Post-Traumatic Head Injury

Most Common Complaint Following Whiplash

  • In 70-90% of cases, individuals who suffer traumatic brain injuries will develop a headache.
  • Can have cognitive, emotional, sleep, and physical consequences.
  • There are many different types of concussions, so proper evaluation is important.
  • Recovery typically takes 1-3 years.

Concussion = Brain Bruise

Mild Traumatic Brain Injury

WE MUST NOT FORGET ABOUT THE BRAIN. During an accident, the brain inside the skull is being thrown around as well. A concussion is a type of traumatic brain injury; a cerebral contusion or bruising of the brain. Concussions are commonly sustained during motor vehicle accidents, even without the head directly striking something. The brain is propelled from its resting position to the back of the skull - then back to the front of the skull - resulting in what are commonly called coup and countercoup injuries. It is always important to seek medical attention immediately after a car accident. There are times when urgent referrals are warranted, or advanced imaging is needed to ensure the good of the patient.

What is a concussion?


  • Concussion = mTBI or mild traumatic brain injury.
  • If concussions go untreated it can lead to what is known as post concussive syndrome or PCS. This leads to slower recovery and persistent symptoms.
  • You are considered to have a concussion when you sustain a loss of consciousness for less than 30 minutes, have a change in neurological status (dilated pupils, confusion, headache, dizziness, sensitivity to light, etc.), and when there are no conclusive findings on structural imaging (CT or MRI).
  • An untreated concussion can lead to post-concussion syndrome (PTS). This leads to slower recovery with persistent symptoms.
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Incidence of concussion/mTBI:


  •  1.7-3.4+ million per year (may be as high as 6-8 million, but concussions often gounreported)
  • Children/pediatric sports related concussions doubled (ages 8-13) and youths (ages14-19) tripled from 1991- 2007 per ER visit information.
  • 15% of students (approximately 2.5 million) reported having at least one concussion during 12 months.
  • Urban versus Rural populations
  • ○ Urban (Denver area)- people are more likely to go to the ER and concussions are typically in the younger population and are related to sports/recreation.
  • ○ Rural (Johnstown)- people are less likely to go to the ER and concussions are more common amongst the older population, who are likely to have more trauma (i.e., falls).
  • Overall, children and teens are more likely to be concussed and typically require more
  • recovery time as the brain is still developing.
  • If you’ve had 1 concussion, you are more likely to have more.


We consider a neuro/bio/psycho/social model, which means no behavior exists in isolation and all factors matter in terms of recovery. We believe in interdisciplinary treatment and referrals. Symptoms to be aware of include:

  • Physical: dizziness, headache, balance issues, vision changes, nausea, sensitivity to light or noise, and numbness/tingling.
  • Emotional: irritability, sadness, nervousness, and heightened emotional states or reactions.
  • Cognitive: mental fogginess, feeling "slowed down," difficulty concentrating, memory loss, and decreased auditory comprehension.
  • Sleep-related: Sleeping more or less than usual or trouble falling asleep.

Red Flags

Important signs of a concussion to watch out for:


  • Headaches are the most common symptom
  • Increased impairment of an individual's conscious state
  • Nausea
  • Decrease in motor function; the individual is stumbling, clumsy, or appears drunk
  • Seizures
  • Pupillary inequality or papilledema


  1. We believe in active rehab versus "rest" after a concussion. Symptoms are fewer for those who are more active as opposed to sleeping/resting more. 
  2. Active rehab means continuing to do the things you would typically do, but in moderation. This aids in strengthening and exercising the brain. For example:
  • Instead of taking three days to a week off from school, think about going back to school for half days or taking frequent rest breaks throughout the day.
  • Instead of missing practice or work, think about doing "light duty" that is safer, but still functional.

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