Nobody's head hit anything. That is the sentence this desk hears most from people who turn out to have a concussion after a crash, and it comes from a reasonable idea: that a brain injury needs a blow. It does not. The brain sits in fluid inside a hard case, and when the case stops suddenly the brain keeps going for a fraction of a second, then stops against the inside of the skull. A rear-end hit at a light on Kingshighway can do it without a single scratch on the forehead.

This page is about recognizing that injury, what the federal health agencies say about it, and the rehab lane Missouri Injury Clinic publishes for it. It is general information. It is not a diagnosis, and a suspected concussion is a reason to be examined, not to read more.

What a concussion is

The Centers for Disease Control and Prevention describes a concussion as a type of traumatic brain injury caused by a bump, blow, or jolt to the head, or by a hit to the body that causes the head and brain to move rapidly back and forth (CDC, HEADS UP). The phrase to notice is a hit to the body. A seat belt that catches a torso at speed is exactly that kind of hit. The National Institute of Neurological Disorders and Stroke lists motor vehicle crashes among the leading causes of traumatic brain injury (NINDS, TBI).

Loss of consciousness is not required. Most concussions do not involve one. What they involve is a change in how the brain works for a while: attention, balance, sleep, mood, and the eyes' ability to track and focus.

A wide St. Louis interstate at dusk seen from an overpass, brake lights stretching toward the downtown skyline and the Arch, wet pavement after rain — Brake lights on the interstate at dusk with the Arch ahead. Stop-and-go is where the rear-end hit lives, and the rear-end hit is where the stop injures the brain.

The signs after a crash

The ones this desk hears about, in roughly the order they get noticed: a headache that does not behave like a normal headache; fog, meaning a sense of being a half step behind a conversation; trouble reading a screen or a page for more than a few minutes; light and noise feeling louder than they should; irritability that surprises the person feeling it; sleep that is either too much or broken; dizziness when standing or turning; and, often, a neck that hurts at the same time, because the same motion that jolted the brain strained the neck.

Two things make this easy to miss. The first is the lag. Like soft-tissue pain, concussion symptoms can take a day or two to be obvious, and people explain them away as being tired or shaken up. The second is that the neck gets the attention, and the fog gets filed under stress. The 72-hour lag applies to the head as much as to the spine.

The emergency lineChest pain, a sudden severe headache, weakness or numbness on one side, trouble speaking, a loss of bowel or bladder control, or a head injury with vomiting or worsening confusion is an emergency room trip right now, not a call to a clinic. A headache that keeps getting worse, repeated vomiting, one pupil larger than the other, a seizure, or someone who cannot be woken is an ER case tonight, full stop.

What the clinic publishes for concussion

Missouri Injury Clinic publishes TBI and concussion rehabilitative therapy after acute injury as one of its three lanes, and on its own site it names the tools: vagus nerve stimulation using gentle microcurrent at the tragus, neurofeedback, Alpha Stim, sensory motor integration, exercise with oxygen, oculomotor rehabilitation, and cognitive rehabilitation using computerized brain-exercise software. This desk lists those because the clinic lists them. What a particular person needs, in what order, is a question for the examining clinician.

The practical point for a St. Louis driver is that the concussion lane lives in the same rooms as the auto injury lane. A person who calls about a sore neck and mentions fog is not sent into a months-long queue somewhere else. The exam covers both, the findings are written down together, and the plan addresses both. The first visit describes what that looks like.

A brain can be injured by a stop, not just a strike.

What to do this week

Say the word on the phone. If you have any of the signs above after a crash, tell the front desk that you may have hit your head or that you feel foggy, so the exam is scoped for it. Bring someone who knows you, if you can; the people around a concussed person often notice the change before the person does. Bring a list, written on paper or a phone, of what has been different since the crash: sleep, screens, mood, headaches, balance.

Then rest the way the clinician tells you to, not the way the internet tells you to. The right amount of activity after a concussion is a clinical judgment, and it changes week to week.

The record for a brain injury

Concussion is an injury that is mostly invisible to everyone except the person living it. A dated exam that writes down what the eyes did, what balance did, what the history was, and what the plan is turns an invisible injury into a documented one. That matters to the next clinician first. If a claim is ever part of your story, the dated record from the first exam is what everyone will ask for. The dated record explains what goes in it and what does not.

Educational only. Nothing on this page is medical advice or a diagnosis; a licensed clinician who has examined you is the person to ask. Facts about the clinic come from moinjuryclinic.com. Emergency symptoms go to the emergency room, not to a clinic or a website.