A concussion is a mild traumatic brain injury (mTBI) resulting from a forceful blow or jolt to the head or body that causes the brain to move rapidly within the skull. This sudden movement temporarily disrupts normal brain function, leading to a variety of symptoms affecting thinking, balance, mood, and sleep. Because the effects of a concussion vary widely, treatment is rarely managed by a single practitioner. Recovery depends on a coordinated, multidisciplinary team of medical specialists who address the physical, cognitive, and emotional aspects of the injury.
Initial Medical Assessment
Following a suspected concussion, the first step is acute medical triage to rule out a more severe injury. This initial assessment often occurs in an Emergency Room (ER) or Urgent Care facility. Emergency medicine physicians or urgent care providers perform a neurological exam and screen for “red flag” symptoms, such as severe, worsening headache, repeated vomiting, or seizure, which may indicate intracranial bleeding or a skull fracture.
If severe complications are suspected, a computerized tomography (CT) scan is typically ordered immediately to identify structural brain injury. For the majority of concussions, which do not show structural damage, the diagnosis remains clinical, based on the mechanism of injury and the patient’s reported symptoms. Primary Care Physicians (PCPs) are equipped for initial diagnosis and management, providing guidance on physical and cognitive rest for the first 24 to 48 hours. The PCP then coordinates subsequent care, referring the patient to specialists if symptoms persist beyond the expected recovery window.
Specialized Medical Management
Once the immediate danger has passed, physician specialists take the lead in overseeing the patient’s overall treatment plan and medical clearance. Neurologists specialize in nervous system conditions and are often consulted for complex or persistent symptoms, such as post-traumatic migraines or chronic dizziness. They perform detailed neurological examinations and can prescribe medications to manage specific symptoms like pain, sleep disturbances, or mood fluctuations.
Physiatrists, specializing in Physical Medicine and Rehabilitation, frequently serve as the central coordinator for the treatment team. They focus on restoring function and develop a comprehensive rehabilitation strategy, prescribing and overseeing various therapies. For athletes, a Sports Medicine Physician, often a primary care physician or physiatrist, manages the return-to-play process. This physician provides the medical clearance necessary for an athlete to safely progress through the return-to-activity protocol.
Rehabilitation and Physical Recovery
Functional recovery from a concussion is driven by rehabilitation therapists. Physical Therapists (PTs), especially those trained in vestibular and cervical rehabilitation, treat physical symptoms like balance issues and neck pain. They employ manual therapy techniques and specific exercises to alleviate headaches that originate from the neck (cervicogenic headaches). PTs also use vestibular rehabilitation exercises to retrain the inner ear and brain connections, helping to resolve dizziness and vertigo.
Occupational Therapists (OTs) focus on restoring a patient’s ability to perform daily activities, such as self-care, work, or school. They address functional problems like cognitive fatigue, sensory sensitivities to light and noise, and difficulties with complex, multi-step tasks. An OT helps a patient re-establish routines and employs strategies to manage energy levels, allowing the brain to heal while maintaining independence. Their work is essential for facilitating a successful return to academic or professional life.
Cognitive and Behavioral Health Support
The cognitive and emotional changes following a concussion require the expertise of mental and behavioral health professionals. Neuropsychologists are licensed psychologists with advanced training in brain-behavior relationships. They conduct formal testing to objectively measure and diagnose specific deficits in thinking skills, such as attention, memory, and processing speed. This testing helps inform the medical team’s treatment plan and assists in making safe decisions regarding returning to work or school.
Other psychologists and counselors provide therapy to address the emotional fallout of the injury. They use techniques like Cognitive Behavioral Therapy (CBT) to help patients manage anxiety, depression, and mood lability that frequently co-occur with persistent concussion symptoms. Separately, a Psychiatrist, who is a medical doctor, specializes in the use of medication to treat these conditions. They may prescribe antidepressants or sleep aids to stabilize mood and improve sleep quality, which are often disrupted after a brain injury.