MIAMI GARDENS, Fla. — The Miami Dolphins lost a key game to their division rival and, even worse, lost their quarterback to another case of head trauma.

Tua Tagovailoa exited the Dolphins’ 31-10 loss to the Buffalo Bills with a concussion on Thursday night at Hard Rock Stadium.

Tagovailoa was scrambling for a first down on fourth-and-4 deep into the third quarter. As he charged forward, he collided head-first with Bills safety Damar Hamlin. Tagovailoa dipped his helmet into Hamlin’s shoulder.

Tagovailoa was down for minutes and went into a fencing posture with his right hand up and fingers curly with the left grabbing at his head while he lied on the turf. Teammates gestured immediately for assistance from the sideline.

Tagovailoa got up and walked on his own with trainers alongside him, escorting him into the tunnel.

He was ruled out for the remainder of the game moments later. He went 17 of 25 for 145 yards, a touchdown and three interceptions before exiting.

The irony with Hamlin being the defender on the tackle is that he once went into cardiac arrest on the field at Cincinnati in January 2023. One of Tagovailoa’s concussions that season also took place in Cincinnati against the Bengals.

In the 2022 season, Tagovailoa suffered multiple concussions, causing him to miss five and half games. He made it through his first full season healthy in 2023.

Tagovailoa said, between the 2022 and 2023 seasons, he considered retirement before returning last season. Ahead of this season, the Dolphins signed Tagovailoa to a four-year contract extension worth $212.4 million.

Backup quarterback Skylar Thompson entered for Tagovailoa after Miami’s starter took the hit.

Tagovailoa’s head injury added to an awful Thursday night for the franchise, solidifying the Dolphins (1-1) are still behind the Bills, who have won the past four division titles, in the AFC East.

Buffalo (2-0) continues to dominate Miami, earning a fifth consecutive win in the AFC East rivalry, with wins in 12 of the last 13 meetings.

Buffalo running back James Cook scorched his hometown team for three total touchdowns — two rushing — while going for 78 yards on the ground and a 17-yard touchdown reception.

Bills quarterback Josh Allen went 13 of 19 for 139 yards and the touchdown pass to Cook.

On a night when star wide receivers Tyreek Hill (3 catches, 24 yards) and Jaylen Waddle (4 catches, 41 yards) were held to 65 combined receiving yards, running back De’Von Achane, after entering questionable with an ankle injury, had 22 carries for 96 yards and seven receptions for another 69 yards and a touchdown through the air.

The night immediately started in Buffalo’s favor as Miami’s opening drive resulted in an interception, and that turnover resulted in a Bills touchdown.

Tagovailoa threw to wide receiver Grant DuBose for his first regular-season target in the NFL. The third-and-13 pass deflected off Dubose’s shoulder pad as he didn’t turn around on his route and was intercepted by cornerback Ja’Marcus Ingram.

His 25-yard return gave Allen a short field, and on fourth-and-3 from the 17-yard line, he found running back James Cook wide open. Linebacker David Long Jr. got tied up in traffic from wide receivers on the left side crossing over the middle, which freed up Cook, the Miami product from Central High.

The Dolphins responded with a 10-play, 70-yard touchdown drive. Achane scored out of the right flat, with Tagovailoa finding him and fullback Alec Ingold out to block for him.

Late in the first quarter, Tagovailoa threw his second interception, targeting wide receiver Robbie Chosen this time. It appeared to be a miscommunication on the route, as Chosen pulled up and Tagovailoa threw over him. The pass was intercepted by Christian Benford.

That turnover gifted Buffalo three points on a 43-yard field goal for Tyler Bass.

With a 10-7 lead, the Bills got back to scoring touchdowns. Cook had a 1-yard rushing score after Allen threw to running back Ty Johnson, beating cornerback Jalen Ramsey on a wheel route, for 33 yards to get to the 1-yard line. Miami safety Jordan Poyer, the former Bill, got hit for a personal foul for a helmet-to-helmet hit on former teammate, wide receiver Khalil Shakir, on the series.

After the Dolphins turned it over on downs on a fourth-down sack in which Bills defensive tackle Ed Oliver beat left guard Robert Jones, Cook scored his third touchdown on the following play from scrimmage, scampering 49 yards to the end zone.

Miami took a 24-10 deficit into halftime after kicking a field goal before intermission.

In the third period, Tagovailoa was facing pressure and trying to throw a pass away to the Buffalo sideline, but he didn’t quite get it there. Ingram took his second interception 31 yards for a touchdown that put the Bills ahead 31-10.

Along with Tagovailoa, Dolphins left tackle Terron Armstead and left guard Robert Jones left early with shoulder injuries.

The Dolphins, coming off the Thursday night game, get the weekend off before they travel to Seattle for a Week 3 game against the Seahawks on Sept. 22.

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