You did not have to black out to have a brain injury

You did not lose consciousness. The CT was normal. You were told you were fine. Weeks later you cannot read a screen without a headache, you lose the thread of conversations, and light feels too bright.

That combination is common. It is not evidence that nothing happened.

Concussion Center, on Woodson Rd in St. Louis next to the airport, exists for that patient. It is directed by Dr. Gurpreet Singh Padda, MD, MBA, MHP, board certified in anesthesiology, pain medicine, interventional pain, addiction medicine and obesity medicine, and a certified rater for the Montreal Cognitive Assessment (background). No referral required.

Not sure whether you belong here, at urgent care or in an ER? Tap the directory assistant, the light in the corner of the page.

Can you have a concussion without blacking out?

Yes. Blacking out is the exception.

The American Congress of Rehabilitation Medicine definition, revised by the World Health Organization, requires a Glasgow Coma Scale of 13 to 15 plus any one of four: loss of consciousness under 30 minutes, memory loss around the event under 24 hours, confusion or disorientation at the time, or a brief neurological deficit. Dazed at the roadside counts. A few lost seconds of memory counts. A moment of double vision counts.

The numbers are consistent. Among 17,549 high school and college football players, only 8.9% of 888 concussions involved loss of consciousness, while 86% involved headache. In a national high school surveillance year of 544 concussions, 4.6% lost consciousness. That puts 91% to 95% of concussions with no blackout.

Does blacking out mean a worse concussion?

No. In 1,507 NCAA athletes tracked for post-concussion syndrome, symptoms lasting four weeks or more, loss of consciousness showed no association at all. What predicted a longer recovery:

• A previous concussion (odds ratio 2.08)
• Memory loss for events before the injury (2.75)
• Difficulty concentrating (2.35)
• Insomnia (2.19)
• Light sensitivity (1.97)

The one sign used at the roadside, on the sideline and in the claims file to separate real concussions from imagined ones predicts nothing. The signs that do predict are the ones dismissed as subjective.

Undiagnosed does not mean harmless either. In two concussion clinics, 30.5% of athletes reported a prior head blow with symptoms that was never diagnosed, and they scored worse when concussed again.

Does a concussion show up on a CT or MRI?

No, by design. A head CT looks for bleeding, skull fracture and mass effect, the injuries that need a neurosurgeon tonight. Concussion is a diffuse functional disturbance with no lesion for the scanner to resolve. A normal CT means you are not in surgical danger. It starts the evaluation. It does not end it.

MRI finds lesions CT misses and matters when symptoms are not following the expected course or the injury burden needs documenting. A normal MRI is the expected result in an uncomplicated concussion.

The GFAP and UCH-L1 blood tests, within 12 hours of injury, rule out a lesion that would show on CT with a negative predictive value around 97%. They are not a blood test for concussion.

Why is concussion an energy crisis?

The injured brain needs more fuel at the exact moment its ability to meet that demand collapses. A flood of the excitatory neurotransmitter glutamate is a defining early event, and every attempt to restore order costs energy the cells cannot produce.

Now drop that mismatch into a typical adult hurt in a crash or a fall at work. Insulin resistance, type 2 diabetes, obesity, obstructive sleep apnea, vascular disease: common in that population. A brain that already struggles to use glucose, or goes short of oxygen all night, starts recovery in the hole. Then come the years that follow: not being believed, cycling through clinicians, fighting a claim, losing work and role. That is a prolonged, inescapable stressor in its own right.

The research the field runs on studied young, healthy, closely monitored athletes and excluded older adults, prior head injuries, diabetes, obesity, sleep apnea and vascular disease. So when a 54-year-old with poorly controlled diabetes and untreated sleep apnea misses a timeline drawn from college football players, the patient is not exaggerating. The evidence base never included them. The metabolic terrain is treated here alongside the injury, not handed off as someone else's problem.

How is a concussion diagnosed?

Clinically, with targeted testing chosen by your history. No fixed panel.

Balance and eye movement

The most productive exam in persistent concussion is the vestibulo-ocular system, how the eyes and balance apparatus work together. Dysfunction there is common, invisible to imaging, and costly: in young patients at a concussion program it carried roughly four times the odds of post-concussion syndrome and a median 40 days of symptoms instead of 21.

