Driving with lingering concussion symptoms: a safety check before every trip
How to decide each day whether your symptoms allow a safe drive
Imagine a 44 year old bookkeeper who was rear ended at a red light in the spring. By fall, most days feel close to normal. Then she sleeps badly, her head pounds by noon, and the store lights make her squint. She still has to pick up her son from practice at 6.
When concussion symptoms drag on for many weeks or months, the condition is called post concussion syndrome (PCS). The symptoms are rarely steady. A good morning can turn into a rough evening, and a quiet side street can feel very different from a busy highway at dusk.
This guide covers the long stretch of recovery after your first return to driving. It offers a quick check before each trip and the signs that it is time to stop for a while.
How changing symptoms can affect your driving
Driving asks your brain to do many jobs at once. A brain injury can affect vision, reaction time, focus, lane keeping and handling several tasks at the same time [3].
Canada’s Living Concussion Guidelines say patients should be told that blurred vision, dizziness, fatigue, thinking problems and headache may affect their driving [1]. They advise a return to driving only when symptoms have eased enough for safe driving [1]. The same guideline also advises that a person who still has symptoms after a concussion should not drive [1]. The CDC urges doctors to be cautious about clearing a patient to drive, especially one who has trouble with attention, reaction time or processing speed [7]. Processing speed means how quickly your brain takes in information and responds.
With PCS, symptoms can be worse on some days than others, so your driving risk can rise and fall too.
- Vestibular problems, which affect your inner ear balance system, can cause dizziness. Brief spinning spells when you move your head can point to an inner ear problem called BPPV [8].
- Light sensitivity can make glare harder to handle. Bright lights and busy visual scenes can make concussion symptoms worse [8].
- Slowed thinking can make you slow to spot signs, judge gaps or decide what to do [3].
- Fatigue can turn into drowsiness. A very tired driver can have micro sleeps, short losses of awareness that can last four or five seconds [9].
- Certain medicines, whether prescribed or bought off the shelf, can make you very drowsy or dizzy [10].
- Getting frustrated, angry or confused easily behind the wheel is one sign of unsafe driving after a brain injury [3].
Comparison compiled by Safety Behind the Wheel Foundation
Symptoms and what they can mean on the road
| Symptom today | How it can show up while driving | A lower risk choice |
|---|---|---|
| Dizziness or motion sensitivity | Unsteady on head turns; busy traffic feels like too much | Do not drive until it settles; get a ride |
| Light sensitivity or blurred vision | Trouble with glare, signs and night driving | Drive in daylight only; skip if vision is blurry |
| Slowed thinking or poor focus | Slow to react; missed signs or signals | Skip if worse than usual; familiar route, phone away |
| Headache flare | Pain pulls attention off the road | Wait until it eases, or get a ride |
| Fatigue or drowsiness | Heavy eyelids; drifting over lane lines | Do not drive; rest first |
| Medicine that causes drowsiness | Sleepy, dizzy or slower | Ask a pharmacist before you drive |
| Anger or worry in traffic | Rushed or confused choices | Wait until calm; short, easy trips; tell your care team |
Sources: Living Concussion Guidelines [1, 8]; CDC [7]; MSKTC [3]; NHTSA [9, 10]. These are general examples, not a medical test.
What research shows about driving after concussion
Most studies of driving after concussion are small, and many tested people in the first days after injury.
In the first days
In a 2010 study in Brisbane, Australia, researchers compared 42 emergency patients with a minor head injury and 43 with minor bone or joint injuries [11]. Everyone was tested within 24 hours of being hurt [11]. They watched real traffic videos filmed from the driver’s seat and clicked on hazards as soon as they saw them [11]. People with head injuries were slower to react to the hazards [11].
A 2017 US study put 14 college age adults in a driving simulator. Each was tested within two days of feeling that their symptoms had cleared [12]. They had less control of the car and swerved more within their lane [12]. The lead researcher said driving should be limited at least until symptoms clear, and perhaps longer [12].
Months and years later
The longer picture is less clear. A 2016 review of 24 studies on brain injury and driving found two studies showing impaired driving within 24 hours of a mild injury [13]. A third study found no impairment years later [13]. The authors said mild injury may affect driving soon after the injury but may not leave lasting problems [13].
A 2018 online survey of 389 people compared those who reported a past mild brain injury with those who did not [14]. Those with a past injury reported more risky driving habits and were more likely to report a recent crash [14]. Driving violations were reported less often the longer it had been since the injury [14]. People reported on themselves, so this shows a link, and it cannot prove cause.
