Your scan was normal, but you still feel unwell after a crash: questions to ask next
Learn what a clear scan rules out and which questions can guide your next visit
Imagine a 47 year old school bus mechanic whose pickup was rear ended at a red light. At the emergency room, a CT scan of her head came back clear. Six weeks later, she has headaches most afternoons, a stiff neck and a foggy feeling at work. Busy stores make her dizzy, and she is tired all the time.
When she brings it up, friends say, “But your scan was fine.” She starts to wonder whether she is imagining things, or whether something was missed.
A normal scan answers some questions well and others not at all. Knowing which is which can help you talk with your care team and skip tests that will not help.
What a head scan after a crash is built to find
A CT scan takes fast pictures of the brain and skull. The American College of Radiology (ACR) rates when each kind of imaging makes sense. Its head trauma ratings were last updated in 2021. They say head CT is very good at spotting early problems that may need surgery, such as bleeding, brain shift or a buildup of fluid [1].
Most people with a mild head injury get a clear CT. The ACR notes that 10 percent or fewer of CT scans after mild head trauma show an injury [1]. A clear result is good news about emergencies, but it does not rule out a concussion.
Concussions rarely show up on standard scans. A 2023 news release about new diagnostic criteria from the American Congress of Rehabilitation Medicine (ACRM) made this point [6]. It added that symptoms can be subtle and can overlap with other conditions [6]. The new criteria can draw on blood tests and on checks of thinking, balance and vision [6].
Guidelines agree that scans are not the way to confirm a concussion. A 2025 U.S. guideline comes from the Action Collaborative on TBI Care. It says that once the first days have passed, brain scans are generally not needed to confirm or exclude a TBI [2]. The 2021 guideline for military and veteran care (VA/DoD) suggests against using brain imaging or blood tests to diagnose mild TBI [3].
What imaging can and cannot show
Each test answers a narrow question. The table below sums up what common tests after a crash are designed to show.
Comparison compiled by Safety Behind the Wheel Foundation
What tests after a crash can and cannot show
| Test | What it can show | What it cannot show |
|---|---|---|
| Head CT | Bleeding, brain shift or fluid buildup that may need surgery | Most concussions; why you feel dizzy, foggy or tired |
| Brain MRI | Small bleeds and white matter injury CT can miss | A reliable forecast of your recovery |
| Neck CT | Broken bones in the neck | Some ligament and disc injuries; whiplash |
| Neck MRI | Discs, ligaments and other soft tissue | Whether a finding explains whiplash symptoms |
| GFAP and UCHL1 blood test | Within 24 hours, whether a head CT is likely needed | A concussion weeks later |
Sources: ACR head trauma criteria [1]; 2025 adapted guideline [2]; FDA clearance [7]; ACR spine trauma criteria, 2024 [8].
MRI
MRI is a different kind of scan. The ACR says it is more sensitive than CT for small bleeds and for injury to white matter, the nerve fibers that link parts of the brain [1]. For head trauma that is weeks or months old, the ACR calls brain MRI the most useful first scan [1]. It rates MRI as usually appropriate when thinking or nerve problems remain unexplained [1].
The 2025 guideline adds an important limit. A brain MRI or CT is not meant to be routine for everyone with lingering symptoms [2]. Clinicians may consider one when the exam shows unusual features or when symptoms keep getting worse [2]. Older guidelines advised against using scans to predict recovery because the evidence was too thin, though research continues [2].
If you ask for a scan that is not needed, the guideline says your clinician should explain why it would be unlikely to change your care [2]. It also asks clinicians to be ready for shared decision making, which means you weigh the choice together [2].
The blood test for brain injury
A 2024 FDA clearance covers a test run on whole blood. It checks levels of two proteins, called GFAP and UCHL1 [7]. The clearance is for people age 18 or over who may have a mild TBI and are tested in the first 24 hours [7]. Its job is to help the care team judge whether a CT of the head is worth doing [7]. A result marked “not elevated” tends to match a CT with no fresh injury inside the skull [7]. The result is read alongside other clinical information, and the clearance does not reach past that first day [7].
Your neck
Two checklists, called the Canadian cervical spine rule and NEXUS, help clinicians decide who needs a neck scan after a crash [8]. The ACR’s spine trauma ratings, revised in 2024, do not recommend neck imaging for adults 16 to 64 who meet the low risk criteria [8]. When a scan is needed, the ACR recommends CT first, since it finds neck fractures far better than plain X-rays [8].