Videonystagmography records eye movement with infrared goggles: ocular testing as you track targets, positional testing as head and body move, and caloric testing of each ear separately, so an asymmetry is measured rather than reported.

Memory and thinking

• MoCA, a structured screen of attention, memory, executive function, language and orientation. It is only as good as its scorer, and Dr. Padda is a certified rater.
• Cognivue, a self-administered computerized test that removes examiner variability and tracks memory, visuospatial processing and reaction time across visits.

Movement

Kinetisense markerless motion capture quantifies posture, balance and movement from video. Impressions become numbers, and a measured deficit exists independently of what the patient says.

Symptom tracking

The same instruments at intake and follow-up, RPQ and BC-PSI for post-concussive symptoms, PCL-5 or CAPS-5 for trauma, so the trajectory is data.

Quantitative EEG, functional MRI, impact sensors and emerging biomarker assays are named honestly: useful lines of work, none a replacement for the clinical exam.

How is a concussion treated?

Not with a dark room. Prolonged rest slows recovery in many patients. Treatment targets what the exam finds.

A headache driven by an eye-movement problem, dizziness from the inner ear, a picture dominated by broken sleep, and a headache that is really coming from the neck are four problems wearing one label. The tools:

• Vestibular and oculomotor rehabilitation, the best-supported intervention where dysfunction is found
• Graded return to activity, symptom-guided, after a day or two of relative rest
• Sleep and headache treatment, the highest-yield early targets, because both amplify everything else
• Interventional treatment of neck-origin headache where a block identifies it
• Metabolic care
• Acceptance and Commitment Therapy, in-house

Why sleep, and why not a sleeping pill?

Insomnia independently predicts persistent symptoms, and disrupted sleep drives headache, poor concentration and low mood. Suspected sleep-disordered breathing is investigated, because no rehabilitation outruns a brain starved of oxygen nightly.

Benzodiazepines are the default elsewhere. Not here. They impair the formation of new memories. Long-term use also flattens slow-wave sleep, the stage where the hippocampus consolidates exactly the memories concussion patients say they are losing. The drug hits the injured system twice: once while awake, once while asleep. Add sedation and fall risk in someone at risk of a second head injury.

The clinic reaches instead for low-risk adjuncts. Glycine lowers core body temperature, the body's own trigger for sleep onset, rather than sedating. GABA works through the gut and the vagus nerve rather than crossing into the brain. The evidence tier is stated plainly: no randomized trial of either in concussion, small human glycine data, mechanistic GABA work mostly in mice. They support sleep hygiene, headache treatment and breathing workups. They replace none of them.

Can therapy help?

Yes, and it does not mean the symptoms are psychological. A real vestibular injury sets off a second problem: fear of whatever provokes symptoms. Avoidance protects for a week and traps for months. In a prospective study of working adults with mild brain injury, persistent fear-avoidance predicted still being off work 6 to 9 months later. ACT cuts the avoidance and rebuilds activity toward what the person wants their life to contain. Delivered in-house, it runs with the physical rehab, not on a separate track.

What should you eat?

Do not under-eat: fuel demand is up. Hydrate, since dehydration worsens headache on its own. Skip alcohol, which disrupts sleep and lowers the seizure threshold. Omega-3s, magnesium and creatine have plausible mechanisms and early support: reasonable, low risk, not established treatment.

Other adjuncts, by evidence

• Transcranial magnetic stimulation: encouraging, not definitive
• Virtual reality rehabilitation: a delivery method for graded vestibular and cognitive work
• Whole body vibration: emerging
• Thermal therapies, cooling and sauna heat: plausible, early

Is my headache from the concussion or my neck?

Often both. The force that concusses the brain in a rear-end collision strains the upper cervical spine and the nerves running through it.

Occipital neuralgia and cervicogenic headache start at the base of the skull, are often one-sided, can feel sharp or electric, and flare with neck movement. Pressing over the occipital nerve often reproduces the headache. Post-concussive headache is more diffuse or frontal, worsens with screens and thinking, and travels with light sensitivity, fog and poor sleep.

