Key takeaways
- CDC danger signs, including worsening headache, repeated vomiting, one pupil larger, slurred speech, or any loss of consciousness, mean the emergency room, not a clinic.
- You do not have to hit anything or black out to get a concussion. The fog, light sensitivity, and slowed thinking can report in late.
- A concussion exam scores symptoms, eye movement, balance, and the neck, so next week has a dated number to compare against.
- Missouri Injury Clinic publishes concussion rehab after acute injury as a lane, with named tools including neurofeedback and oculomotor rehab.
You did not black out. You remember the whole thing. You talked to the officer, you drove home, and the next morning the inside of your skull feels like someone turned up the gain on everything. That is not the same as being fine, and it is the one injury on this desk where the emergency line comes before the reporting.
The bright line, first
The Centers for Disease Control and Prevention publishes the danger signs that mean an emergency room, not a clinic: a headache that gets worse and does not go away, weakness, numbness or decreased coordination, repeated vomiting or nausea, slurred speech, one pupil larger than the other, drowsiness or inability to wake up, convulsions or seizures, increasing confusion or agitation, or any loss of consciousness. If any of those are in the picture, stop reading and go. Nothing below applies until the ER has had its turn.
Concussion without a knockout
A concussion is a mild traumatic brain injury caused by a bump, blow, or jolt to the head, or by a hit to the body that makes the head move rapidly back and forth. You do not have to hit anything to get one; the same whip motion that strains the neck can jar the brain inside the skull. You do not have to lose consciousness. Most people with a concussion do not. What they get instead is a cluster: headache, pressure in the head, fog, trouble concentrating, sensitivity to light or noise, feeling slowed down, sleeping more or less than usual, irritability, and sometimes nausea or balance trouble.
Like the neck and the back, the head can report in late. The fog that felt like a bad night's sleep on day one is harder to explain on day three. Tell the clinician about it. Say the head when you call. It changes the exam.
What an exam looks for
A concussion exam after a crash is partly questions and partly watching. History of the crash and where the head went. A symptom checklist, scored, so there is a number to compare against next week. Eye movement: tracking a target, converging on a near point, shifting gaze quickly between two points, all of which are commonly affected and all of which can be measured. Balance. Reaction time. Neck exam, because the neck and the head get hurt together and a stiff upper neck produces its own headaches.
What you should walk out with is the same thing every page on this desk asks for: findings written down and dated, and a plan. With a head injury the plan usually includes a staged return to screens, work, driving, and exercise, and a clear list of symptoms that would send you back to the ER.
What concussion rehab at the clinic involves
Missouri Injury Clinic publishes TBI and concussion rehabilitative therapy as one of its three lanes, for after the acute injury has been handled. The tools named on the clinic's own TBI rehab page are vagus nerve stimulation, described as gentle microcurrent at the tragus of the ear; neurofeedback; Alpha Stim; sensory motor integration; exercise with oxygen; oculomotor rehabilitation, which is the eye-movement work described above; and cognitive rehabilitation using computerized brain-exercise software. This desk lists those because the clinic lists them. Which of them, if any, belongs in a given plan is a clinical call made in the room, not on a website.
The neck and the head together
Most crash-related head injuries arrive with a neck injury attached, and the two can be hard to tell apart from the inside. Headache at the base of the skull that gets worse when you turn your head is often the neck. Headache with light sensitivity and fog is more often the head. Dizziness can be either. A clinician who examines both at once and writes both down is doing it right. The neck has its own page.
The lane, and the order
Order matters here more than anywhere else on this desk. Danger signs: ER, now. No danger signs but a head that does not feel right: call the nearest Missouri Injury Clinic room, say the head, and ask for the next opening. Three rooms, nearest to this desk in Hazelwood, all closed 12 to 2 daily. Rooms are here. Bring whoever drove you, because they will remember the symptoms you will forget to mention.
Bulletin / Missouri Injury Clinic
Say the head when you call.
After acute care, Missouri Injury Clinic publishes concussion rehab as a lane. An exam this week puts a dated number on the fog so next week has something to compare against.
Hazelwood: Mon to Thu 9am to 6pm, Fri 9am to 12pm. Closed daily 12 to 2. South County and O'Fallon numbers are on the rooms page.