Who can help with persistent concussion symptoms? Understanding your care team
Learn who treats each lingering symptom and how to ask for the referral you need
Imagine a 34 year old dental hygienist whose bike was clipped by a turning pickup truck. Seven weeks later, she still gets dizzy when she leans over a patient. Reading charts brings on a headache, and she wakes at 3 a.m. most nights. Her family doctor has been kind and careful, but she wonders who else should be involved.
When symptoms last, the list of possible helpers can feel long. Many titles sound alike. You may not know which person handles which problem, or how to raise a referral without feeling pushy.
Below, you will find a map of the professionals who treat lasting concussion symptoms and the points where guidelines suggest bringing them in. Near the end are a planning sheet and words you can use at your next visit.
Start with your primary care team
Primary care is the family medicine, internal medicine or general practice office you use for most health needs. Most adults whose head injury did not need a hospital stay can get their concussion care here [1]. That is the view of a 2025 U.S. guideline from the Action Collaborative on TBI Care [1]. A 2021 guideline written for military and veteran health systems (VA/DoD) also suggests care led by primary care that targets each symptom [2].
Canada’s Living Concussion Guidelines, updated in 2023, ask primary care to watch for anyone whose recovery does not follow the expected pattern [6]. They add that headaches, poor sleep and mood changes are often the hardest lasting symptoms [6]. Neck pain and other body pain should be checked as well [6]. For headaches that start in the neck, the 2025 guideline says hands on treatment of the neck, called manual therapy, may also help [1]. Ask your clinician who offers that care near you.
What your primary care clinician can do
- Look at all your symptoms together and check for other health problems.
- Screen for anxiety, depression and posttraumatic stress. The 2025 guideline strongly recommends this check, both for new problems and for earlier ones that have flared since the injury [1].
- Start first treatments and write referrals.
- Keep track of your care when several specialists are involved.
Some people play down how they feel at visits. The 2025 guideline notes that bringing a family member or caregiver into the assessment can help [1]. A partner or friend may have noticed changes you have missed.
For the hygienist, a good first visit might cover her sleep, her mood and her medicines. Her doctor can then decide which problems need a specialist and which can be handled in the office.
When a referral makes sense
The 2025 guideline lists three situations where a referral to specialty care should be considered [1]:
- Your symptoms are still disabling more than 30 days after the injury.
- First treatments in primary care are not helping.
- You have a high risk of lasting symptoms.
The guideline rates this advice “weak for.” That means the evidence is limited, so clinicians should consider it when it fits your own preferences and values [1]. It also notes that up to 1 in 3 people may still have symptoms after 30 days that get in the way of daily life [1].
Canada’s guideline gives similar advice its top grade of evidence. People whose symptoms last more than a month should be considered for referral to an interdisciplinary concussion clinic [6]. Interdisciplinary means a group from several fields, such as neuropsychology, physical therapy and occupational therapy, that plans your care as a team [6].
A clinic or one experienced clinician?
If you have many symptoms, you will usually do best at an interdisciplinary TBI clinic, the 2025 guideline says [1]. If no clinic is within reach, or you have only one or two main symptoms, one clinician with TBI experience may be enough [1]. It names a neurologist, a physical therapist or a rehabilitation medicine doctor as examples [1].
A clinic can also be the wrong choice. The same guideline warns that sending someone who is recovering well to a clinic could cause harm [1]. Clinics that skip quality standards raise that risk [1]. For mild TBI, the VA/DoD guideline says the evidence is too thin to back or rule out specialized programs [2].
What a good clinic looks like
The Living Concussion Guidelines publish standards for concussion clinics [7]. They were written for Ontario, Canada, but they make a useful yardstick anywhere. Look for a clinic that:
Checklist from Safety Behind the Wheel Foundation
- Has at least three different kinds of health professionals on its team [7].
- Gives the team direct, ongoing access to a doctor experienced in concussion care [7].
- Uses licensed, regulated professionals to treat concussion symptoms [7].
- Makes clear what each team member does [7].
- Offers treatments supported by evidence or by guidelines [7].
Who does what on a concussion care team
The table below is a quick map. Titles and roles overlap, and they vary by state, health system and insurer. Treat it as a starting point for questions.