The largest study comes from Ontario and was published in BMJ Open in November 2025. The figures here are as reported in a news release from the research institutes and in a news summary [2, 15]. Researchers used health records for more than 3 million patients over a 10 year follow up [15]. That included 425,158 adults diagnosed with a concussion [2]. Their crash risk was 49% higher than in people treated for an ankle sprain [15]. The extra risk was highest in the first four weeks, and it grew with repeat concussions [2]. It also showed up for people hurt while crossing the street on foot [2]. The study had no data on how severe each concussion was, and it cannot show cause and effect [2].
No study can say whether you are safe to drive today. Still, the 2017 simulator study suggests that feeling better does not always mean your driving skills have fully recovered [12].
A safety check before every trip
A clearance from months ago cannot tell you how you are doing this morning. A one minute check before each trip can help you spot a bad day. It is not a medical test, and it does not replace your care team’s advice. If you cannot check every box, do not drive yet. Wait, change your plans until every box is true, or find another way to get there.
Checklist from Safety Behind the Wheel Foundation
- I slept fairly well and do not feel drowsy right now.
- Any headache is at my usual low level and not building.
- I have no dizziness, spinning or unsteady feeling when I turn my head.
- My vision is clear, with no new blurring or double vision.
- Light and glare feel manageable for the time I will be driving.
- My thinking feels clear enough to plan the route and handle a surprise.
- I have not taken a medicine, drink or other substance that makes me sleepy or slow.
- My worry about this drive feels manageable.
- The trip is short or familiar, or I have planned breaks along the way.
- My phone and directions are set before I start, and I know where I can pull over.
- No one who knows me well has said I seem off today.
Many people with a brain injury may not notice their own driving problems [3]. That is why family, friends and your care team should have a say in the choice to drive [3].
If symptoms build during a drive, pull over somewhere safe and stop. Crossing lane lines or hitting a rumble strip are signs of drowsiness [9]. Call someone to pick you up if the symptoms do not settle.
Get emergency care right away
If you spot any of these signs after a head injury, phone 911 or get a ride to the closest hospital emergency department at once [16]:
- A headache that grows stronger and does not let up.
- Weakness, numbness, clumsiness, convulsions or seizures.
- Throwing up more than once.
- Slurred words or strange behavior.
- One pupil (the dark circle in the middle of the eye) bigger than the other.
- Confusion, restlessness or agitation, or trouble recognizing people or places.
- Fainting, extreme drowsiness, or being impossible to wake.
Never drive yourself for this kind of care. Have someone else call for help or drive you.
Ways to lower your risk on days you drive
Even on good days, a few choices can make a drive easier on a healing brain.
Choose easier conditions
A brain injury fact sheet from the Model Systems Knowledge Translation Center (MSKTC) suggests driving less than you did before the injury [3]. It also suggests daylight, familiar roads, light traffic and good weather [3]. Turn off the radio and leave your phone alone [3]. The Ontario researchers advised against high speed trips late at night in bad weather in the first month after a concussion [2]. If your symptoms are still active months later, the same caution makes sense.
A simple plan for lower risk trips might look like this:
- Start with short trips close to home, such as a store you know well.
- Hold off on highways, night driving and rush hour until short trips go well for a few weeks and your care team agrees.
- Keep the car calm. Children, pets and lively talk can pull your attention away.
- Set directions and music before you pull out.
- Avoid the times when drowsiness peaks, from midnight to 6 a.m. and in the late afternoon [9].
- On longer trips, plan stops. If you feel sleepy, pull over. NHTSA suggests a short nap of about 20 minutes in a safe spot, such as a lighted rest stop, and notes that coffee alone is not always enough [9]. If you still feel drowsy or unwell, do not drive on. Call for a ride.
Check your medicines
Read every label. Warnings about running heavy machinery also apply to driving a car [10]. Ask your pharmacist whether any of your medicines, including ones you buy without a prescription, can make you drowsy or dizzy. Before you stop or switch any medicine, check with the person who prescribed it.
Treat what drives the symptoms
The Ontario researchers urged patients to treat insomnia, headaches, depression and substance misuse [2]. The Living Concussion Guidelines recommend vestibular rehabilitation, a type of therapy for the balance system, for dizziness that limits daily life [8]. They also suggest considering a referral to a trained vision professional when vision problems limit daily life [8].
When to stop driving and get a formal evaluation
MSKTC lists signs of unsafe driving after a brain injury [3]. They include driving too fast or too slowly, and missing traffic signs or signals [3]. Others are trouble judging distance, being slow to decide, drifting into other lanes, near misses, and getting lost in places you know [3]. If you notice any of these, or someone who rides with you does, stop driving and talk with your care team.
Imagine a 29 year old line cook with PCS. He feels fine most days. But twice this month his wife has seen him drift over the center line on the drive home after a long shift. That pattern is a reason to pause driving and ask for a formal evaluation.
What a driving evaluation involves
Driver rehabilitation specialists help drivers of every age and ability [4]. A certified driver rehabilitation specialist (CDRS) holds a credential that ADED calls the benchmark for quality in the field [4].
