When a workers’ compensation claim begins with reports of headaches following a workplace accident, it can seem like a relatively straightforward soft-tissue complaint. However, when a treating physician or attorney requests a transfer of care to a neurologist, it raises a critical question: Could there be an underlying brain injury?

For claims adjusters and nurse case managers, early identification of potential brain injuries—exceptionally mild traumatic brain injuries (mTBIs)—is essential to managing the claim appropriately and avoiding delays in care or prolonged disability.

Start with the Context of the Injury
Ask:

• Was there a direct blow to the head?
• Was the individual involved in a fall, car accident, or struck by an object?
• Was there a loss of consciousness, even briefly?
• Did the employee report feeling “dazed,” “foggy,” or disoriented at the scene?

Even without loss of consciousness, these mechanisms can support suspicion of a concussion or mTBI.

Red Flag Symptoms to Monitor
If the initial complaint is headache, look for other symptoms that may suggest a brain injury. These include:

• Dizziness or balance issues
• Memory problems
• Difficulty concentrating
• Sensitivity to light or noise
• Sleep disturbances
• Mood changes (irritability, anxiety, depression)
• Nausea or vomiting
• Visual disturbances

The presence of multiple symptoms, especially if persistent beyond 10–14 days, may point to a concussion or more significant brain trauma.

Key Questions to Ask During Case Review
When reviewing medical notes or speaking with providers, consider asking:

• What specific symptoms beyond headaches is the patient reporting?
• Has there been any cognitive testing performed (e.g., SCAT5, ImPACT, MoCA)?
• Did imaging (CT/MRI) rule out structural damage—or has imaging even been done yet?
• Is the patient showing delayed recovery from what would be expected for soft-tissue injuries?
• Has the neurologist or referring physician documented any diagnosis of post-concussion syndrome or mTBI?
• Are psychological symptoms (e.g., anxiety, mood swings) emerging that could complicate recovery?

When to Consider Neuro Referral Justified
A referral to a neurologist may be warranted when:

• Headaches are persistent, worsening, or interfere with function
• Neurological symptoms are reported or observed
• The treating physician suspects post-concussive syndrome
• Cognitive issues are impacting return-to-work readiness
• There is a history of prior concussions or head trauma

The Role of Objective Testing

While many concussions do not show up on imaging, neurocognitive testing can provide objective insight into memory, reaction time, and processing speed. Asking if such testing has been or will be performed is essential to confirm the need for neurological care and document impairment.

Takeaway for Claims Professionals

Not every headache after an accident signals a brain injury—but ignoring the possibility can result in delayed recovery, frustrated claimants, and increased claim costs. You can better manage complex claims and support appropriate care pathways by asking the right questions, identifying red flags early, and recognizing when a neuro referral is appropriate.