Most Concussions Do Not Need Imaging A standard MRI or CT scan will look normal after a concussion. This is by definition: concussion is a functional brain injury (how neurons communicate and metabolize) not a structural injury (tissue damage visible on imaging). Normal imaging after a concussion does not mean you're fine or that the injury isn't real. It means the type of injury doesn't produce visible structural changes on standard scans (McCrory et al., 2017). Routine brain imaging after uncomplicated concussion is not recommended by any major concussion guideline. It does not improve diagnosis, does not predict recovery, does not guide treatment, and does not change outcomes. Imaging adds cost ($1,000-$5,000 for MRI), delays treatment initiation, and often creates anxiety when results are "normal" and patients interpret this as meaning their symptoms aren't real. The appropriate role for brain imaging after head injury is to rule out structural injuries (skull fracture, brain bleeding, brain swelling) that require emergency medical or surgical intervention. These structural injuries present with specific red flag symptoms that trained clinicians identify during clinical assessment. When Imaging IS Necessary CT scan indications (emergency). CT is the first-line imaging for acute head injury when structural damage is suspected. CT is fast (5 minutes), widely available, and excellent at detecting bleeding and fractures. The Canadian CT Head Rule identifies patients who need CT after head injury: Glasgow Coma Scale score below 15 at 2 hours after injury Suspected open or depressed skull fracture Signs of basal skull fracture (raccoon eyes, Battle's sign, CSF leak from nose or ears) Two or more episodes of vomiting Age 65 or older Amnesia before impact extending 30+ minutes Dangerous mechanism (pedestrian struck by vehicle, ejection from vehicle, fall from elevation greater than 3 feet or 5 stairs) MRI indications. MRI provides better soft tissue detail than CT and is indicated when: Symptoms worsen despite appropriate management Focal neurological deficits develop (weakness on one side, speech changes, vision loss) Symptoms persist beyond expected timelines without improvement (to evaluate for alternative diagnoses) Suspicion of structural lesion not visible on CT Clinical presentation inconsistent with typical concussion recovery What imaging does NOT do: Diagnose concussion (clinical diagnosis only) Predict recovery timeline Guide treatment decisions for standard concussion Determine return-to-play readiness Measure concussion severity Advanced Imaging in Research Diffusion tensor imaging (DTI). This MRI technique shows white matter tract integrity and detects microscopic axonal injury not visible on standard MRI. DTI reveals concussion-related changes in some research studies but is not clinically validated for individual concussion diagnosis. DTI is a research tool, not a diagnostic tool for clinical practice. Functional MRI (fMRI). fMRI measures brain activity patterns and shows altered activation in concussed individuals. Research demonstrates changes in default mode network connectivity and task-related activation after concussion. Like DTI, fMRI is a research tool and not validated for clinical concussion diagnosis or management. Susceptibility-weighted imaging (SWI). This MRI technique detects small bleeds (microhemorrhages) that standard MRI misses. SWI findings after head injury suggest more severe injury than typical concussion and have prognostic value in moderate-to-severe traumatic brain injury. SWI is available in clinical practice and is sometimes useful for complicated concussions. These advanced techniques show promise for future clinical application but are not currently standard of care for concussion diagnosis or management. Do not seek or pay for "advanced concussion imaging" from clinics marketing these as diagnostic tools outside of research protocols. Cervical Evaluation: What Imaging Often Misses While patients request brain imaging, the cervical spine is frequently overlooked. Cervical dysfunction from the same injury mechanism produces many "post-concussion" symptoms and is treatable with targeted intervention: JME 1 Cervical rotation assessment identifies neck involvement that causes dizziness and headache attributed to concussion. Treating cervical rotation deficits resolves these symptoms faster than waiting for "brain healing." JME 14 Chin tucks address deep cervical flexor weakness that produces tension headaches mistakenly attributed to concussion alone. JME 5 Cervical extension mobility reduces posterior neck tension contributing to occipital headache patterns after head injury. JME 6 Cervical flexion addresses anterior neck dysfunction and headache patterns originating from cervical structures. Start your 14-day free trial for cervical mobility programming that addresses the musculoskeletal component of post-concussion symptoms. Supporting Upper Body Recovery JME 3 Lateral flexion addresses asymmetric cervical tension that perpetuates one-sided headache patterns after concussion. JME 44 Shoulder mobility reduces upper quarter tension that contributes to cervicogenic headache patterns post-injury. JME 153 Upper back mobility addresses thoracic stiffness that increases mechanical load on the cervical spine during recovery. JME 164 Scapular mobility supports the shoulder-neck kinetic chain that distributes load away from the injured cervical structures. What to Do Instead of Requesting Imaging Get a proper clinical assessment. A comprehensive concussion evaluation (SCAT5, VOMS, cervical examination) provides more diagnostic and prognostic information than any scan. Clinical assessment identifies the specific symptom profile, functional deficits, and cervical involvement that guide individualized treatment. Follow up within 48-72 hours. A follow-up visit allows the clinician to assess symptom trajectory, identify emerging patterns, and initiate treatment for persistent symptoms. Early active treatment (cervical therapy, vestibular rehabilitation, graded aerobic exercise) improves outcomes more than any imaging finding. Trust the clinical process. If your clinician says imaging isn't needed, that is not dismissive. It reflects appropriate clinical judgment that imaging will not change your diagnosis, treatment, or outcome. If symptoms are concerning, your clinician will order imaging. Request imaging when you have specific concerns (worsening symptoms, new neurological symptoms), not as routine confirmation. Focus on active recovery with simplmobility's structured mobility programs. Will my concussion show up on an MRI? No. Standard MRI will appear normal after concussion. Concussion is a functional brain injury that does not produce visible structural changes on current clinical imaging. A normal MRI does not mean you don't have a concussion or that your symptoms aren't real. It means the injury is not the type that produces imaging findings. Should I get a CT scan at the emergency room after hitting my head? Only if you have red flag symptoms: loss of consciousness lasting more than 30 seconds, repeated vomiting, worsening headache, seizure, weakness or numbness on one side, confusion that worsens over time, or signs of skull fracture. If you have a headache and feel "off" but are otherwise neurologically intact, CT is not indicated and will not help. Are there any brain scans that detect concussion? Research techniques (functional MRI, diffusion tensor imaging, PET scans) detect concussion-related brain changes in group studies but are not validated for individual clinical diagnosis. No currently available clinical scan reliably diagnoses concussion in an individual patient. Concussion remains a clinical diagnosis based on symptoms, cognitive testing, and physical examination. References McCrory, P., et al. (2017). Consensus statement on concussion in sport. British Journal of Sports Medicine, 51(11), 838-847. PubMed Stiell, I. G., et al. (2001). The Canadian CT Head Rule for patients with minor head injury. The Lancet, 357(9266), 1391-1396. PubMed