Lately I have been seeing patients who have sustained a mild traumatic brain (mTBI), also known as a concussion, who are being sent for evaluations that are not necessary nor appropriate. It is important to know what you need to do and what is a waste of your time and resources. Below are some recommendations to discuss with your healthcare practitioner, but please don’t take this as medical advice. If you have sustained a concussion, you need to have a doctor managing your case to help you track what steps to need to be taken and what can be avoided. I recommend seeking the care of a doctor who has has specialized training in concussion treatment/management such as someone certified by the Brain Injury Alliance of America: CBIS after their name like what I have.
- Do I need an MRI of my brain?
- This may come as surprise to some, but more often then not… no you do not need an MRI of your brain. If you have been in a car accident and if you have hit your head, you likely were taken to the ER and given a CT scan of your head to rule out any brain bleeds. But lately I have been speaking with patients and other fellow doctors about follow up brain MRIs. When symptoms persist, some doctors will choose to send the patient for a brain MRI or patients will ask if I can send them for one. My question back is the same in both cases: what do you expect to find on the brain MRI? Concussions cannot be seen on regular MRIs. That is worth repeating: concussions CANNOT be seen on MRIs. If only we could see concussions on a brain MRI it would make things easier; especially when dealing with insurance companies. There are some other specialized testing procedures that can help pinpoint what areas of the brain are not functioning appropriately such as a functional MRI or qEEG, however these often are not covered by insurance, are expensive and the same information can be gleaned from a detailed history, comprehensive bedside examination, MOCA, Videonystagmography (VNG) and balance assessment. All of these tests are done in my clinic.
- Do I need my eyes checked?
- Possibly. When I do a VNG assessment or when we begin visual retraining and it becomes clear the eyes are not working well together, I will refer for an evaluation by a neuro-optometrist. Optometrists who have special training in evaluating those who have sustained a head injury will do a detailed evaluation and may recommend such interventions as prism glasses, light therapy and/or targeted visual therapy. Those practitioners who list affiliations with associations such as NORA will know how to appropriately evaluate your visual system.
- Do I need my hearing checked?
- If your concussion is accompanied with tinnitus (ringing in the ears) it may be a good idea to have your hearing checked. Tinnitus with hearing loss may not be able to be fixed. This is due to actual damage to the inner ear. However, if your hearing testing is within normal limits, the tinnitus may likely go away with specialized attention to brain rehab, upper cervical spine work and massage to the TMJ complex. You can start the process of checking for hearing loss with most primary care offices.
- It was recommended to me that I see a therapist. Do I need to be evaluated by one?
- This is a very personal decision, but if there is an increase in anxiety, depression or signs of PTSD (all common after sustaining an mTBI) then I do recommend patients be evaluated by a mental health practitioner. And, yes, you guessed it…there are therapists out there who specialize in working with those who have sustained a head injury. Again, the Brain Injury Alliance of America (or in my case of Oregon) will have practitioners listed who can help.
Bottom line…do not suffer alone. The old advice of waiting in a dark room until symptoms resolve is not the standard of care anymore and hasn’t been for several years. If you’re unsure where to get started, find a doctor who has specialized mTBI/concussion training and get an evaluation. And if you aren’t improving and they aren’t referring you out for further evaluation, then find someone else. There is not one doctor on this planet who knows how to fix every symptom in every patient. It really can sometimes take a village…or as I like to say a team. Find team players and get your life back.