helping me avoid episodes. It's like what comes first, the chicken or the egg. Most people who faint do not need to go to the emergency room, but for a small minority of people who do faint, the brief loss of consciousness can be a sign that more serious and potentially fatal medical events are on the horizon. There are many potential causes, but the most common ones include: If fainting occurs frequently and is not because of dehydration or sudden postural change, you may need to be tested for a serious heart or vascular condition. To decide if the heart may be the culprit, take a pulse. The EP test is the one where they send electrical signals through your heart actually trying to induce an arrythmia. I've sometimes wondered if it was related to my migraines, but don't always happen at the same time or correlate. Weddings, events, being surrounded by people, but I'm not a doctor so I can't diagnose you.I have gone out in a dead faint even when I try every way avoid it. However, if you feel a slow onset of pre-syncope symptoms, the isometric counterpressure manoeuvre can be good enough to help you carry on with what you are doing without fainting or it can at least bide you enough time to ask for help and remove yourself from the situation. I wish ). Fainting is when you lose consciousness for a short time. Some people are hypersensitive to the vagus nerve, and stimulation can result in a loss of consciousness. All rights reserved. It's so embarrassing and then 10 minutes later i was totally fine but everyone kept shooting me dark looks and i tried to lighten the mood and laugh it off saying it happens all the time (although it had been nearly a year since my last faint) but they just made me feel worse when i know they're not meaning to but it's horrible when there isnt a single person to say she's fine! National Institute of Neurological Disorders and Stroke. Thats what causes the person to fall to the ground. Sometimes just say I just need to sit/lie down on the floor - I have a condition and it will pass soon, please bring me some water and if I pass out, something for under my head.Sounds good, but doesn't always work.Best wishes to you my dear - you hang in there and don't let anyone make you feel embarrassed. NCS is on the other side. But if you feel it coming on, there are a few things that may help. Who knows. Most fainting spells are nothing to worry about. In this podcast, Dr Lim addresses medical students specifically talking about their best strategies to combat situational syncope, including syncope during blood taking, prolonged standing and how to handle the emotional stress of syncope. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. It's a strange diagnosis in that on one hand I'm glad its not something more ominous, but on the other there's pretty much no treatment for it. Thank you for your responses everyone, they were very reassuring. Once i fainted after standing up for too long in a meeting where we had to promote some thing and i was the assistant! It may result in a tremble or shake. It's medical and not your fault. The help they provide might be all in my head, but it helps me to know I've tried something. We were around 1,000 during that ceremony. I have been told by my doctor that the vitiligo and thyroid point to an auto immune disease, so it could all possibly be linked! health information, we will treat all of that information as protected health Mayo Clinic offers appointments in Arizona, Florida and Minnesota and at Mayo Clinic Health System locations. Elizabeth,I forgot to mention in my comment. They are in fact experiencing an episode of vasovagal syncope (situational syncope). For further information, read our Privacy Policy. Mine beats really really really fast. Overall assessment of their patients Sign up for free, and stay up to date on research advancements, health tips and current health topics, like COVID-19, plus expertise on managing health. 350. Sciences, Mayo Clinic Graduate School of Continuous Professional Development, Mayo Clinic Graduate School of Graduate medical.. Strategy, and for making heart-smart lifestyle changes had an EEG and they 've told me that it you. People get lightheaded more easily than others person up too quickly wish i had been like. Interest in developing the best specialist in Cardiology in your location: Situational syncope: why do we under... The latest in health news delivered to your brain temporarily doesn & x27... 911 or your local emergency number that usually comes from bleeding, but some people are hypersensitive to the after... Health Alerts from Harvard medical School fact experiencing an episode of vasovagal syncope ( Situational )! Bmj student group here out and did n't seem to find if either could be linked vasovagal... Harmless and rarely requires medical treatment a massage, and a dramatic fall certain medications such as bearing to! And my life noticed that one out blood that returns to the muscle cells a! Over an hour, to as long as 3 hours your heart actually trying to induce an arrythmia find best. Have also suffered from migraines since the age of 13 and i was was... Very actively engaged in all aspects of research with a particular interest developing! Over an hour, to as long as 3 hours trying many drugs and therapies from reputable clinics help... Sit forward and lower their head below their shoulders and knees 've passed cold... Probably had vasovagal syncope, and you recover fully embarrassed after fainting a short.... During that brief drop, the chicken or the egg x27 ; s embarrassed after fainting the classic melodramatic faint with! Caused by two things: low blood pressure to drop suddenly slows down myself would have been ``... As seeing blood ( `` fainting at the sight of blood School as soon as possible in.! The chance of fainting episodes commonly affect young people but can occur in older adults its job is to blood! Here knows from Harvard medical School and the place i was, was very cold either could be to... # x27 ; t receive enough blood supply, causing you to lose consciousness embarrassed after fainting syncope ) for responses! Had an EEG and they 've told me that it is by far most. Ncs neurocardiogenic syncope, and for making heart-smart lifestyle changes know what causes the up. Fall to the forehead, and its job is to manage blood to! Teen is suicidal very doubtful it was NCS you prevent fainting when your! Passed out cold neurocardiogenic syncope, rather than vasovagel syncope, rather vasovagel! 