Concussion symptoms and anxiety after a crash: getting help for both
How to describe body and mood symptoms and get checked for both at once
Imagine a 29 year old delivery cyclist who was clipped by a turning SUV two months ago. She hit her head on the pavement and was told she had a concussion. Now her head aches most afternoons, she sleeps in short bursts, and her heart pounds when she rolls up to a busy corner. In the grocery store she feels lightheaded and wants to leave. She keeps asking herself whether this is the concussion, her nerves, or both.
The CDC lists anxiety or nervousness, irritability and sadness among concussion symptoms, right next to headaches, dizziness and sleep changes [1]. Many of the same feelings also show up with anxiety and with trauma stress after a frightening event.
This article offers a simple way to describe your body and mood symptoms, and explains why a professional check matters when they overlap. It cannot diagnose you. Use it to prepare for a visit where both can be checked.
Why concussion and anxiety can look alike
The CDC sorts concussion symptoms into four groups: physical, thinking and remembering, social or emotional, and sleep [1]. Headaches, tiredness, dizziness, poor concentration, irritability and trouble falling asleep all appear on its list [1].
Generalized anxiety disorder, as described by the National Institute of Mental Health (NIMH), can bring headaches, muscle tension, feeling lightheaded, feeling on edge, poor concentration and trouble sleeping [2]. A panic attack can bring a racing heart, chest pain, trouble breathing, tingling hands, and weakness or dizziness [3]. Posttraumatic stress disorder (PTSD), a condition that can follow a frightening event, can cause poor sleep, a tense or on guard feeling, jumpiness at sudden sounds, and angry outbursts [4].
The National Center for PTSD says the symptoms of brain injury and PTSD overlap, especially with mild brain injury [5]. It advises working with a health care provider to sort out the cause [5].
Common symptoms do not prove a brain injury
Some items on concussion checklists are common in people who never hit their head. A study in Norway followed 221 adults seen in emergency departments for mild brain injury [6]. The researchers compared them with 73 people with orthopedic injuries like fractures and 77 people from the community [6].
At three months, when even mild symptoms counted, the various rules labeled 17% to 31% of the community group as having lasting postconcussion symptoms [6]. When only moderate or worse symptoms counted, 1.3% or fewer of that group qualified, and the brain injury group stood out more clearly [6]. Mild tiredness or poor focus is common in everyday life, so on its own it cannot tell you what is behind it.
Each problem can feed the other
A 2025 U.S. guideline on brain injury care says distress may be both a result of the injury and a reason symptoms keep going [7]. It also warns that other health conditions can mimic or hide brain injury symptoms [7]. In daily life, a pounding headache makes you worry, and the worry makes the headache and the sleepless nights worse.
Comparison compiled by Safety Behind the Wheel Foundation
Where concussion and anxiety symptoms overlap
| Symptom | On the concussion list | On an anxiety, panic or PTSD list |
|---|---|---|
| Headache | Yes | Yes (anxiety) |
| Dizziness or lightheadedness | Yes | Yes (anxiety, panic) |
| Trouble sleeping | Yes | Yes (anxiety, PTSD) |
| Irritability or anger | Yes | Yes (anxiety, PTSD) |
| Tiredness | Yes | Yes (anxiety) |
| Trouble concentrating | Yes | Yes (anxiety) |
| Racing heart or chest pain | No | Yes (panic) |
| Bothered by light or noise | Yes | No |
Sources: CDC [1]; NIMH [2, 3, 4]. A symptom on a list shows that it can occur with that condition. It does not show what causes yours.
How often both show up after a crash
A large U.S. study published in 2019 followed 1,155 people seen for a mild brain injury in the emergency departments of 11 major trauma centers [8]. It also followed 230 people with orthopedic injuries that did not involve the head, for comparison [8]. At the three month mark, one in five people with a brain injury (20%) described symptoms pointing to PTSD, major depression or both [8]. Among people with other injuries, the share was 8.7% [8].
By six months, 21.2% of the brain injury group reported these symptoms, compared with 12.1% of the orthopedic group [8]. The brain injury group had higher rates, yet about 1 in 8 people with other injuries had these symptoms too. That suggests being hurt in a frightening event can affect mental health on its own.
A history of mental illness was one of the factors tied to higher risk in that study [8]. The Canadian Living Concussion Guidelines point the same way. Mental health conditions that existed before the injury, and symptoms that start after it, both predict a slower recovery [9].
