Seeing a neurologist
What are neurologists?
A neurologist is a medical doctor (MD) who has gone through medical school (4 years) and then a 4-year residency program in neurology. Neurology itself is the study of the whole nervous system, it's diseases, and how to treat them. Neurologists are an excellent choice for evidence-based, professionally integrated, medical care for a concussion.
There are a few sub-specialties in neurology which are the best for treating concussions. The best subspecialty for a concussion is sports neurology, followed by headache neurology. Working with a sports neurologist who is affiliated with a sports concussion clinic is ideal, as it ensures a multidisciplinary approach. Typically Sports Concussion clinics will accept patients whether or not the concussion was sports-related.
Regarding headache neurologists, most major cities will have several neurologists with this specialty. If you are looking for a specialist, these doctors/doctors offices will advertise themselves as having these specialists, or you can ask a local neurologist.
There are a small number of headache neurologists who specialize in concussions, such as Dr. Bert Vargas, Director of the UT Southwestern Sports Neuroscience and Concussion Program.
Neurologists and concussions
Neurologists who do not specialize in concussions are not always the best choice for a healthcare provider. According to Dr. Jessica Schwartz, “2015 was the first year that neurology residencies were receiving formal didactic education in concussion."
Neurologists without specialized concussion may prescribe medication as the first and only treatment. Neurologist Dr. Chris Giza, Director of the Steve Tisch BrainSPORT Program at UCLA, recommends that concussion patients avoid taking medications that create problematic side effects, and that medications only be used in conjunction with rehabilitative therapy (PT, OT, etc.) and lifestyle changes.
What will a neurologist do?
When you go to a neurologist appointment, you can expect them to run some sensory, motor, and psychological tests (these are measured on standardized scales) to establish the severity of symptoms. Depending on how long it has been since the concussion the neurologist will recommend different treatment and rehabilitation regimes. For this rehabilitation, they may recommend a short rest period, but often they will start the patient on a low-intensity non-contact exercise and physical therapy.
Who will a neurologist work with?
For rehabilitation, a neurologist will most often recommend a concussion patient to a physiotherapist or physical therapist; particularly helpful are physiotherapists who do vestibular therapy. In rarer cases, they may recommend patients to a nutritionist, psychologist, endocrinologist, and/or occupational therapist.
Some top neurology clinics for concussion patients
The Sports Neurology Clinic which “specializes in the treatment of all active lifestyle individuals, of all ages and levels of play, who regularly engage in sports, recreation, and military.” The clinic is led by Dr. Jeffrey Kutcher, an internationally recognized expert, and sports neurology pioneer.
Clinic locations: Brighton, MI; Sandy, UT, Park City, UT
The UCLA Steve Tisch BrainSPORT Program, led by neurologist Dr. Christopher Giza, who serves on the Center for Disease Control’s Pediatric mild TBI committee, the NCAA Concussion Task Force, and more.
Clinic locations: Santa Monica, CA; Los Angeles, CA
The Norton Neuroscience Institute Sports Neurology Center, led by neurologist Dr. Tad D. Siefert, who also serves as an independent neurotrauma consultant for the National Football League, heads up the NCAA Headache Task Force, and whose research specialty is post-traumatic headaches.
Clinic location: Louisville, Kentucky
Podcast interviews with neurologists specializing in concussions
Concussion Corner podcast host Dr. Jessica Schwartz has interviewed some of the most influential neurologists who specialize in concussions. Although the podcast is geared to professionals, there is a lot of information for patients and caregivers as well. Concussion Corner on iTunes, Concussion Corner on Spreaker Concussion Corner on Google Play.
Dr. Christopher Giza, season 1, episode 14 (April 29, 2018)
Dr. Tad Siefert, Role of the Fellowship Trained Headache Neurologist, season 1, episode 19 (July 4, 2018)
Dr. Tad Siefert, Fight Medicine, Concussion, & The Ringside Doc, season 1, episode 21 (July 22, 2018)
Dr. Jeffrey Kutcher MD on Sport Neurology’s Role in Concussion, Season 1, episode 29 and 30 (Jan 27 & 28, 2018)
Dr. Bert Vargas, Telemedicine and Concussion Management, season 2, episode 26 (December 14, 2018)
What other treatments/rehabilitation would a neurologist recommend?
Most neurologists will recommend some combination of rest, physical therapy, psychological therapy, and occupational therapy. Your neurologist will recommend treatments that have evidence-based positive results and have been verified as safe. However, many alternative therapies/treatments are being proposed which offering various degrees of evidence.
I spoke with Dr. Josh Kamins (MD) from UCLA Steve Tisch BrainSPORT Program about what he would recommend regarding looking into alternative treatments. He said that any patient looking into alternative treatments should ask themselves three questions.
Could the treatment itself cause more harm?
Does it take away energy from other activities that would help the patient more?
Is it financially doable?
If you are OK with the answers to all three of these questions, then you may want to look into different types of treatments.
What if you aren’t satisfied with your neurologist?
If you think that your neurologist isn’t helping enough or exploring all your options, Dr. Kamins recommends that you first search out another neurologist, hopefully, one who has one of the specialties listed above (headache neurology or sports neurology). Also important to keep in mind is that research into concussions and the number of treatments for concussions has expanded massively in the past 15 years, so many doctors are not versed in the current research or the newest treatment. This does not mean that the new treatment doesn’t work, but just that it's new and relatively untested or not thoroughly researched.