After a concussion or traumatic brain injury, many people know something is wrong even when routine testing does not provide a clear explanation.
They may experience persistent headaches, dizziness, balance problems, vision changes, anxiety, depression, or difficulty thinking. When those symptoms cannot be seen easily, patients may begin questioning whether anyone believes them.
During this episode of Mind Matters: Navigating Head Injuries and Concussions, legal nurse consultant Kiley Como continued her conversation with Dr. Bell about early diagnosis, rehabilitation, family involvement, and emerging treatments for the lasting effects of traumatic brain injuries.
Objective Testing Can Validate the Patient’s Experience
One of the most meaningful moments in brain injury care may occur when a patient finally sees objective evidence explaining their symptoms.
Dr. Bell described patients who felt relieved to learn they were not imagining their headaches, dizziness, or balance problems.
Many concussion symptoms cannot be identified through a simple physical examination or routine scan. That can make the recovery process especially frustrating.
Objective neurological, cognitive, visual, and vestibular testing may help demonstrate how the injury has affected the patient’s function.
Even when testing does not provide every answer, it can give the patient confirmation that the symptoms are real and deserve appropriate attention.
Early Diagnosis Creates an Opportunity for Treatment
The value of early diagnosis extends beyond reassurance.
Identifying a problem quickly may allow treatment to begin before the condition becomes more difficult to manage.
Dr. Bell emphasized that no provider can guarantee a complete recovery. Some patients may not return to exactly where they were before the accident.
However, improving their condition from its current level can still significantly affect their independence and quality of life.
Early treatment may help reduce symptoms, restore function, and prevent certain deficits from becoming more deeply established.
Balance Problems May Require Rehabilitation
Dizziness and balance problems are common after concussions and traumatic brain injuries.
These symptoms may result from dysfunction involving the vestibular system, which helps the brain understand movement, orientation, and balance.
A patient may feel unsteady while walking, become dizzy when turning their head, or struggle in visually busy environments.
Dr. Bell explained that early identification of vestibular dysfunction allows the treatment team to begin rehabilitation sooner.
Vestibular therapy may involve controlled movements and exercises designed to retrain how the brain processes information from the eyes, inner ears, muscles, and joints.
In some cases, significant back, shoulder, knee, or neck pain may need to be addressed before the patient can fully participate in balance rehabilitation.
The Neck Can Contribute to Dizziness
The cervical spine plays an important role in balance and orientation.
Muscles and joints in the neck send the brain information about where the head is positioned in space. When those structures are injured, the signals may no longer match the information coming from the eyes and inner ears.
This mismatch may contribute to dizziness, headaches, poor balance, and motion sensitivity.
Dr. Bell noted that treating cervical problems may sometimes improve vestibular symptoms.
That does not mean every dizzy patient has a neck injury. It means the cervical spine should be considered as part of a complete evaluation.
Vision Problems May Need Specialized Care
Brain injuries can also affect the systems responsible for focusing, tracking, eye coordination, and processing visual information.
A patient may experience blurred or double vision, headaches while reading, difficulty using screens, or discomfort in stores and crowds.
Visual and vestibular testing may help providers identify the specific deficit.
Depending on the findings, the patient may be referred to:
- A physical therapist with vestibular training
- A neuro-optometrist
- A neuro-ophthalmologist
- Another vision rehabilitation specialist
Treatment may include specialized exercises, corrective lenses, or other strategies intended to reduce visual strain and improve function.
Persistent Headaches Need Their Own Evaluation
Headaches are among the most common symptoms following a concussion.
They may be related to migraine-like neurological changes, irritated nerves, muscle tightness, neck injuries, or several overlapping factors.
Dr. Bell recommended beginning with the more direct and treatable contributors.
Physical therapy for tight cervical muscles may reduce headache severity for some patients. Others may benefit from medication, injections, nerve blocks, Botox, or other specialized procedures.
The correct treatment depends on the location, pattern, triggers, and suspected source of the headache.
Nerve Blocks Can Help Identify the Pain Source
Certain post-traumatic headaches may involve irritated nerves around the head and neck.
Examples include the occipital nerves at the back of the head and nerves located around the forehead and temples.
Dr. Bell explained that a local anesthetic nerve block may be used to determine whether a particular nerve is contributing to the pain.
When a block provides meaningful temporary relief, it may help confirm the suspected headache source.
That information can then guide additional treatment decisions.
What Is Cryoablation?
Cryoablation, also called cryoneurolysis, uses controlled cooling to reduce activity in a sensitized nerve.
Dr. Bell discussed using this approach for selected patients with headaches involving the occipital, supraorbital, supratrochlear, or auriculotemporal nerves.
