Concussion is not one condition. Research has identified distinct clinical profiles — vestibular, ocular-motor, cognitive/fatigue, post-traumatic migraine, cervical, and anxiety/mood — each with its own symptoms and its own matched treatment. Identifying which profile a patient has is what changes the recovery curve.
The old model, and why it failed people
For decades, concussionA mild traumatic brain injury from a blow or jolt to the head. Symptoms can include headache, dizziness, and trouble concentrating; most people recover with proper rest and follow-up care. was treated as a single, undifferentiated injury with a single prescription: rest until the symptoms go away. Every patient got broadly the same advice regardless of whether their dominant problem was dizziness, double vision, migraine, neck pain, or anxiety.
That approach produced a predictable result. Patients whose problem happened to resolve on its own did fine. Patients whose problem needed specific treatment — vestibular rehabilitation, vision therapy, migraine management, neck rehabilitation, mood care — waited, and often got worse while waiting.
The profiles model
Modern concussion research reframed the injury. Rather than one condition, concussion presents as a set of clinical profiles — also called subtypes or trajectories — each with a characteristic symptom pattern and a matched treatment pathway. A patient may have one profile, or several at once, and the mix is what shapes the treatment plan.
Aptiva’s concussion team works from six profiles:
1. Cognitive / fatigue. Mental fatigue, difficulty concentrating, slowed processing speed, memory problems. Often the dominant profile for students returning to school and for professionals returning to mentally demanding work. Treatment centers on pacing, structured cognitive load, and a graduated return-to-learn or return-to-work plan.
2. Vestibular. Dizziness, vertigo, feeling off-balance, motion sensitivity, difficulty tolerating head movement or busy visual environments — grocery stores and school hallways are classic triggers. Treated with vestibular rehabilitation therapy by a vestibular-certified physical therapist.
3. Ocular-motor. Difficulty with eye movement, double vision, convergence insufficiency (the eyes will not focus together at close range), trouble reading, screen sensitivity. Frequently misattributed to “tired eyes” or “stress,” which is one reason it goes untreated. Responds to targeted vision and ocular-motor rehabilitation.
4. Post-traumatic migraine. Headache with migraine characteristics — pulsing pain, light and sound sensitivity, sometimes nausea — that began after the injury. Managed with combination strategies that may include migraine-specific medication, sleep regulation, and trigger management.
5. Cervical. Neck pain, neck stiffness, and headache originating from the neck rather than from the brain itself. Common after whiplash-mechanism injuries, including motor vehicle collisions. Responds to manual therapy and targeted neck rehabilitation — treatment aimed at the brain will not fix it.
6. Anxiety / mood. Anxiety, low mood, mood swings, and irritability that began or clearly worsened after the injury. Often dismissed by patients and families as “just stress” from being injured. It is frequently a treatable profile in its own right, addressed in coordination with mental health clinicians.
Sleep disturbance sits alongside these and commonly co-occurs with several of them. Disrupted sleep makes almost every other profile worse, so it is assessed and treated rather than waited out.
Why the distinction changes outcomes
The clinical logic is straightforward once the profiles are visible:
- A patient with a dominant vestibular and ocular-motor picture needs specialized physical therapy and vision work. Rest does not treat it.
- A patient with a dominant cognitive/fatigue picture needs pacing and a graded return to mental load — not more isolation.
- A patient with post-traumatic migraine needs headache management, which is a different medication conversation entirely.
- A patient with a cervical driver needs their neck treated, and may never improve if the whole plan is aimed at the brain.
- A patient with an anxiety/mood driver needs that named and treated, not normalized.
Generic “rest in a dark room until you feel better” advice — the standard for decades — is now understood to produce worse outcomes for most concussion patients than treatment matched to the profile.
How a profile is identified
Identifying the profile is a clinical assessment, not a single test. A comprehensive concussion evaluation typically includes:
- A detailed history of the injury mechanism and the symptom timeline
- A neurological examination
- A structured symptom inventory
- Vestibular and ocular-motor screening — provoking the systems under controlled conditions to see which ones reproduce symptoms
- Neurocognitive testing such as ImPACT, compared against the patient’s own baseline where one exists
- Assessment of the neck, sleep, and mood
Where the picture is complex — prolonged post-concussion symptoms, suspected cognitive complications, multiple injuries, or documentation needed for legal or insurance purposes — a comprehensive neuropsychological assessment by a clinical neuropsychologist goes deeper across cognitive domains.
Why this requires a team, not a single provider
The profiles model has a structural implication that is easy to overlook: if six profiles need six different treatments, a clinic with one clinician cannot deliver matched care. It has to refer out, and the patient spends the critical early weeks driving between buildings and repeating their history to providersAnyone licensed to give you medical care — a physician, nurse practitioner, or physician assistant. Clinics use "provider" as a catch-all for whoever is caring for you. who doA medical doctor — "MD" or "DO" — with four years of medical school plus a multi-year residency in a chosen field. not share records.
Aptiva’s Concussion & Sports MedicineCare focused on preventing, diagnosing, and treating injuries related to activity and exercise — for athletes and non-athletes alike. Institute was built around this problem — two clinical neuropsychologists, a sports medicine physician, a vestibular-certified physical therapist, additional physical therapists, and a certified athletic trainer working from shared charts and shared treatment planning.
Both of Aptiva’s concussion neuropsychologists completed postdoctoral fellowships at the UPMC Sports Medicine Concussion Program in Pittsburgh, the program most closely associated with developing and validating the clinical-profiles approach:
- Lisa Manderino, PhD, Director of Concussion Care — PhD in clinical psychology with a neuropsychology concentration (Kent State University), UPMC fellowship 2020–2022 under Dr. Michael Collins and Dr. Anthony Kontos, licensed in Kentucky and Indiana. Her peer-reviewed work on concussion identification, treatment, and recovery appears in Archives of Clinical Neuropsychology, the Journal of Athletic Training, and the American Journal of Sports Medicine, and she co-authored the concussion chapter in Sideline Management in Sports.
- Nathan Ramirez, PsyD, concussion neuropsychologist — PsyD from the California School of Professional Psychology, UPMC fellowship 2023–2024 with Dr. Kontos as research mentor and Dr. Collins as clinical mentor, with 15+ peer-reviewed publications and 35+ international conference presentations. He treats patients across the lifespan, from youth and high-school athletes through collegiate, professional, and adult patients.
Smart questions to ask
- Which concussion profile or profiles do I have?
- What treatment is matched to that profile, and what should improve first?
- Who on the team delivers that treatment, and when do I start?
- How will we know whether the treatment is working, and when would we change course?
- If I am not improving, what is the next step?
Sources
- Aptiva Health — The 6 Subtypes of Concussion
- Consensus statement on concussion in sport — 6th International Conference, Amsterdam 2022 (British Journal of Sports Medicine, 2023)
- CDC — HEADS UP: About Concussion
- Aptiva Health — Lisa Manderino, PhD
- Aptiva Health — Nathan Ramirez, PsyD