FROM MY PT SCHOOL NOTES · NEUROLOGY · UNIT 7 · CHAPTER 26
When do vision, headache and concussion findings change a PT plan?
Headache, eye discomfort, dizziness and neck pain can overlap. A good exam identifies relevant systems and safeguards against assuming every complaint has the same cause.
Examination and clinical reasoning
Know which symptoms are not interchangeable
Migraine can involve nausea, sensory sensitivity, aura and episodic headache or vestibular complaints. Cervicogenic headache may relate to neck function. A visual-field deficit, double vision, eye-tracking problem and spatial neglect are different findings that can all disrupt reading or mobility.
After concussion, reported ‘blurry vision’ may relate to accommodative or binocular problems, motion sensitivity, fatigue or other factors. Ask what task provokes it, associated neurologic findings and how it affects daily participation.
Screen serious red flags
Sudden severe or thunderclap headache, new weakness, acute diplopia with ataxia or speech change, new loss of vision, or worsening headache after trauma warrants emergency or timely medical assessment depending on context. Cervical trauma and potential vascular pathology take precedence over routine manual treatment.
The Amsterdam concussion consensus emphasizes a multimodal approach rather than diagnosing by one symptom-provoking screen. The uploaded vision lecture includes very broad intervention claims; do not apply unverified eye exercises to all patients.
Build a coordinated evaluation
After safety screening, focus on cervical range and task tolerance, gaze and eye symptoms, balance, visual-field/attention concerns, exertion response and function. Work with optometry, neuro-ophthalmology, neurology, SLP or vestibular specialists as indicated.
PT interventions should address supported impairments and functional goals. Reassess headache, reading tolerance, movement and participation; do not declare that a visually provoked symptom proves vestibular nerve damage.
Quick distinctions
| Migraine-like | Screen for neurologic headache features and medical care |
| Cervical-related | Assess relevant neck findings and red flags |
| Visual/oculomotor | Differentiate diplopia, field problems, tracking and attention |
| Concussion overlap | Multidomain examination and staged return to activities |
Clinical reasoning case
Two weeks after concussion a person reports reading-related headache, neck pain when turning and dizziness in grocery stores.
Reasoning: Assess several possible contributors and red flags; use targeted cervical, visual/vestibular or exertional evaluation and referral rather than only prescribing generic gaze exercises.
Check your understanding
Why should a visual-field deficit not be described as neglect?
Original uploaded sources: Headache.pdf; Vision Therapy.pdf; VOMS .pdf; Concussion .pdf; 6 Vestibular Disorders.pdf.
Historical note: Compare older headache and vision lecture recommendations with current concussion, eye-care and vestibular evidence.
Educational material, not a patient-specific diagnostic or emergency-care protocol.