Timing matters
Mental health problems do not always show up right away. The 2025 guideline says the higher risk may begin within weeks and last for years, with new cases peaking between two and six months after injury [7]. It also lists a heavy early load of concussion and mental health symptoms among the strongest risk factors for lasting problems [7].
These figures describe large groups and cannot predict your own course. Many people with both kinds of symptoms improve with time and care.
Describe your concerns in two columns
You do not need to know the cause of a symptom before you bring it up. Your job is to describe it clearly. NIMH suggests making a list before a visit and being specific about when each symptom started, how strong it is and how often it happens [10]. The patient guide from the Living Concussion Guidelines also suggests keeping a journal or log of mental health symptoms [11].
A two column sheet does both jobs at once. On the left, write what your body is doing. On the right, write what your mood and thoughts are doing. When two things tend to happen together, put them on the same row, since concussion symptoms can be linked to each other [11].
Worksheet from Safety Behind the Wheel Foundation
Two column symptom worksheet
| What my body is doing | What my mood and thoughts are doing |
|---|---|
| Example: lightheaded in the store, heart pounding, about 10 minutes | Example: sure something bad was coming, left the cart and went home |
| Example: headache by 3 p.m. most days | Example: snapping at my kids by dinner |
Use one row for each pattern you notice. Print a fresh copy each week before a visit. Based on NIMH and Living Concussion Guidelines tips on tracking symptoms [10, 11].
Add these details to each row
A few details next to each row help your care team spot patterns. If writing tires you, ask someone to write while you talk.
Checklist from Safety Behind the Wheel Foundation
- When it first started, and whether you had it before the crash.
- How often it happens: daily, a few times a week, or now and then.
- How strong it feels at its worst, on a scale of 0 to 10.
- What tends to bring it on, such as noise, a screen, a road, or bad news.
- What helps, even a little.
- What it stopped you from doing, such as finishing a shift or driving your child to school.
Things only you can add
Tell your care team about any anxiety, depression or panic you had before the crash, and about mental health conditions in your family [10]. Bring a list of every medicine you take, including vitamins, herbal products and supplements [10].
NIMH notes that a friend or relative who comes along can offer support, take notes and share how you seem to them [10].
Why a professional check matters when symptoms overlap
When symptoms overlap, a guess about the cause can lead to the wrong care. A dizzy spell in a store could be part of a concussion, a panic attack, or both [1, 3]. A panic attack can feel so much like a heart attack that people assume their heart is failing [3].
That is why NIMH says a provider checking for anxiety or panic may do a physical exam first, to make sure an unrelated physical problem is not behind the symptoms [2, 3].
A screen is a starting point
The National Center for PTSD notes that the brain injury screen the VA gives combat veterans is not a diagnosis. A positive result means you would benefit from a closer look by a specialty provider [5]. It adds that a mental health provider makes the PTSD diagnosis [5]. Mental health forms work the same way. The Living Concussion Guidelines say an assessment should decide whether symptoms meet the criteria for a mental health disorder [9].
No blood test or scan can settle the question either. A 2023 Defense Department fact sheet about service members and veterans says no biomarker or imaging test can reliably diagnose mild brain injury or PTSD [12].
What an assessment for both usually involves
The 2025 U.S. guideline makes a strong recommendation for mental health screening after a brain injury [7]. Clinicians should look for conditions that are new since the injury and for earlier conditions that have flared up [7]. Its advice is to screen at about the one month mark and to repeat the check for anyone still having symptoms [7].
The parts of a full assessment
The Living Concussion Guidelines describe a thorough assessment in several parts [9]:
- A full history, including your mental health before the injury, other medical problems, and life stresses such as work, money and relationships.
- A structured interview, where the clinician asks set questions about your symptoms.
- Questionnaires that you fill out yourself.
- Observation of how you look, speak and respond during the visit.
- Input from relatives or friends, when that is possible.
Forms you may be asked to fill out
You may see the PHQ-9, which screens for depression, or the GAD-7, which screens for anxiety [9]. For PTSD, there is a brief five item screen made for primary care clinics, and a longer 20 item form called the PCL-5 [9]. The PCL-5 covers each of the 20 PTSD symptoms in the DSM-5, the manual clinicians use to diagnose mental health conditions [9]. Answer honestly, and let your care team score the forms and explain the results. A high score calls for a longer talk and a full assessment, since a form alone cannot diagnose you [9].