Comparison compiled by Safety Behind the Wheel Foundation
Who does what on a concussion care team
| Professional | Often helps with | Ask about |
|---|---|---|
| Primary care clinician | First checks, mood screening, referrals, coordination | License; board certification |
| Physiatrist (rehabilitation doctor) | Recovery plan, function, leading a rehab team | Board certification; brain injury medicine |
| Neurologist | Harder to treat headaches; unexpected scan findings | Board certification; brain injury medicine |
| Physical therapist | Dizziness, balance, vision exercises | License; vestibular training |
| Occupational therapist | Daily tasks, vision rehab, thinking skills | License; OTR certification |
| Speech language pathologist | Attention, memory, language, thinking skills | License; ASHA certificate |
| Neuropsychologist | Detailed tests of thinking skills | Psychology license; ABPP board certification |
| Mental health professional | Anxiety, low mood, PTSD, insomnia therapy | License; type of therapy offered |
| Optometrist or ophthalmologist | Focusing, eye teaming, blur, light sensitivity | License; concussion experience |
| Audiologist | Hearing loss, ringing, sound sensitivity | License; ASHA certificate |
| Sleep specialist | Lasting insomnia, daytime sleepiness, sleep apnea | Sleep medicine board certification |
Sources: 2025 adapted guideline [1]; VA/DoD [2]; Living Concussion Guidelines [8, 9, 10, 11]; MSKTC [12]; ABMS [3]; ABPN [13]; AACN [14]; AASM [15]; ASHA [4]; NBCOT [5]. Roles vary by area.
Doctors who guide medical care
A physiatrist is a doctor who specializes in physical medicine and rehabilitation. These doctors treat problems of the muscles, bones and nervous system, including brain injury, and may lead a rehab team [3]. The MSKTC, whose full name is the Model Systems Knowledge Translation Center, advises taking recovery questions to a physiatrist [12].
A neurologist focuses on the brain and nerves. The 2025 guideline mentions neurology when a scan shows a possible problem that the ordering doctor does not know well [1]. It adds that specialty care can help sort out headache types that are harder to treat [1].
Some doctors hold an extra credential called brain injury medicine. It is open to neurologists, psychiatrists and physiatrists, and it requires a year of accredited fellowship training in brain injury care [13]. Sports medicine is a related field. The 2025 guideline says elite athletes will likely benefit from sports medicine clinicians [1].
Therapists for balance, vision and thinking
Vestibular means your inner ear balance system. Vestibular rehabilitation is an exercise program for dizziness, and the VA/DoD guideline names physical therapists and occupational therapists as the specialists who provide it [2]. Canada’s guideline recommends this therapy for dizziness that limits daily life [8]. Some people develop an inner ear problem called BPPV. If one to three treatments have not cleared it, the guideline points to an ear, nose and throat doctor or a clinician certified in vestibular rehab [8].
For eye problems that limit your day, referral may go to an ophthalmologist, an optometrist, an occupational therapist or a physical therapist with vision training [8]. Double vision or other complex eye symptoms call for a neuro ophthalmologist [8]. Trouble focusing, aiming both eyes together or tolerating light may improve with help from a qualified optometrist [8].
For thinking problems, the MSKTC says the therapy itself often comes from an occupational therapist, a speech therapist or a neuropsychologist [12]. Speech language pathologists can also check for aphasia, which means trouble finding, saying or following words [12].
Testing your thinking skills
A neuropsychologist gives detailed tests of memory, attention and other thinking skills, and the results can shape a treatment plan [12]. Canada’s guideline lists four signs that a referral may fit [9]:
- Thinking problems limit your daily life.
- Other issues that affect thinking, such as sleep or mood, have been well managed.
- Your thinking is no longer improving.
- The problems have lasted longer than 4 weeks.
Waits can be long. In that case, Canada’s guideline points to occupational or speech therapists who have concussion training [9]. The 2025 guideline adds that formal testing can be offered to help you plan your return to a job, classes or sport [1].
Mood, stress and sleep
Mental health professionals include social workers, psychologists and psychiatrists [16]. For mental health conditions after concussion, Canada’s guideline recommends talk therapies such as cognitive behavioral therapy, or CBT [11]. The therapist does not need to be a concussion specialist [11]. If symptoms are severe or complex, for example if suicide is a risk, the referral should happen right away [11].
For insomnia, the same guideline recommends referral for CBT designed for sleep [10]. A sleep specialist or a sleep study should be considered if insomnia or daytime sleepiness keeps going, or if another sleep disorder such as sleep apnea is suspected [10].
If you are struggling right now
If thoughts of ending your life show up, or you fear you may not stay safe, please reach out today. The 988 Lifeline answers calls and texts at 988 and online chats at 988lifeline.org [17]. Veterans who dial 988 can then press 1, or they can send a text to 838255. Pressing 2 after dialing 988 connects you in Spanish [17]. If a life is in danger this minute, phone 911.
