What a Post Concussion Evaluation Covers

People put off a post concussion appointment partly because they do not know what happens in one. The word evaluation sounds like a test you could fail, or like a long day in a hospital gown. In practice it is mostly a conversation, a short physical exam, a few paper or tablet questionnaires, and a decision about where you go next. Here is what that hour usually contains, so you can walk in knowing the shape of it.

One note before the details. When mood rather than headache is the thing that brought you in, name it inside the first two minutes. A visit leans toward whatever gets said early, and a mood change following an injury stands on its own as a reason to be sitting there.

What gets collected before anyone examines you

Expect questions about the event itself. When did it happen, what hit what, were you wearing a helmet or a seatbelt, did anyone see it, were you confused afterward, did you vomit, did you keep playing or keep working. If you cannot remember parts of it, say that, because a gap is clinically meaningful rather than an embarrassment.

Then comes the history around the event. Previous concussions and roughly when. Migraines or bad headaches before the injury. Motion sickness, ADHD, learning differences, prior anxiety or depression, and any mood medication you have taken, including ones you stopped. Sleep apnea. Alcohol, cannabis, and nicotine use, and whether any of that changed after the injury. None of it is asked to catch you out. Each item changes how the clinician reads your current symptoms.

You will also be asked what you have stopped doing: driving at night, reading for long, screen work, lifting, exercising, going to loud restaurants. That list is the most useful thing most patients bring, and it is worth writing out at home while you can think.

What gets screened in the room

Symptom inventories come first. Plenty of clinics hand over a standard post concussion checklist that asks you to score headache, dizziness, fogginess, irritability, and sleep, alongside a short mood screen like the PHQ-9 and an anxiety screen like the GAD-7. Those tools are short on purpose. They are conversation starters and a way to compare your answers against the same questions in six weeks, not verdicts.

The physical exam is more hands on than people expect and still fairly quick. Common pieces include eye movement tracking, looking for pain or nausea when your eyes follow a finger, convergence testing for near focus, balance with your feet together and your eyes closed, neck range of motion and tenderness, a brief strength and reflex check, and sometimes a short walk while turning your head. Some clinics add a brief computerized attention and reaction task. If something provokes symptoms, that is information, and you should say so out loud when it happens rather than pushing through quietly.

Neck and vestibular findings get specific attention because they often explain symptoms people attribute to the brain alone. Dizziness with head turns, pain at the base of the skull, and tight upper back muscles are frequently treatable with physical therapy, and sorting that out early can take one layer off the pile.

Imaging, and what a normal scan actually means

Most people with a concussion do not need a scan at the evaluation. When a CT is ordered it is looking for bleeding or a fracture, which are urgent problems, and it is not designed to show a concussion. An MRI may be ordered if symptoms are unusual, focal, or not improving. Clean imaging does not mean you invented the symptoms, nor that the appointment is finished. What it does mean is that the dangerous structural problems are off the table, and attention shifts to function and to how you feel day to day.

What a referral looks like on the way out

Most evaluations end with two or three referrals rather than a single answer. Vestibular or vision therapy for balance and focus. Physical therapy for the neck. A gradual return to activity plan with specific limits, rather than rest until you feel normal, which is no longer the standard advice. A letter for work or school with accommodations such as shorter screen blocks, a later start time, or no contact practice. And, if mood or sleep is part of the picture, a behavioral health referral with a name and a phone number attached.

That last referral is where depression gets its own track. Past head trauma belongs on the short list of reasons a depressive episode may refuse to yield to one antidepressant, or to the next, which is exactly why the medication history and the follow up calendar both get attention. That history alone does not make ketamine or esketamine indicated, and a careful clinician will say as much. Should either one come up down the road, the reason will be a depression already treated without improvement, and no approval exists for either drug covering concussion or brain injury.

For symptoms that date to a single crash or fall, a clinic in this region called Brain Recovery Centers publishes an explainer organized around the date of the accident, and it previews the questions that tend to follow an impact history.

Before you leave, ask these

What do you think is driving the worst symptom right now. What am I allowed to do this week, and what should I hold off on. Which referral matters most if I can only get to one. When do you want to see me again, and what would make me call sooner. Who reads the results of the therapy visits, and will my primary care doctor get a copy.

Take notes or bring someone who can. Attention is often the symptom that makes an appointment hard to remember, and a second set of ears costs nothing. If you leave without a written plan, call the office and ask for one, because the plan is the part you actually use.