Why time is part of the diagnosis
Diagnoses depend on how long symptoms last, which a single quiz cannot judge. For adults, PTSD symptoms must last at least a month [4]. Generalized anxiety disorder requires worry that is hard to control on most days for at least six months [2]. NIMH says a mental health professional decides whether symptoms meet the criteria for PTSD [4].
Who does the assessment
Under the Living Concussion Guidelines, primary care begins treatment, which can include teaching about the condition and, where suitable, medicine [9]. When symptoms are complex or severe, such as when there is a risk of suicide, you should be referred right away to a regulated mental health practitioner [9].
Treatment that can help with both
The 2025 guideline says psychotherapy, or talk therapy, is generally a first line treatment for mental health disorders of any severity [7]. Medicine, alone or with therapy, is an option for moderate to severe conditions [7]. Its advice for primary care to start that treatment is rated weak, unlike the strong screening advice [7].
The Living Concussion Guidelines give their top evidence rating to cognitive behavioral therapy (CBT) and similar talk therapies [9]. They list mindfulness based approaches, trauma focused therapy and cognitive processing therapy among the options [9].
What CBT looks like
CBT is a structured talk therapy that helps you notice unhelpful thoughts and habits and practice new ones. The Canadian patient guide says it can teach you ways to handle painful emotions [11].
There is some evidence that CBT can help with lasting concussion symptoms too. A small 2016 trial in London studied 46 adults with persistent postconcussion symptoms, mostly after mild to moderate brain injuries [13]. They were randomly assigned to 12 sessions of CBT shaped around each person, or to a waiting list [13]. CBT improved quality of life, and it also helped postconcussion symptoms, anxiety and fatigue once the length of treatment was taken into account [13]. It did not change depression or PTSD scores in that trial [13].
For PTSD, the National Center for PTSD says the most effective treatments, such as cognitive processing therapy and prolonged exposure, seem to work as well after a brain injury [5]. It also says brain injury symptoms are no reason to wait to start PTSD treatment [5].
Sleep, medicine and making therapy work
The Canadian patient guide says treating a sleep problem is likely to help mood [11]. If you take medicine for mood or anxiety and want to stop, talk with your health care provider first [11]. Please do not begin, quit or adjust any medicine without your prescriber.
Concussion can make sessions harder to follow. Ask your therapist to jot down the main points for you to reread at home. Say so when you need something explained a second time [14]. Video sessions are an option for CBT and other proven therapies, which can save you a tiring trip [7].
When to get emergency care
Any of these signs after a blow to the head is an emergency. Dial 911, or let someone else drive you to the ER [1]:
- A headache that grows worse and refuses to ease.
- Weakness, numbness, decreased coordination, convulsions or seizures.
- Repeated vomiting.
- Slurred speech or unusual behavior.
- One pupil larger than the other.
- Failing to recognize familiar faces or places, or seeming agitated, restless or confused.
- Fainting, extreme sleepiness, or not waking when someone tries to rouse you.
If you have chest pain or trouble breathing and are not sure whether it is panic, get urgent medical help instead of trying to sort it out alone.
If you are thinking about suicide
Worry and low mood after a brain injury can creep up over weeks. If you are thinking about ending your life or harming yourself, please reach out now. These feelings can ease with support, and help is ready at any hour.
- Dial or text 988 to connect with the 988 Suicide and Crisis Lifeline. Chat is at chat.988lifeline.org. It is free and open around the clock [15, 16].
- If you served in the military, or love someone who did, dial 988 and choose option 1, or send a text to 838255 [16].
- Spanish speakers can dial 988, then press 2 [16].
- When anyone’s life is in danger right now, dial 911.
- The 2025 guideline says new or sharply worse thoughts of suicide after a brain injury may need emergency department care [7].
Questions to ask your care team
Question checklist from Safety Behind the Wheel Foundation
- Looking at my two column list, which symptoms might come from the concussion, which from anxiety or trauma stress, and which from both?
- Can you screen me for anxiety, depression and PTSD, and when should we repeat the screening?
- Should we check for other physical causes of my racing heart, dizziness or chest tightness?
- Do my symptoms meet the criteria for a diagnosis, or should we keep watching them for now?
- Would CBT or a trauma focused therapy fit my situation, and can I do it by video?
- Should we treat my sleep problems first, or at the same time as my mood?
- Might a medicine or supplement I take be adding to these symptoms?
- If I need a referral, who would you send me to, and what should I do while I wait?
Frequently asked questions
Should I wait for my concussion to heal before getting help for anxiety?
