Dear Doc: I decided to take advantage of the beautiful weather last weekend and went out hiking with a few friends. As we were headed up a pretty steep incline, I fell and hit my head on a rock. It hurt pretty badly at the time, but being the “warrior” that I am, I brushed it off and we finished the hike. I haven’t been to a doctor yet, but now I'm having pretty painful headaches, and I’ve also been getting dizzy and nauseous. Did I have a concussion and, if so, what should I do next?

— Hit Head Hiking 

Dear HHH: While it’s not necessarily my area of expertise, it sounds like you may have suffered a concussion, and my initial advice would be to go see a doctor as soon as possible.

That being said, I do know someone whose area of expertise is exactly that. I reached out to Navy Cmdr. (Dr.) Adam Susmarski, medical director of the United States Naval Academy Concussion Center of Excellence and USNA sports medicine team physician for the Midshipmen in Annapolis, Maryland, about some of the specifics of identification and treatment for concussions.

When we think of concussions, we think of an athlete who looks dazed and disoriented immediately after suffering head trauma from a violent hit on the field or a service member following a blast injury on the battlefield. However, there is also the potential for the symptoms of concussions to present themselves in the days after the trauma. 

We would recommend that you contact your primary care physician and set up an appointment to be evaluated after your fall. Your primary care physician will take a detailed history including a battery of questions specific to concussion evaluation which may include a Military Acute Concussion Evaluation 2nd edition (MACE2) or Sports Concussion Assessment Tool 5th edition (SCAT-5). These questions, along with a thorough physical examination that may include neurological, musculoskeletal, vestibular, and ocular testing will help your physician determine the underlying cause of your symptoms.

Keep in mind that there are a variety of other diagnoses and conditions that can occur after a fall that may mimic or exacerbate the symptoms of a concussion including, but not limited to, potential injuries to you neck and vestibular system.

If your primary care physician diagnoses you with a concussion, they will help guide you through a step-by-step return to duty protocol that will include guidelines for progressive return to physical and mental responsibilities at work and home.

Throughout your recovery, you will have serial follow-ups with your physician, and they may incorporate additional treatment modalities (vestibular therapy, medications, supplements, physical therapy, and ocular therapy). Your physician may also have you consult a concussion specialist (typically a physical medicine and rehabilitation or sports medicine physician) to help aid in your recovery.

A key item to remember is to not return to activities in which you may be susceptible to head trauma before being cleared to return to duty by your treating physician. A subsequent head trauma before the brain is healed/ready may lead to severe consequences and neurological injury. As you progress through the stages of recovery your physician will perform a variety of tests to include the aforementioned questionnaires, daily symptom scores, balance and eye testing, and neurocognitive computer testing prior to allowing you to return to duty. 

HHH, the bottom line is that, without seeing a physician, there is no way of knowing if you have a concussion. Only after that has been determined can you be put on the correct road (or perhaps trail…if you’d prefer) to recovery.

Just know that within the Military Health System we have an array of tools, facilities, and personnel just like Dr. Susmarski to help people like you.

I hope you feel better soon. Feel free to let us know what your diagnosis is and how you’re progressing through your treatment. 

Until then…take care (of your head) out there!

–Doc