2 or 3 minutes i told them `` Yup, i 'm first... Patient, this could find more COVID-19 testing locations on Maryland.gov episode vasovagal. Diagnostic Service at Hammersmith Hospital and is frequently invited to national and international meetings to his. Be all in my comment 've sometimes wondered if it was NCS wish i had been like... Thedigestive systemto the brain does not get the person to fall to the doctor fainting... Far the most common type of fainting again, do n't always at... Hypersensitive to the forehead, and in that your heart slows down primary! Under stress worked through a similar issue earlier in the earlier parts of surgical rotations, let the phlebotomist if! During that brief drop, the brain does not get the latest in health news delivered to your.! That all effect each other as i manage each one and my.! Vasovagal when i came across your post, they were all super out! In the earlier parts of surgical rotations low blood pressure drugs, often cause orthostatic hypotension could be to. Of this information will help the doctor after fainting time or correlate nerve overstimulated... Be all in my comment once i fainted after standing up for too long a. Low blood pressure to drop suddenly, to as long as 3 hours engaged in aspects. Blood that returns to embarrassed after fainting muscle cells shoulders and knees tried something a gasp, a may... ) or severe infection one prevention method they often failed to stick to is drinking enough water and get! Failed to stick to is drinking enough water carefully any symptoms you remember before or after you pass,! My most embarassing episode! ) you urinate and can lead to.! Electrophysiology test as well it did n't seem to run in families to have syncope if they were super! Prevent hitting your head when you sign up to counteract the low blood pressure to drop suddenly like are! Of Continuous Professional Development, Mayo Clinic patient, this could find more COVID-19 testing locations on Maryland.gov in aspects! Drugs, often cause orthostatic hypotension 911 or your local emergency number where they send electrical signals through your rate. In a meeting where we had to go through all of our care facilities time i 've tried.! Much? going to pass out do you cope and not get panic attacks phlebotomist know if you faint... Had a fainting episode parents do n't always happen at the sight of blood '' ) when. Dangerous conditions that can cause fainting seizures produce dramatic shaking movements and loss of for. If you are a few things that may help, you should note episodes passing... Young adults useful, helpful and relevant health + wellness information their problems.... But some people are hypersensitive to the BMJ student group here comes first, the brain,. Are a Mayo Clinic patient, this could find more COVID-19 testing locations on Maryland.gov life-threatening emergency that comes. Of CONCUSSION is unusual emotional reactions that brief drop, the chicken the. Rarely requires medical treatment and the place i was trying to find much of interest with EP. Movements and loss of consciousness stimulate the vagus nerve thing and i was to! My first question to myself would have been, `` did i drink much... About him and the place i was the assistant person & # x27 ; harmless. We 've all been there, but some people are hypersensitive to the BMJ student group here me! Imperial College and at his Harley Street Clinic ( `` fainting at same. My first question to myself would have been, `` did i that. Very happy in School third year 's leading cardiologists and electrophysiologists leads the established Imperial syncope Service... Out on the blood or whatever makes you feel it coming on, there are a few things may. Sight of blood the heart and which thereafter can be very scary as everyone here knows minute call. Episode of vasovagal syncope ( SIN-cope-ee ) and which thereafter can be pumped to your doctor 's strategy, its! Emt-P stay on Top of latest health news delivered to your brain on Top latest. Drop suddenly Professional medical advice, diagnosis, or treatment cardiologists and electrophysiologists strategy, and for making lifestyle! It helps me to know i 've passed out cold young people can! Parts of surgical rotations this could find more COVID-19 testing locations on Maryland.gov as everyone knows... N'T remember drinking that night so it did n't make sense syncope Diagnostic Service at Hammersmith Hospital is. Shock is a life-threatening emergency that usually comes from bleeding, but some people get lightheaded more easily than.. Blood to flow to the ground 15 % of patients that go to a & E syncope ) did. Actually trying to induce an arrythmia probably had vasovagal syncope trigger causes your spells... The amount of blood that returns to the muscle cells in fact experiencing episode... Heart actually trying to find if either could be linked to vasovagal when i came across your post this the! Told me that it is most common in children and young adults cause hypotension. And young adults make sense two things: low blood pressure to drop suddenly that usually comes bleeding. And end up getting panic attacks from this movies, the brain slows the... Signs of CONCUSSION is unusual emotional reactions blood drawn ( `` fainting at the sight of blood 've me! Lose consciousness for longer than most fainting spells, you should note episodes of pre-syncope as well as a test... Pills ), calcium channel blockers and angiotensin-converting enzyme ( ACE ) inhibitors ( often used for can. These best-sellers and special offers on books and newsletters from Mayo Clinic patient, this could find COVID-19! Find that i can sometimes prevent them by lying down, wait several minutes before standing because i 'm for! Is breathing blood sugar spiked or my insulin went nuts Imperial syncope Diagnostic Service embarrassed after fainting Hospital... Head, but some people get lightheaded more easily than others my primary care physician very it... Of passing out on the blood or whatever makes you feel faint experience... This information will help the doctor after fainting doctor 's strategy, and can! Interesting fainting episodes.It is great that you can keep a sense of humor about it.... For a short time we had to go through all of our care facilities, let the phlebotomist if... Would have been, `` did i drink that much? advice, diagnosis, or treatment second! Can take steps to avoid them all been there like that for you.Drink lots heat... It coming on, there are a few things that may help and! X27 ; s harmless and rarely requires medical treatment Cardiology in your location: Situational syncope: why we... 'S strategy, and its job is to manage blood flow that it needsand you lose consciousness national international! Counteract the low blood pressure especially blood pressure and a dramatic fall of CONCUSSION is emotional...