The Invisible Injury
One of the most underdiagnosed injuries I see at Accident Care and Treatment Center is mild traumatic brain injury — commonly called concussion. Unlike a broken arm or a cut, a concussion doesn’t show on routine imaging. Patients often don’t realize they have one. Sometimes they attribute symptoms to fatigue, stress, or the whiplash they know they have — never considering that their brain may have been injured too.
Understanding how concussion happens in a car accident, what symptoms to look for, and when to get evaluated can make the difference between a full recovery and months of unexplained cognitive problems.
You Don’t Need to Hit Your Head
The most common misconception about concussion is that you have to hit your head on something to get one. This is false. A concussion occurs when the brain moves rapidly inside the skull — which happens whenever your head is suddenly accelerated or decelerated, regardless of whether you strike an object.
The same whiplash motion that injures the cervical spine can also cause the brain to impact the inside of the skull. This is why many patients with whiplash also have concussion, even when no direct head trauma occurred.
The Mechanics of Brain Injury in a Crash
Several forces can injure the brain during a collision:
- Coup-contrecoup — the brain slams into one side of the skull, then rebounds and hits the opposite side
- Rotational forces — the brain twists on the brainstem, stretching and shearing nerve fibers
- Direct impact — the head strikes the steering wheel, window, airbag, or another surface
- Secondary whiplash — the violent flexion-extension of the neck transmits force directly into the brainstem
Symptoms to Watch For
Concussion symptoms fall into four categories:
Physical
- Headache — often persistent and worsening
- Dizziness or balance problems
- Nausea or vomiting
- Blurred or double vision
- Sensitivity to light or noise
- Fatigue or drowsiness
Cognitive
- Difficulty concentrating
- Memory problems — especially about events around the crash
- Feeling "foggy" or slowed down
- Trouble finding words
- Problems with multi-step tasks
Emotional
- Irritability or short temper
- Anxiety
- Sadness or depression
- Increased emotional reactivity
Sleep
- Difficulty falling asleep
- Sleeping more than usual
- Difficulty staying asleep
- Unrefreshing sleep
Why Concussion Is Often Missed
Several factors contribute to concussion being the most frequently missed crash injury:
- No visible damage — routine CT and X-ray often appear normal
- Delayed symptoms — cognitive and emotional symptoms can take days or weeks to appear
- Overlap with other injuries — whiplash headaches mask concussion headaches; fatigue from injury masks concussion fatigue
- Under-recognition — many primary care and ER physicians are not trained specifically in concussion evaluation
- Self-minimization — patients attribute symptoms to stress, poor sleep, or "getting old"
When to Seek Immediate Evaluation
Some symptoms are medical emergencies. Go to an emergency room immediately if you experience any of the following after a crash:
- Loss of consciousness, even briefly
- Severe or worsening headache
- Repeated vomiting
- Seizures
- Confusion or disorientation
- Unusual drowsiness or difficulty staying awake
- Weakness or numbness on one side of the body
- Pupils of different sizes
- Slurred speech
- Clear fluid draining from the nose or ears
These may indicate more severe brain injury — skull fracture, brain bleeding, or swelling — that requires urgent imaging and possible surgical intervention.
Getting Evaluated for Concussion
Proper concussion evaluation includes:
- Detailed history — mechanism of injury, symptom timeline, prior head injuries
- Neurological exam — cranial nerves, balance, coordination, reflexes
- Cognitive screening — standardized tests of memory, attention, processing speed
- Vestibular/ocular assessment — eye movement, balance, visual tracking
- Imaging when indicated — CT or MRI for red-flag symptoms or persistent problems
The vast majority of concussions don’t require brain imaging. Imaging is reserved for patients with red-flag symptoms or whose symptoms don’t improve on the expected timeline.
Recovery Timeline
Most concussions resolve in:
- 7–14 days — simple, uncomplicated concussion in a healthy adult
- 3–4 weeks — typical range for most patients
- Beyond 3 months — called "post-concussion syndrome"; occurs in 15–20% of cases
Factors that prolong recovery include prior concussions, age over 40, pre-existing migraines, anxiety or depression, and continued cognitive or physical stress during recovery.
Treatment: Active Recovery, Not Total Rest
For decades, the standard advice for concussion was complete rest — a dark room, no screens, no activity. Current evidence has changed that approach. After a brief initial rest period (24–48 hours), most patients benefit from gradual, symptom-guided return to activity, including:
- Light aerobic exercise within a few days
- Vestibular and oculomotor therapy
- Manual therapy for associated cervical injury
- Sleep hygiene support
- Gradual cognitive loading
- Cognitive-behavioral support when emotional symptoms are prominent
The Overlap With Whiplash
Many patients who have whiplash also have concussion. The two injuries feed each other — cervical dysfunction contributes to headaches and dizziness, while concussion contributes to muscle tension and fatigue. Treating them separately often fails; treating them together produces better outcomes. This is one of the reasons integrated MD and physical therapy care under one roof is ideal for crash patients.
Don’t Dismiss the Symptoms
If you have been in a crash — even one you thought was minor — and you’re experiencing any cognitive, emotional, or sleep symptoms that weren’t present before, consider the possibility of concussion. Early diagnosis and treatment dramatically reduce the risk of chronic post-concussion symptoms.
Schedule an evaluation or call (405) 842-3209. We will help you determine if concussion is part of what you’re dealing with — and how to recover fully.