An evaluation usually has two parts [4]. The first is a clinic review of skills such as vision, attention and reaction time [4]. An occupational therapist or another trained professional may do this part [3]. The second is a behind the wheel test of how you drive [4]. Doctors and others can refer you [4]. Some programs take health insurance, and others charge a fee for each service, so ask about cost first [4]. State vocational rehabilitation agencies may help pay for evaluations [3]. ADED keeps a current list of specialists [4].
Results may lead to training made for your needs, or to equipment changes [4]. You may also need to pass a state licensing test for any limits on your license [4]. Our guide to returning to driving after a brain injury covers the first return in more detail.
Getting around when you should not drive
Plan for bad days before they come. Line up two or three people you can call for rides. For medicines that cause drowsiness, NHTSA suggests public transit when you can [9]. Ask your employer whether you can work from home or shift your hours on days when symptoms flare.
State rules, reporting and commercial licenses
Driving laws for people with a brain injury vary by state [3].
Reporting rules
A 2024 study reviewed every state motor vehicle website in November 2022 [5]. Six states required doctors to report some medically impaired drivers [5]. In California, Delaware, Nevada and New Jersey, the rule covered conditions with lapses of consciousness, such as epilepsy [5]. Oregon and Pennsylvania required reports on a wider range of problems, including vision loss and memory loss in Alzheimer disease [5]. In 37 states, the law protected doctors from liability for reporting [5]. The study found wide variation, and rules may have changed since then [5].
Whether lingering concussion symptoms fall under these rules depends on your state and your symptoms. Ask your care team, and check your state’s driver licensing agency.
Medicines and the law
Every state, plus the District of Columbia, bans driving while impaired by a drug, even one prescribed to you or sold over the counter [10]. If you are unsure how your condition or medicines affect your license or your auto policy, ask your state agency or your insurer.
Commercial drivers
Commercial drivers who fall under federal rules need a medical exam from an examiner listed on the Federal Motor Carrier Safety Administration’s National Registry [6]. The examiner decides whether you meet the federal standards [6]. The 2024 handbook for examiners lists traumatic brain injury, along with headaches, vertigo and dizziness, under its section on epilepsy, seizures and loss of consciousness [6]. Certificates generally last up to 24 months, and some drivers get shorter ones [6]. The handbook is guidance, and it does not carry the force of law [6]. Tell your examiner and your employer about your concussion and any lasting symptoms before you go back to commercial driving.
Teens and new drivers with lingering symptoms
In a 2020 study, a Children’s Hospital of Philadelphia team used registry data on 332 drivers, ages 16 to 19, seen at its concussion program in 2018 [17]. Nearly half were already driving about two weeks after injury, and most of them had not changed how they drove [17]. Teens who did change cut back on the number and length of trips and avoided night driving [17].
The researchers urged doctors to bring up driving with families [17]. They suggested a gradual return to driving that is as careful as the return to school, or more careful [17].
Graduated driver licensing (GDL) gives teens more freedom in stages: a learner’s permit, then an intermediate license, then a full license [18]. Many states require parents to certify a set number of supervised practice hours [18]. Most states also limit teen passengers [18]. New drivers rarely crash while an adult is supervising them [18].
For a teen with PCS, a few steps help:
- Check with the care team before permit practice starts again, and skip practice on bad symptom days.
- Restart in empty parking lots or quiet streets before busier roads.
- Wait to schedule the road test until practice drives go well for a steady stretch.
- Add a symptom rule to your family’s driving ground rules [18].
Questions to ask your care team
Question checklist from Safety Behind the Wheel Foundation
- Which of my symptoms worry you most for driving right now?
- Are there times of day or kinds of roads I should avoid for now?
- Could any of my medicines make me drowsy, dizzy or slow?
- Would vestibular or vision therapy help the symptoms that affect my driving?
- Should I have a formal driving evaluation, and can you refer me?
- Does my state require you or me to report my condition to the licensing agency?
- I drive for work or hold a commercial license. What do I need before I go back?
- For my teen, how should permit practice or the road test fit into recovery?
Frequently asked questions
Can I drive on good days if my symptoms come and go?
Talk with your care team first. The Living Concussion Guidelines advise that people who still have symptoms should not drive, and that driving resume only once symptoms ease enough for safe driving [1]. If your care team clears you, use the check before each trip, and skip the drive on days when symptoms flare.
How long does the higher crash risk last?
No one knows for sure. The Ontario study tracked patients over 10 years, and the extra risk was highest in the first four weeks [2, 15]. The study cannot prove the concussion caused the crashes [2].
Does my doctor have to report me to the DMV?
It depends on your state and your condition. As of late 2022, six states required doctors to report some medically impaired drivers [5]. Ask your care team and check with your state’s licensing agency.