For whiplash, the ACR says imaging has limited value because the diagnosis rests mainly on clinical findings [8]. Imaging may still help if signs of an unstable neck show up late or were missed at first [8]. MRI shows soft tissue well, but its findings generally do not match whiplash symptoms or how they change [8]. A 2009 article in a Canadian medical journal made a related point: wear and tear in the neck is common in people with no symptoms, especially older adults [9].
Why you can feel unwell when the scan is clear
Symptoms that last for months after a head injury are common. TRACK TBI, a large U.S. study, followed 2,039 people age 17 and older with TBI [4]. All were treated at level 1 trauma centers and had a head CT ordered [4]. A year later, more than half still rated three or more symptoms as worse than before the injury [4]. That was true in the mild TBI group too [4]. Scores did improve over time [4].
The same study compared two other groups: people with orthopedic injuries, such as broken bones, and a group of the patients’ friends [4]. They reported some of the same symptoms, so the symptoms are not unique to brain injury [4]. Still, the TBI group’s symptom burden was more than double [4]. Keep in mind that trauma center patients may have been hurt worse than many people seen elsewhere.
Looking at adults treated outside the hospital, the 2025 guideline says most are back to their normal routine in roughly four weeks [2]. As many as 1 in 3, though, have symptoms past day 30 that still interfere with work, home or other usual activities [2].
Other sources your care team may look at
Headaches, fatigue, poor focus and dizziness can come from more than one place. Canada’s Living Concussion Guidelines point out that people with long term pain, depression, anxiety or sleep disorders often report the same kinds of symptoms [5]. They give their top grade to a careful search for other causes [5]. The 2025 guideline adds that health problems from before the crash can mimic or hide concussion symptoms [2]. It also notes that emotional distress can grow out of the injury and can then help keep symptoms going [2].
Your care team may consider:
- A neck strain from whiplash. Canada’s guideline includes an exam of the neck when headaches are assessed [5].
- Problems with the inner ear balance system or with eye movements, which a clinician can check directly [5].
- Sleep problems, including sleep apnea, which is common after brain injuries of any severity [10].
- Pain from other injuries, such as sprains, bruises or broken bones [2].
- Worry, low mood or posttraumatic stress [5].
- Medicines, supplements, alcohol or other substances. Frequent use of simple pain relievers can lead to rebound headaches [5].
- Rarely, changes in hormone levels. A military fact sheet says this affects a small number of people [11]. Testing is usually not done in the first 3 months, and a specialist should order and read the results [11].
This list is for your care team to work through. You do not need to decide which item fits you. Your job is to describe what you notice as clearly as you can.
What can tell your care team more than another scan
Canada’s guideline asks clinicians to record lasting symptoms on a standard rating form [5]. It also asks them to directly check your main problem areas, such as headache, mood, sleep, balance, eye movements and thinking [5]. A review of all your medicines, supplements and substance use is part of that visit [5].
Other tests answer other questions. A sleep study, done at home or in a sleep lab, can look for sleep apnea [10]. A family member may be the first to notice snoring [10]. Some people report fewer symptoms than they really have, and the 2025 guideline says including a relative or caregiver in the visit can help [2].
Describe it, do not diagnose it
Labels such as “brain damage,” “whiplash” or “inner ear problem” are for your care team to test and decide. Plain descriptions are more useful to them. Use the sheet below for a week or two before your visit.
Worksheet from Safety Behind the Wheel Foundation
My symptom description sheet
| What I notice | When it happens | What it stops me doing | Better, worse or same |
|---|---|---|---|
| Example: ache behind my eyes | After 2 hours at the bench | Finishing a full shift | Same for 3 weeks |
Bring this sheet with the checklist below. Symptom tracking and medicine review follow the Living Concussion Guidelines [5].
Before your visit
Checklist from Safety Behind the Wheel Foundation
- List every medicine and supplement you take, with how often you take pain relievers.
- Ask someone you live with whether you snore, gasp or stop breathing in your sleep.
- Note every injury from the crash, including your neck, back, arms and legs.
- Rate your three worst symptoms from 0 to 10 once a week.