An anesthetic occipital nerve block settles it. Numb the nerve, the headache stops, the nerve was the source. The block is a procedure performed here, not a referral, which is what a concussion practice run by an interventional pain physician brings. Longer control: pulsed radiofrequency of the occipital nerves for occipital neuralgia, radiofrequency of the cervical facet joints for cervicogenic headache. Misfile a neck headache as post-concussion syndrome and the patient gets patience instead of the procedure, sometimes for years.

Headache without an injury: see headache and migraine treatment.

What are the long-term effects?

Most concussions clear in one to four weeks. The minority whose symptoms persist are not lying. They are what a minority means.

The damage lands on sleep, concentration and income: rereading the same paragraph, losing the thread of a meeting, work that takes twice as long. Return-to-work figures diverge sharply. A New Zealand study of 175 working adults found only 53% back at work-related activity 6 to 9 months after mild TBI. A Finnish cohort of 113 adults found 98% fully back at one year, with a median of 6 days for uncomplicated injuries, 17 with intracranial lesions and about 31 with multiple lesion types on MRI. Most people return. The tail is long for a minority. Anyone quoting one number is choosing which study to mention.

Can a concussion cause PTSD?

It can, and the same crash often causes both. In civilians, a meta-analysis found PTSD after brain injury in 12.2% at three months and 18.6% at twelve, roughly a 70% increase in risk, with the authors' own warning that the studies varied widely. Complex PTSD adds emotional dysregulation, a negative sense of self and relationship trouble, and it is routinely misfiled as the brain injury, depression or personality. Pattern tells them apart: what provokes symptoms, how they respond to mental versus emotional load, whether vestibular findings exist. Both get identified before either plan is built. Where psychiatric care is needed, the clinic says so and helps you get there.

What does Concussion Center not treat?

It treats concussion and mild TBI, persistent post-concussive symptoms, injuries without loss of consciousness or with normal imaging, and symptoms months or years out. A late assessment beats none.

It does not provide emergency or trauma care, neurosurgery, or inpatient rehabilitation for moderate to severe injury.

Dr. Padda is not a neurologist. He is an anesthesiologist who specialized in pediatric neuroanesthesia: the brain under physiological stress, cerebral perfusion, intracranial pressure, oxygenation. That is closer to post-concussive care than the label suggests. If you need neurology, neurosurgery or a rehab program, you are told so and helped there.

Call 911 for worsening headache, repeated vomiting, seizure, weakness or numbness, slurred speech, growing confusion, or anyone who cannot be roused.

How does a concussion hold up in an injury claim?

Two facts will be used against you: no loss of consciousness and a normal scan. Neither means what it is presented to mean, and a denial does not answer them. A record does: a contemporaneous account of the mechanism, objective vestibular and eye findings, repeated symptom measures, a functional before and after, and a causation opinion with the reasoning written out. Delay gets read as nothing happened, so be seen early.

Where impairment lasts, the clinic supplies the clinical foundation a life care planner builds on. It gives no legal advice and predicts no settlement values. See Accident and Injury Experts and medical-legal pain documentation.

How do I book?

4477 Woodson Rd, Suite 105, St. Louis, MO 63134, next to the airport, serving Missouri and Illinois. Call (314) 887-5866 or text (314) 886-5902. Monday through Friday, 8:00 AM to 5:00 PM. Book online or send a request for a callback. Bring ER or urgent care records with imaging reports, an account of the first minutes after the injury, your symptoms and what changes them, your medications, and any claim reference. The clinic is part of the pain and metabolic medicine hub. A same-day head check that is not an emergency can also start at Express Urgent Care.

Frequently asked questions

Is a concussion the same as a TBI?

A concussion is a mild TBI. Mild is GCS 13 to 15, moderate to severe 3 to 12. The mild label describes the score, not the symptoms.

My injury was years ago. Is it too late?

No. Vestibular and eye-movement problems can be found and treated long after, and many patients here were told years ago to wait it out.

Do I need all of these tests?

No. Dizziness and visual intolerance point to vestibular work. Memory and concentration point to cognitive testing. The history decides.

Is a nerve block a permanent fix for neck headache?

Usually not alone. Its early value is answering where the pain comes from. Radiofrequency is the step for longer control.

Could a long claim itself cause complex PTSD?

It can contribute. Years of disbelief, repeat examinations and lost work are a sustained stressor, so the clinic assesses for it rather than blaming everything on the brain injury.