After a concussion or traumatic brain injury, receiving a diagnosis can provide validation. It may finally explain why someone continues experiencing headaches, dizziness, balance problems, vision changes, anxiety, or difficulty thinking.
But patients also need to know what can be done next.
During this episode of Mind Matters: Navigating Head Injuries and Concussions, legal nurse consultant Kiley Como spoke with Dr. Gilbert Mbeo about the importance of early diagnosis, symptom-specific rehabilitation, family involvement, and emerging treatment options for the lasting consequences of brain injuries.
Objective Testing Can Validate Invisible Symptoms
Many brain injury symptoms are difficult for other people to see.
A patient may describe dizziness, headaches, visual discomfort, or feeling mentally disconnected while routine imaging appears normal. After months of uncertainty, they may begin wondering whether the symptoms are real or whether anyone believes them.
Dr. Mbeo explained that objective neurological, visual, vestibular, and cognitive testing may help demonstrate functional problems that are not obvious during a brief examination.
For some patients, seeing measurable evidence is meaningful on its own.
It confirms that they were not imagining their difficulties and provides a clearer direction for treatment.
Early Diagnosis Creates More Treatment Opportunities
Early diagnosis does not guarantee a complete recovery, but it may allow providers to begin treatment before certain problems become more established.
Dr. Mbeo emphasized that the goal is not always returning someone immediately to exactly where they were before the accident.
Improving their current level of function can still make a major difference.
For a person who feels they have gone from functioning at 100% to below zero, even a partial improvement may help them regain independence, participate in family activities, or tolerate everyday tasks more comfortably.
Balance Problems Often Need Movement-Based Treatment
Dizziness and poor balance are common after concussions and traumatic brain injuries.
These symptoms may result from problems involving the vestibular system, which helps the brain understand motion, balance, and the position of the body.
A patient may feel unsteady while walking, become dizzy when turning their head, or struggle in crowded and visually active environments.
Dr. Mbeo explained that significant musculoskeletal injuries may sometimes need to be addressed before the patient can fully participate in balance rehabilitation.
Once appropriate, vestibular therapy may use controlled movements and exercises to retrain how the brain processes information from the eyes, inner ears, muscles, and joints.
The Neck May Contribute to Dizziness and Headaches
The cervical spine provides the brain with important information about head position and movement.
After a collision, injured or tight neck muscles may send distorted signals that do not match the information coming from the eyes and inner ears.
That mismatch may contribute to headaches, dizziness, motion sensitivity, and poor balance.
Physical therapy addressing tight cervical muscles may therefore improve more than neck pain alone.
A complete concussion evaluation should consider whether the cervical spine is contributing to the patient’s neurological symptoms.
Visual Problems May Require Specialized Care
A brain injury can affect the ability to focus, track objects, coordinate both eyes, judge distance, and tolerate visual motion.
Patients may struggle to read, use a computer, drive, or enter a busy store.
A visual and vestibulo-ocular examination may help identify which functions have been disrupted.
Depending on the findings, treatment may involve:
- Vestibular physical therapy
- Vision rehabilitation
- Corrective or specialized lenses
- A neuro-optometry evaluation
- A neuro-ophthalmology consultation
Identifying the specific deficit allows treatment to be more targeted than simply telling the patient to rest their eyes.
Persistent Headaches Need Their Own Treatment Plan
Post-traumatic headaches can arise from several sources.
They may have migraine-like features, originate from tight neck muscles, or involve irritated nerves around the head and scalp.
Dr. Mbeo discussed beginning with treatable contributors, such as cervical muscle tension.
When physical therapy and conventional medication are not enough, additional options may include:
- Occipital nerve blocks
- Other cranial nerve blocks
- Botox
- Cryotherapy or cryoablation
- Transcranial magnetic stimulation
The correct treatment depends on where the pain occurs, what triggers it, and which nerves or muscles appear to be involved.
Nerve Blocks Can Help Identify the Source
A nerve block involves placing a local anesthetic near a suspected pain-producing nerve.
If the patient experiences meaningful temporary relief, the response may confirm that the nerve is contributing to the headaches.
Dr. Mbeo discussed nerves around the forehead, temples, and back of the head, including the occipital nerves.
That information may guide the provider toward a more lasting treatment.
Rather than using the same headache medication for every patient, the physician can focus on the specific pain pathway involved.
What Is Cryoablation?
Cryoablation, also called cryoneurolysis, uses controlled cooling to reduce activity in a sensitized nerve.
When a diagnostic nerve block is successful, the provider may consider cryoablation to extend the period of relief.
The treatment does not permanently remove the nerve.
Instead, it temporarily reduces the nerve’s ability to transmit abnormal pain signals while it gradually recovers.
Dr. Mbeo described cryoablation as an office-based, medication-sparing option for selected patients with cranial neuralgia and persistent headaches.