The bottom line
Recommendation from Safety Behind the Wheel Foundation
Lingering concussion symptoms can change how well you drive from one day to the next. Guidelines advise driving only when symptoms have eased enough to drive safely, and a large study linked concussion with higher crash risk [1, 2].
If your care team has cleared you, run the check before each trip and pick easier roads and times while you recover. If warning signs show up, stop driving and ask for a formal evaluation. Rules change, so confirm the current ones with your state licensing agency, and with your medical examiner if you drive commercially. Ask your insurer or your state insurance department how your condition could affect your auto policy.
Sources and further reading
- 1Living Concussion Guidelines. Initial management (section 2), recommendation 2.6. Updated August 2022. concussionsontario.org/…/initial_management
- 2Redelmeier DA, et al. Concussions and risk of a subsequent traffic crash: retrospective cohort analysis in Ontario, Canada. BMJ Open. 2025;15(11):e105391. Summary: ICES and Sunnybrook Research Institute news release, November 2025. eurekalert.org/news-releases/1104575
- 3Model Systems Knowledge Translation Center. Driving after traumatic brain injury. 2024. msktc.org/…/driving-after-traumatic-brain-injury
- 4ADED. Frequently asked questions. Accessed October 2026. aded.net/page/FAQs
- 5Tran EM, Lee JE. Reporting requirements, confidentiality, and legal immunity for physicians who report medically impaired drivers. JAMA Network Open. 2024;7(1):e2350495. jamanetwork.com/…/2813610
- 6Federal Motor Carrier Safety Administration. Medical examiner’s handbook, 2024 edition. January 2024. fmcsa.dot.gov/…/Medical%20Examiner%27s%20Handbook%202024%20Edition_0.pdf
- 7Centers for Disease Control and Prevention. Managing return to activities (HEADS UP, for health care providers). Reviewed July 2025. cdc.gov/…/clinical-guidance/index.html
- 8Living Concussion Guidelines. Vestibular (balance/dizziness) and vision dysfunction (section 10). Updated May 2023. concussionsontario.org/…/vestibular-balance-dizziness-vision-dysfunction
- 9National Highway Traffic Safety Administration. Drowsy driving. Accessed October 2026. nhtsa.gov/risky-driving/drowsy-driving
- 10National Highway Traffic Safety Administration. Drug-impaired driving. Accessed October 2026. nhtsa.gov/risky-driving/drug-impaired-driving
- 11Preece MHW, Horswill MS, Geffen GM. Driving after concussion: the acute effect of mild traumatic brain injury on drivers’ hazard perception. Neuropsychology. 2010;24(4):493-503. Summary: Headway, the brain injury association. headway.org.uk/…/driving-after-concussion-the-acute-effect-of-mild-traumatic-brain-injury-on-hazard-perception
- 12Schmidt JD, et al. Driving after concussion: is it safe to drive after symptoms resolve? Journal of Neurotrauma. 2017. DOI: 10.1089/neu.2016.4668. Summary: University of Georgia news release, Newswise, February 6, 2017. newswise.com/…/a-concussion-may-affect-your-driving-even-after-symptoms-disappear-says-study
- 13Palubiski L, Crizzle AM. Evidence based review of fitness-to-drive and return-to-driving following traumatic brain injury. Geriatrics. 2016;1(3):17. mdpi.com/2308-3417/1/3/17
- 14Bernstein JPK, Calamia M. Assessing the longer-term effects of mild traumatic brain injury on self-reported driving ability. PM&R. 2018;10(11):1153-1163. doi.org/10.1016/j.pmrj.2018.05.008
- 15News-Medical. One concussion can raise your car crash risk by nearly 50%. November 10, 2025. news-medical.net/…/One-concussion-can-raise-your-car-crash-risk-by-nearly-5025.aspx
- 16Centers for Disease Control and Prevention. Symptoms of mild TBI and concussion. Updated September 15, 2025. cdc.gov/…/signs-symptoms/index.html
- 17McDonald CC, et al. Changes in driving behaviors after concussion in adolescents. Journal of Adolescent Health. Published online December 15, 2020. DOI: 10.1016/j.jadohealth.2020.10.009. Summary: Children’s Hospital of Philadelphia news release, December 14, 2020. chop.edu/…/nearly-half-young-drivers-are-resuming-driving-just-weeks-after-sustaining-concussion
- 18National Highway Traffic Safety Administration. Teen driving. Accessed October 2026. nhtsa.gov/road-safety/teen-driving
This article reflects the safety priorities of safe driving and brain injury recovery education. It shares general information and is not medical, legal or insurance advice. Licensing and reporting rules change and differ by state, so confirm them with your state’s driver licensing agency. Make driving decisions with your own care team. Reviewed October 2026.
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