Anyone contemplating slipping behind the wheel of a vehicle after a head injury should think twice. Driving after a concussion or other traumatic brain injury (TBI) can pose very serious risks.
There’s no question that these brain injuries can lead to the impairment of judgment, coordination and focus on the road. According to a 2020 Pediatric Quality and Safety report, the most common medical reasons for restricting driving after a concussion were vestibular or ocular dysfunctions.
Because each brain injury is unique and healing times vary, it’s imperative to spread awareness about the risks of driving with a concussion. From recognizing lingering symptoms to taking proper precautions, we’re answering your important questions surrounding brain injury and driving.
Is Driving with a Concussion Safe?
In the first 24 to 48 hours after a concussion or TBI, driving should be avoided to protect yourself and others on the road. “Let someone else do the driving, and let your brain rest,” says Dr. Vincent Schaller, M.D., DABFM, CIC, founder and medical director of the Mid-Atlantic Concussion (MAC) Alliance.
The ability to make critical, split-second decisions is vital for any driver to lower the risk of accidents. Now imagine adding the effects of a concussion or lingering persistent post-concussion symptoms (PPCS). Even after symptoms begin to diminish, patients can still experience problems, including vision problems, balance issues, nausea or slowed reaction times while driving.
When Can I Resume Driving After a Concussion?
Resuming normal driving activities after a concussion is a gradual process and one that should be evaluated on a case-by-case basis, but not driving for the first day or two is advised. If concussion symptoms are severe immediately after your brain injury, you may be asked to abstain from driving for up to one week. Consulting with your physician or concussion specialist before getting back into the driver’s seat is strongly advised in any situation.
Easing Back Into the Driver’s Seat
Dr. Schaller asks his patients to refrain from driving or riding in a moving vehicle for more than 30 minutes a day, post-concussion. “If a patient is experiencing dizziness, headaches, or light sensitivity, they need to limit their driving to short distances,” he says. In addition, he recommends they avoid long commutes by working remotely or studying from home. “As symptoms and deficits begin to show improvement, including balance, vision, and cognitive processes, patients can begin to gradually increase riding or driving times.”
“Today we have technologies that provide objective brain health screenings. There is no need to guess if the time is right to return to driving after a concussion or other TBI,” says Dr. Schaller.
Teen Drivers and Concussions
While concussion symptoms can affect many activities and daily routines of teenagers, driving carries significant risks. According to one survey of the American Medical Society for Sports Medicine, over 30% of teen patients reported they did not receive driving instructions from their healthcare providers. In fact, roughly 51% of physicians admitted they did not routinely advise on the subject.
In 2020, researchers from the Children’s Hospital of Philadelphia reviewed studies on adolescents with concussions and driving and found that teenagers with concussions can be affected by visual, cognitive, motor and vestibular symptoms that impact their ability to drive. They found that while the Centers for Disease Control (CDC) and the American Medical Society for Sports Medicine agreed that adolescents should be counseled on how to safely return to driving after a concussion, there is a lack of standardized guidelines to help patients and their families.
“Much more is out there about return-to-play and return-to-learn post-concussion, but not return-to-drive,” says Dr. Schaller. “And not just for adolescents, but for adults as well.”
Talk to Your Teen
In an effort to create change, practices to improve patient and parent education, recommendations, and communication on driving safety guidelines for teens with concussions are crucial. Maintaining an open dialogue with your teen driver is strongly encouraged, stressing health and safety concerns while helping them monitor and report persistent symptoms, such as:
- Sleep issues
- Balance
- Uncharacteristic eye movements
- Vision troubles
- Headaches or migraines
- Brain fog
These are just a few signs that your teen driver is not ready to be behind the wheel and may be at greater risk if driving with a concussion.
Sports-related concussions are often a concern of parents with teen drivers. Prolonged recovery time in sports concussions alone has become more evident through research. It is vital that health practitioners, coaches, and parents are more diligent about recognizing post-concussion syndrome (PCS) before handing over the keys.
Recognizing Symptoms of Concussion Before Driving
Common symptoms of concussion may include, but are not limited to:
- Dizziness
- Difficulty with memory or concentration
- Persistent headaches or migraines
- Fatigue or drowsiness
- Sleep disruptions
- Anxiety or sudden changes in mental health
Since concussions can disrupt balance and spatial orientation, the movement of a car may overstimulate and overwhelm the injured brain’s vestibular input. Accelerating, decelerating, and frequent turning can cause headaches, nausea and migraines in post-concussion patients. Even the consistent visual input by objects passing by the window can affect an injured brain and cause increased symptoms.
Photophobia: Night Driving and Concussions
Night driving is a particular concern for concussion or TBI patients. The oncoming headlights pose a real problem when the patient has photophobia. This sensitivity to bright lights can cause visual strain and headaches. In addition, many patients who are riding as passengers will often keep their focus inside the car or may close their eyes to avoid visual stimulus from outside distractions.
“Out-of-car distractions are a big problem for drivers and passengers with post-concussion syndrome or TBI, as the visual stimulus bombards the injured brain,” Dr. Schaller points out. This overstimulation cannot be handled well due to a “broken filter” caused by bruising of the brain, and possibly torn nerve fibers.
How to Evaluate Common Driving-Specific Symptoms
Proper concussion recognition and assessment are key to improved outcomes. Dr. Schaller notes that in the urgent care and emergency room, head injury patients may not exhibit concussion symptoms immediately, before they get back behind the wheel in the aftermath of an accident. So they may not get the advice not to drive from the urgent care or ER provider.
After the urgent care or ER visit, a concussion specialist can help assess, treat and monitor patients through a recovery program designed around their individual case—either in the office or via telemedicine.
The most common driving-specific neuropsychological deficits after a concussion include:
- Slower reaction time
- Lowered attention span
- Decreased executive function
Testing using the VOMS exam is a standard, low-tech examination for brain injury. Processing and reaction times can be evaluated by using the neuro-cognitive tests, such as ImPACT and Creyos (formerly Cambridge Brain Sciences). Objective vestibular screenings using technologies such as BrainScope, RightEye and EyeGuide may be used as well. Balance testing using Sway Balance System, and in some cases Brain SPECT Scan technology can be used as well.
At Mid-Atlantic Concussion Alliance, our network of certified medical professionals and team (along with MAC affiliates in physical therapy, occupational therapy and athletic training), are committed to your health. Providing a diagnosis, treatment, and long-term concussion and TBI care is our priority. For more information on concussions and driving, or to locate a MAC partner near you, contact us today.