Botox for Post-Traumatic Headaches
Botox is widely known for cosmetic use, but it is also used medically for certain chronic headache conditions.
Dr. Mbeo discussed injecting Botox according to established headache protocols, targeting areas involved in migraine-like or persistent pain.
Treatment may be repeated approximately every three months, depending on the patient and the clinical response.
Botox does not treat every consequence of a traumatic brain injury.
However, reducing headache frequency or intensity may improve sleep, concentration, activity tolerance, and overall quality of life.
Cognitive Changes May Require Rehabilitation
A concussion can affect memory, attention, processing speed, organization, and the ability to complete several tasks at once.
Neurocognitive testing may help identify which abilities have changed.
The patient can then begin cognitive rehabilitation focused on rebuilding skills or learning strategies to compensate for ongoing difficulties.
Treatment may include structured routines, memory aids, written reminders, pacing techniques, and exercises designed to improve attention or processing.
Early recognition gives the patient an opportunity to begin this work before frustration and failed attempts become part of daily life.
The Psychological Effects Are Easy to Miss
Dr. Mbeo identified the psychiatric consequences of traumatic brain injury as one of the most commonly overlooked areas.
Patients may experience:
- Depression
- Heightened anxiety
- PTSD
- Fear of driving
- Difficulty focusing
- Emotional instability
- Panic near the crash location
People with preexisting mental health conditions may experience a significant worsening after the injury.
These symptoms should not be dismissed simply because they appear emotional rather than physical.
A traumatic event can injure the brain while also leaving the nervous system in a persistent state of fear and alertness.
Stellate Ganglion Blocks and PTSD
The stellate ganglion is part of the sympathetic nervous system, which helps control the body’s fight-or-flight response.
A stellate ganglion block involves delivering medication near this nerve structure in the neck.
Dr. Mbeo discussed the procedure as an emerging, medication-sparing option for selected patients with PTSD and heightened anxiety.
The treatment has been used historically for other conditions and is now being studied and used in certain trauma-related settings.
It is not a universal cure for PTSD, and patients may still need counseling, medication, or other mental health treatment.
However, reducing the body’s physical overdrive may make the broader recovery process more manageable.
Family Members Can Help Identify Changes
Brain injury survivors may not recognize every change in their own behavior or abilities.
Memory problems, reduced insight, and emotional changes may make self-reporting incomplete.
Family members, friends, roommates, and coworkers knew the person before the accident and can describe what has changed.
They may notice that the patient:
- Repeats questions
- Forgets appointments
- Becomes easily frustrated
- Withdraws socially
- Struggles with responsibilities
- Acts differently from before
Dr. Mbeo welcomed their involvement because they can provide a before-and-after comparison that helps build a more complete clinical picture.
Transcranial Magnetic Stimulation
Transcranial magnetic stimulation, or TMS, uses magnetic pulses to stimulate selected areas of the brain.
It is already used clinically for treatment-resistant depression.
Dr. Mbeo discussed emerging research examining its possible role in traumatic brain injury symptoms, including depression, PTSD, and persistent headaches.
TMS is noninvasive and does not rely on daily medication, but treatment protocols vary.
Research continues into which patients are most likely to benefit and how many sessions may be needed.
Hyperbaric Oxygen Remains an Emerging Area
Hyperbaric oxygen therapy involves breathing oxygen inside a pressurized chamber.
Dr. Mbeo explained that the evidence for its use after traumatic brain injury remains incomplete.
Some patients report meaningful improvement, but questions remain about patient selection, treatment pressure, duration, and long-term effectiveness.
Different facilities may also use different kinds of chambers.
Hyperbaric oxygen should therefore be considered an evolving treatment rather than an established solution for every concussion patient.
The Goal Is to “Diagnose and Do”
Dr. Mbeo summarized his approach with the phrase “diagnose and do.”
A diagnosis provides answers, but patients also need a plan for improving the symptoms that continue interfering with their lives.
Modern brain injury treatment may include:
- Vestibular rehabilitation
- Vision treatment
- Cervical physical therapy
- Cognitive rehabilitation
- Mental health care
- Nerve blocks
- Botox
- Cryoablation
- TMS
- Selected emerging therapies
Not every patient needs every treatment.
The provider must determine which systems have been affected and which symptoms are causing the greatest limitations.
Earlier Is Better, but Improvement Can Still Matter Later
Early identification and treatment may improve the opportunity for recovery.
However, patients who were not diagnosed immediately should not assume nothing can be done.
Treating one persistent headache, balance problem, visual deficit, or psychological symptom may still improve quality of life.
Brain injury care is not always about finding one treatment that restores everything at once.
It is often about identifying each disrupted system, addressing the most treatable problems, and gradually helping the patient regain function.
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