Hearing and ringing ears
If everyday sounds feel too loud, or you notice hearing loss or ringing, Canada’s guideline advises a hearing test by an audiologist when no other cause is found [8]. For ringing in the ears, called tinnitus, the guideline’s background notes point to a neuro otolaryngologist, an ear doctor who focuses on nerve related problems [8]. It adds that no single tinnitus treatment after concussion has evidence for or against it [8].
How to check training and credentials
Ask every professional for a state license number, then look it up on your state licensing board’s website. Then check any extra credentials that matter for your symptoms.
The American Board of Medical Specialties website offers patients a tool to check whether a doctor is board certified [3]. Brain injury medicine is listed as a separate subspecialty [3, 13]. Sleep medicine is a subspecialty too, certified through several ABMS member boards, such as internal medicine, family medicine, and psychiatry and neurology [15].
The title neuropsychologist can mean different things. The American Academy of Clinical Neuropsychology points out that in most states, any licensed psychologist may use it, even without proven training in brain conditions [14]. Board certification through the American Board of Professional Psychology (ABPP) is one way to tell training apart [14]. It requires a demanding review by ABPP’s clinical neuropsychology board [14]. The academy’s directory lists board certified members by name and location [14].
The American Speech Language Hearing Association (ASHA) awards a Certificate of Clinical Competence to speech language pathologists and audiologists, and its website lets you verify it [4]. Occupational therapists may hold the OTR credential, short for Occupational Therapist Registered [5]. It shows they passed a national exam and keep their skills current, and the board offers a lookup tool [5].
Credential check
Checklist from Safety Behind the Wheel Foundation
- State license is active, with no limits I should ask about.
- Board certification or specialty certificate, if the role has one.
- Experience with concussion or brain injury, in their own words.
- Vestibular, vision or sleep training, if that is why I am going.
- A clear answer about how they will share notes with my other clinicians.
How to ask for a referral
Referrals go more smoothly when you give clear facts. Describe what the symptom stops you from doing, how long it has lasted and what you have already tried. Then ask an open question about next steps.
Use the planning sheet below before your visit. Fill in one row for each symptom that still limits you.
Worksheet from Safety Behind the Wheel Foundation
My referral planning sheet
| Symptom | What it stops me doing | Who might help | Asked on |
|---|---|---|---|
| Example: dizzy when bending | Cleaning teeth, carrying laundry | Vestibular therapist | Oct 12 |
Bring this sheet to your visit and update it after. Timing guides: 30 days [1]; one month [6, 8].
Imagine the hygienist uses these words at her next visit. Her doctor agrees that the dizziness has lasted past the 30 day mark and refers her to a vestibular therapist. Her doctor also starts a sleep plan and books a follow up in four weeks to review her headaches.
Referrals and your health plan
The Brain Injury Association of America (BIAA) explains that HMO plans usually cover care only inside the plan’s network, except in emergencies [18]. PPO plans let you go outside the network, but care usually costs more, and some services may need a referral or prior approval [18]. A network is the set of doctors, hospitals and other providers that have a deal with your insurer [18].
Care outside your network can cost you more, and some plans will not pay for it [18]. Your insurer can tell you which local providers your plan covers [16]. The BIAA also suggests getting a full copy of your policy so you can learn its rules and limits [18].
When you call your plan, ask:
- Does this service need a referral or prior approval?
- Which in network providers treat concussion, dizziness or vision problems?
- How many therapy visits are covered each year?
- Can some visits happen by video?
If a service is denied, ask why, and ask how to appeal, since plans often have more than one level of appeal [18]. Note the date of each call, who answered and what they told you. If the crash involves auto insurance or a claim, coverage rules differ by state and by policy, so check your own policy or your state insurance department.
Questions to ask about your care team
Question checklist from Safety Behind the Wheel Foundation
- Who is coordinating my care, and who should I call when something changes?
- Which of my symptoms can we manage here, and which need a specialist?
- Am I at higher risk of lasting symptoms, and how does that change the plan?
- Would one specialist or a concussion clinic fit me better, and why?
- Has anyone checked my neck, balance, vision and hearing?
- Should I be screened for anxiety, depression or posttraumatic stress?
- Would testing of my thinking skills help me plan a return to work?
- What training in concussion care do you or the person you are referring me to have?
- What should change, and by when, for us to call this plan a success?
Frequently asked questions
Do I need a concussion clinic to get better?
Not always. Most adults can be cared for in primary care [1]. A clinic fits best when a month has passed and more than one symptom still gets in your way [1, 6]. One experienced clinician may be enough if you have one or two main problems [1].