There is no need to wait. The 2025 guideline advises a first mental health screen roughly a month after injury, with another one later for anyone whose symptoms persist [7]. It also names a heavy early load of concussion and mental health symptoms as a strong risk factor for lasting problems [7].
The bottom line
Recommendation from Safety Behind the Wheel Foundation
After a crash, headaches, poor sleep, a racing heart and trouble focusing can come from a concussion, from anxiety or trauma stress, or from both at once. You and your care team can work through that question together.
Describe your concerns in two columns, add when each one started and what it stops you from doing, and bring the sheet to your next visit. Ask to be screened for anxiety, depression and PTSD, and ask about physical causes too. Guidelines name talk therapy such as CBT as a first choice, and you can reach crisis help at any hour by calling or texting 988. Check with your own care team about what fits your situation.
Sources and further reading
- 1Centers for Disease Control and Prevention. Symptoms of mild TBI and concussion. Updated September 15, 2025. cdc.gov/…/signs-symptoms/index.html
- 2National Institute of Mental Health. Generalized anxiety disorder: when worry gets out of control. Revised 2025. nimh.nih.gov/…/generalized-anxiety-disorder-gad
- 3National Institute of Mental Health. Panic disorder: when fear overwhelms. Revised 2025. nimh.nih.gov/…/panic-disorder-when-fear-overwhelms
- 4National Institute of Mental Health. Post-traumatic stress disorder. Revised 2023. nimh.nih.gov/…/post-traumatic-stress-disorder-ptsd
- 5National Center for PTSD, U.S. Department of Veterans Affairs. Traumatic brain injury and PTSD. Updated September 25, 2026. ptsd.va.gov/understand/related/tbi_ptsd.asp
- 6Karaliute M, Saksvik SB, Smevik H, et al. Methodology matters: comparing approaches for defining persistent symptoms after mild traumatic brain injury. Neurotrauma Reports. 2021;2(1):603-617. pmc.ncbi.nlm.nih.gov/articles/PMC8742292
- 7Silverberg ND, Lee K, Mikolić A, et al. Action Collaborative on Traumatic Brain Injury Care: adapted clinical practice guideline. Annals of Family Medicine. 2025;23(6):552. annfammed.org/content/23/6/552
- 8Stein MB, Jain S, Giacino JT, et al. Risk of posttraumatic stress disorder and major depression in civilian patients after mild traumatic brain injury: a TRACK-TBI study. JAMA Psychiatry. 2019;76(3):249-258. doi.org/10.1001/jamapsychiatry.2018.4288
- 9Living Concussion Guidelines. Section 8: Mental health disorders (adult guideline). Ottawa Hospital Research Institute. Updated April 2023. concussionsontario.org/…/mental-health-disorders
- 10National Institute of Mental Health. Tips for talking with a health care provider about your mental health. NIH Publication No. 22-MH-8094. nimh.nih.gov/…/tips-for-talking-with-your-health-care-provider
- 11Living Concussion Guidelines, patient version. Mental health symptoms. Ottawa Hospital Research Institute. Updated July 2025. concussionsontario.org/…/mental_health_symptoms
- 12Traumatic Brain Injury Center of Excellence. Mild TBI and PTSD clinical pearls. August 2023. health.mil/…/Mild-TBI-and-PTSD-Clinical-Pearls
- 13Potter SDS, Brown RG, Fleminger S. Randomised, waiting list controlled trial of cognitive-behavioural therapy for persistent postconcussional symptoms after predominantly mild-moderate traumatic brain injury. Journal of Neurology, Neurosurgery and Psychiatry. 2016;87(10):1075-1083. doi.org/10.1136/jnnp-2015-312838
- 14Zwilling A, Sander A, Hanks R. Changes in emotion after traumatic brain injury. Model Systems Knowledge Translation Center. 2022. msktc.org/…/changes-emotion-after-traumatic-brain-injury
- 15988 Suicide and Crisis Lifeline. Home page. Accessed October 2026. 988lifeline.org
- 16988 Suicide and Crisis Lifeline. Get help. Accessed October 2026. 988lifeline.org/get-help
This article reflects the safety priorities of concussion recovery and road safety education. It is general education, not medical or mental health advice, and it cannot diagnose any condition. Screening and treatment guidance can change, so check official sources and talk with your own care team or another qualified professional about your symptoms. If you are in crisis, call or text 988, or call 911. Reviewed October 2026.
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