- Write down any symptom that is new or getting worse, and when it started.
- Bring copies of your scan reports, or ask the office to have them ready.
When another scan may be worth discussing
The 2025 guideline lists features that may call for a brain MRI or CT weeks after an injury [2]. Your clinician looks for them during an exam, so this is not a list to test yourself against. They include:
- A headache that is new, gets worse quickly, or depends strongly on body position.
- Alertness or thinking that gets worse later on.
- New trouble speaking or understanding words.
- Unusual eye movements or eyes that do not move together.
- Weakness in the face, an arm or a leg.
The aim of a scan at that stage is to find complications, such as bleeding that shows up late or a stroke [2]. If a scan shows something your doctor does not often see, the guideline suggests a referral to neurology or neurosurgery [2].
If a brand new symptom begins a month or more after a mild TBI, the VA/DoD guideline suggests looking at that symptom for other possible causes [3].
Canada’s guideline has separate advice for older adults. It says older people who take certain blood thinners should be scanned right away after a new head injury [12]. For people 65 and older who take blood thinners, it does not recommend routine repeat CT scans after a first scan comes back normal [12]. Your own care team can tell you which advice fits, and a blood thinner should never be stopped without your prescriber.
Get emergency care right away
These signs after a head injury mean you need emergency care now. Phone 911 right away, or go straight to the closest hospital emergency department [13]:
- Head pain that builds and does not let up.
- Weakness, numbness, decreased coordination, convulsions or seizures.
- Vomiting again and again.
- Slurred speech or unusual behavior.
- One pupil larger than the other.
- Confusion, agitation or restless behavior, or failing to recognize familiar faces or places.
- Fainting, extreme sleepiness, or nobody can wake the person.
Suicidal thoughts also need help right away. Dial or text the three digits 988 for the Lifeline, or open the chat window at 988lifeline.org [14]. Veterans who call 988 can choose option 1 or text 838255, and Spanish speakers can choose option 2 [14]. When a life is at risk this minute, phone 911.
Getting your report and making sense of it
Under the federal HIPAA privacy law, you can view your own records and ask for copies of them, X-rays and other images included [15]. Offices usually get 30 days at most to respond [15]. They may charge a reasonable fee, and you can often pick the format, for example a copy sent by email [15].
Ask for both the written report and the images. Reports use technical terms and may list findings that have nothing to do with the crash. Ask your clinician to explain each line and what it means for your symptoms.
Be careful with tests sold straight to consumers. In 2019, the FDA warned that people should not use any concussion assessment device on their own [16]. Every device the agency has cleared for concussion needs a health professional involved [16]. Unreviewed products could give a wrong answer and delay care that someone needs [16].
If your symptoms are part of an insurance or injury claim, keep copies of visit notes, test reports and your symptom sheets. Rules vary from one policy and one state to the next. Read your own policy, contact your state insurance department with questions, and talk with a qualified professional about your situation.
Questions to ask your care team
Question checklist from Safety Behind the Wheel Foundation
- What question was my scan meant to answer, and what did it rule out?
- Did the report mention anything else, and does it matter for my symptoms?
- Did my exam show anything that would make another scan useful, and what would it change?
- Could my neck, my inner ear balance or my eyes be adding to my symptoms?
- Could poor sleep or sleep apnea be part of this, and do I need a sleep study?
- Could pain from other injuries, or stress, worry or low mood, be playing a part?
- Could any medicine, supplement or pain reliever be adding to my headaches or fog?
- Can we use a standard symptom questionnaire to track my progress?
- If I am not better after 3 months, would hormone tests or a referral make sense?
- Which changes should make me phone your office, and which call for the emergency room?
Frequently asked questions
My CT was normal, so why did no one order an MRI?
The 2025 guideline does not call for routine brain scans in everyone whose symptoms linger [2]. It saves scans for unusual exam findings or symptoms that keep getting worse [2]. The ACR rates MRI as reasonable when thinking or nerve problems remain unexplained, so ask what an MRI would change in your case [1].
Can the brain injury blood test show my concussion now?
No. Its FDA clearance is about the first day after an injury, when it helps a care team decide if a CT of the head makes sense [7]. It does not explain symptoms weeks later.
Should I pay for an advanced brain scan a clinic is offering?