The procedure is not appropriate for every headache patient.
A provider may first perform a diagnostic nerve block. If the block helps, cryoablation may be considered as a longer-lasting treatment option.
Dr. Bell described it as a minimally invasive, medication-sparing procedure that may be completed in an office setting.
Botox May Help Migraine-Like Headaches
Botox is widely known for cosmetic use, but it is also used medically for certain chronic headache disorders.
Dr. Bell discussed administering Botox according to established headache protocols, targeting areas associated with migraine-like pain.
Treatment is generally repeated at scheduled intervals rather than given as a one-time injection.
Botox does not repair a traumatic brain injury itself. It may help reduce one of the most disabling consequences: frequent or persistent headaches.
Patients should be evaluated by an appropriately trained provider to determine whether their headache pattern fits this treatment.
Cognitive Changes Need Rehabilitation Too
Brain injuries can affect memory, attention, processing speed, organization, and problem-solving.
Neurocognitive testing may help identify the specific skills that have changed.
Once those deficits are recognized, the patient may be referred for cognitive rehabilitation.
Therapy may focus on restoring certain abilities while also teaching strategies to compensate for problems that remain.
For example, a patient might use structured routines, memory tools, written reminders, or task-planning systems to function more independently.
Do Not Overlook the Psychological Effects
Dr. Bell described the psychiatric effects of brain injury as one of the easiest consequences to miss.
Patients may develop:
- Post-traumatic stress disorder
- Heightened anxiety
- Depression
- Difficulty focusing
- Emotional instability
- Fear of driving
- Panic when returning to the crash location
Existing mental health conditions may also become worse following an injury.
These symptoms should not be dismissed as unrelated simply because they appear emotional rather than physical.
A serious accident may affect the brain while also exposing the person to a frightening and potentially life-changing event.
Stellate Ganglion Blocks and PTSD
Dr. Bell discussed the stellate ganglion block as one possible intervention for selected patients experiencing post-traumatic stress symptoms.
The stellate ganglion is part of the sympathetic nervous system, which contributes to the body’s fight-or-flight response.
A stellate ganglion block involves injecting medication near this nerve structure in the neck.
The procedure has been studied for several conditions, including certain pain disorders and PTSD. However, it is not a universal treatment, and the research continues to develop.
Patients should receive a careful evaluation of the possible benefits, risks, and alternatives.
Family Members Provide Critical Information
Brain injury patients may not recognize every change in themselves.
Memory problems, reduced insight, personality changes, or emotional instability can make self-reporting difficult.
Family members, friends, roommates, and coworkers may be able to describe how the person functioned before the accident and what has changed since.
Dr. Bell welcomed their involvement because they can provide valuable comparisons between the patient’s previous and current behavior.
They may notice that the patient repeats questions, withdraws socially, becomes easily frustrated, or can no longer manage responsibilities they handled before.
That information may help the provider build a more complete clinical picture.
Transcranial Magnetic Stimulation
Transcranial magnetic stimulation, commonly called TMS, uses magnetic pulses to stimulate selected areas of the brain.
It is already used clinically for certain cases of treatment-resistant depression.
Dr. Bell discussed emerging research examining TMS for symptoms associated with traumatic brain injury, including depression, PTSD, and headaches.
Treatment protocols may vary depending on the condition and the available evidence.
TMS is noninvasive and does not require surgery, but it should still be provided under qualified medical supervision.
Research into its role in traumatic brain injury continues.
The Uncertain Role of Hyperbaric Oxygen
Hyperbaric oxygen therapy involves breathing oxygen in a pressurized chamber.
Dr. Bell said the evidence for its use after traumatic brain injury remains mixed and incomplete.
Some patients have reported meaningful improvements, but questions remain about the appropriate pressure, duration, patient selection, and overall effectiveness.
Different facilities may also use different types of chambers, ranging from lower-pressure systems to hospital-grade equipment.
Hyperbaric oxygen should therefore be viewed as an evolving area rather than a proven treatment for every concussion patient.
“Diagnose and Do”
Dr. Bell summarized his approach with the phrase “diagnose and do.”
A diagnosis is important, but patients also want to know what can be done to reduce their symptoms and improve their lives.
Modern brain injury care may combine:
- Vestibular rehabilitation
- Cervical therapy
- Vision treatment
- Cognitive rehabilitation
- Mental health care
- Headache medication
- Botox
- Nerve blocks
- Cryoablation
- TMS
- Selected emerging therapies
No single treatment will address every symptom.
The first step is identifying which systems have been affected. From there, the treatment team can focus on the problems that are most disruptive and begin building a personalized recovery plan.
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