What if no concussion specialist is near me?
The 2025 guideline suggests one clinician with TBI experience when a clinic is hard to reach [1]. For thinking problems, Canada’s guideline names occupational therapists and speech language pathologists with concussion training as options [9]. Ask whether some visits can happen by video.
Can I see a specialist without a referral?
It depends on your plan. Some plans need a referral or prior approval, and going outside the network may cost more or not be covered [18]. Call the number on your insurance card before you book.
Who keeps everyone on the same page?
Usually your primary care team. Ask each specialist to send notes to that office, and keep your own copies of reports and referral letters.
The bottom line
Recommendation from Safety Behind the Wheel Foundation
Many people recover with help from their primary care team. When symptoms still disrupt life after about a month, guidelines suggest asking about a referral [1, 6]. That may mean one clinician with brain injury experience or a clinic with several kinds of professionals [1].
Before you book, check licenses and credentials. At the visit, describe each symptom by what it stops you from doing. Rules on referrals and coverage differ by plan and by state, so check your own health plan, any auto policy and your state insurance department before you book.
Sources and further reading
- 1Silverberg ND, Lee K, Mikolić A, et al. Action Collaborative on Traumatic Brain Injury Care: adapted clinical practice guideline. Annals of Family Medicine. 2025;23(6):552-569. annfammed.org/…/552.full-text.pdf
- 2Department of Veterans Affairs and Department of Defense. VA/DoD clinical practice guideline for the management and rehabilitation of post-acute mild traumatic brain injury, version 3.0. Provider summary. 2021. healthquality.va.gov/…/VADoDmTBICPGProviderSummaryFinal508.pdf
- 3American Board of Medical Specialties. American Board of Physical Medicine and Rehabilitation. Accessed October 2026. abms.org/…/American-board-of-physical-medicine-rehabilitation
- 4American Speech-Language-Hearing Association. Certification. Accessed October 2026. asha.org/certification
- 5National Board for Certification in Occupational Therapy. What does it mean to be board certified by NBCOT? Accessed October 2026. nbcot.org/…/what-is-an-otr-or-cota
- 6Living Concussion Guidelines. Section 5: Management of prolonged symptoms. Updated April 2023. concussionsontario.org/…/management-of-prolonged-symptoms
- 7Living Concussion Guidelines. Standards for concussion clinics. Ottawa Hospital Research Institute. Accessed October 2026. concussionsontario.org/…/standards-for-concussion-clinics
- 8Living Concussion Guidelines. Section 10: Vestibular (balance/dizziness) and vision dysfunction. Updated May 2023. concussionsontario.org/…/vestibular-balance-dizziness-vision-dysfunction
- 9Living Concussion Guidelines. Section 9: Cognitive difficulties. Updated May 2023. concussionsontario.org/…/cognitive-difficulties
- 10Living Concussion Guidelines. Section 7: Sleep-wake disturbances. Updated May 2023. concussionsontario.org/…/sleep-wake-disturbances
- 11Living Concussion Guidelines. Section 8: Mental health disorders. Updated April 2023. concussionsontario.org/…/mental-health-disorders
- 12Neumann D, Lequerica A. Cognitive problems after traumatic brain injury. Model Systems Knowledge Translation Center; 2020. msktc.org/…/cognitive-problems-after-traumatic-brain-injury
- 13American Board of Psychiatry and Neurology. Brain injury medicine. Accessed October 2026. abpn.com/…/brain-injury-medicine
- 14American Academy of Clinical Neuropsychology. About board certification. Accessed October 2026. theaacn.org/about-board-certification
- 15American Academy of Sleep Medicine. American Board of Anesthesiology receives ABMS approval to offer sleep medicine exam. Undated news item. Accessed October 2026. aasm.org/…/american-board-of-anesthesiology-receives-abms-approval-to-offer-sleep-medicine-exam
- 16National Institute of Mental Health. Help for mental illnesses. Last reviewed April 2026. nimh.nih.gov/health/find-help
- 17988 Suicide and Crisis Lifeline. Get help. Accessed October 2026. 988lifeline.org/get-help
- 18Brain Injury Association of America. Health insurance tips. Updated May 2026. biausa.org/…/health-insurance-tips
This article reflects the safety priorities of concussion recovery and road safety education. It offers general education about care teams and referrals, not medical, insurance or legal advice. Roles, credentials and plan rules differ by state and insurer, so check official sources and your own plan, and talk with your own care team about what fits your situation. Reviewed October 2026.
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