Talk with your care team first. The ACR found too little evidence to use these scans for one person, and the 2025 guideline does not recommend them for clinical care [1, 2].
Could my symptoms be coming from my neck?
They could be part of the picture. Canada’s guideline includes a neck exam when headaches are assessed and lists whiplash among the conditions to consider [5]. The ACR adds that whiplash is diagnosed mainly through clinical findings, so the exam matters more than a scan [8].
The bottom line
Recommendation from Safety Behind the Wheel Foundation
A normal scan is real reassurance about bleeding and other emergencies, though it cannot answer every question about how you feel [1, 2]. Many people still feel unwell weeks after a crash, and causes such as neck strain, poor sleep, pain, stress and medicines can add to concussion symptoms [4, 5].
At your next visit, describe what you notice in plain words and ask what any new test would change. Keep the emergency signs where you can see them. If a claim or coverage question comes up, check your own policy and your state insurance department.
Sources and further reading
- 1Shih RY, Burns J, Ajam AA, et al. (Expert Panel on Neurological Imaging). ACR Appropriateness Criteria head trauma: 2021 update. Journal of the American College of Radiology. 2021;18(5S):S13-S36. doi.org/10.1016/j.jacr.2021.01.006
- 2Silverberg 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
- 3Department 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
- 4Machamer J, Temkin N, Dikmen S, et al. Symptom frequency and persistence in the first year after traumatic brain injury: a TRACK-TBI study. Journal of Neurotrauma. 2022;39(5-6):358-370. pmc.ncbi.nlm.nih.gov/articles/PMC8892966
- 5Living Concussion Guidelines. Section 4: Diagnosis/assessment of prolonged symptoms. Updated April 2023. concussionsontario.org/…/diagnosis-assessment-of-prolonged-symptoms
- 6University of British Columbia. International group of experts redefines concussions. News release via EurekAlert. May 23, 2023. eurekalert.org/news-releases/989899
- 7U.S. Food and Drug Administration. 510(k) decision summary K234143: i-STAT TBI cartridge with the i-STAT Alinity system. Decision date March 27, 2024. Reproduced by Innolitics FDA 510(k) database. fda.innolitics.com/device/K234143
- 8Hassankhani A, Freeman CW, Banks J, et al. ACR Appropriateness Criteria: acute spinal trauma. American College of Radiology. Revised 2024. acsearch.acr.org/…/TopicNarrativePdf?topicId=23
- 9Jensen L. Investigations and whiplash. BC Medical Journal. 2009;51(5):214. bcmj.org/node/3474
- 10Bell K, Greenwald BD, Nakase-Richardson R. Obstructive sleep apnea after traumatic brain injury. Model Systems Knowledge Translation Center; 2022. msktc.org/…/obstructive-sleep-apnea-after-tbi
- 11Traumatic Brain Injury Center of Excellence, Defense Health Agency. Neuroendocrine dysfunction (NED) following concussion/mild TBI (mTBI): information for the primary care manager. August 2022. health.mil/…/Neuroendocrine-Dysfunction-Following-Concussion-Mild-TBI-Provider-Fact-Sheet
- 12Living Concussion Guidelines. Section 13: Older adults. Updated July 2025. concussionsontario.org/…/older-adults
- 13Centers for Disease Control and Prevention. Symptoms of mild TBI and concussion. Updated September 15, 2025. cdc.gov/…/signs-symptoms/index.html
- 14988 Suicide and Crisis Lifeline. Get help. Accessed October 2026. 988lifeline.org/get-help
- 15U.S. Department of Health and Human Services. Get it. Check it. Use it. (Your right to access your health information). Content last reviewed July 31, 2026. hhs.gov/…/right-to-access/index.html
- 16U.S. Food and Drug Administration. FDA warns public not to use unapproved or uncleared medical devices to help assess or diagnose a concussion. News release distributed by PR Newswire. April 10, 2019. prnewswire.com/…/fda-warns-public-not-to-use-unapproved-or-uncleared-medical-devices-to-help-assess-or-diagnose-a-concussion-300830003.html
This article reflects the safety priorities of concussion recovery and road safety education. It explains in general terms what scans and other tests can show, and it is not medical, legal or insurance advice. Testing guidance and device clearances change, so check official sources and talk with your own care team about your symptoms and results. Reviewed October 2026.
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