There’s a saying, “Concussion fights dirty.” It means that the symptoms of a concussion can vary widely and feel relentless.
One of the lingering symptoms of concussion is anxiety. “Anxiety after concussion is insidious,” says Christopher Burley, PhD, a neuropsychologist with the UPMC Sports Medicine Concussion Program. “Not a lot of people know how to recognize it and treat it.”
Though symptoms can feel strong, anxiety after a concussion is treatable. The biggest hurdle with concussion anxiety is making the connection about what’s going on.
What’s the Connection Between Concussion and Anxiety?
How can a concussion cause anxiety? It starts with a psychological understanding of what a concussion is.
“A concussion is an energy problem,” Dr. Burley explains. When you have a blow to the head or neck, it can make the brain move inside the skull. The neurons stretch because of this movement.
Chemical changes begin to happen, with calcium flooding in and potassium leaking out. As a result, you have vasoconstriction, meaning your blood vessels narrow, decreasing blood flow.
“Your brain has less blood at the very time it needs it most,” he says. “That causes an energy imbalance, which disrupts your brain’s networks.”
The energy imbalance creates different sets of problems for different people. This is why concussion symptoms are so wide-ranging.
People associate concussion with symptoms like headaches, nausea, confusion, and dizziness. But concussions can also affect your vision, balance, concentration, memory, sleep, and mood.
There are actually six main types of profiles for a concussion.
- Cervical (neck).
- Cognitive fatigue.
- Migraine headache.
- Mood/anxiety.
- Ocular (your vision system).
- Vestibular (your balance system).
No imaging or blood tests can identify your type, Dr. Burley says. Instead, it’s about identifying and unpacking your symptoms.
How Anxiety Shows Up After a Concussion
People often ask, “Do concussions cause anxiety?” The answer is yes — but in a more specific way than you might expect.
“Anxiety is a catch-all term,” Dr. Burley says.
As a concussion response, anxiety usually has a lot of physiological symptoms. This includes:
- Feeling overwhelmed, especially in a busy place.
- Lightheadedness.
- Panic.
- Racing thoughts.
- Rapid heartbeat.
- Restless sleep.
- Trouble regulating body temperature.
“People are often having these symptoms and have no idea where it’s coming from,” he says. It can feel like a very physical type of anxiety.
Concussion can make underlying anxiety or depression worse, especially if you’re already not managing it well. Conversely, already managing your anxiety and depression well will put you in a better place to recover from concussion.
It’s more common that a person doesn’t even recognize the feelings they’re having as anxiety.
Also, people who have anxiety after a concussion are more likely to have vestibular symptoms. This is because the vestibular system and sympathetic nervous system share the same neural pathway.
“They’re both primitive systems deep-rooted in our brain that help us do basic things,” he says. This shared pathway is the reason that even simple tasks, such as shopping in a grocery store, can cause increased anxiety.
The feeling of “brain fog” is a common vestibular symptom that people with anxiety also face. Part of getting the right treatment for concussion is figuring out which system is causing the symptoms.
For example, someone might present with migraines after a concussion. If you treat their migraines, the anxiety might go away.
But it might not if it’s the other way around — if anxiety is at the root, and migraines are secondary.
Treating Anxiety After Concussion
“We often need to treat anxiety to help with other concussion symptoms,” Dr. Burley says.
Treatments include:
- Exercise — “Aerobic exercise is the gold standard for treating anxiety,” Dr. Burley says. Exercise, or exertion therapy, can bring down your nervous system response and release dopamine.
- Medication — Drugs, such as selective serotonin reuptake inhibitors (SSRIs), aren’t usually the first line of treatment. But SSRIs can help because some of them also act on the shared vestibular and autonomic pathways. “Daily SSRI use can calm the system down over time,” he says.
- Psychotherapy — Talk therapy can help, especially if someone also has some post-traumatic stress from an accident or injury. “But we tell people not to focus too much on symptoms because rumination can increase anxiety.” People should work through their stressors in therapy, rather than fixating on symptoms.
- Vestibular therapy — Vestibular therapy helps improve balance and feelings of dizziness. It can involve balance training, head movements, eye movements, and gaze training. Sometimes, it entails doing what makes you dizzy so your brain can relearn how to stabilize.
To Reduce Anxiety After Concussion, Stay Active
Dr. Burley says the days of treating concussions by lying in a dark room are over. Prolonged rest is no longer a key part of all concussion recovery plans. “People weren’t really getting better,” he says.
The thinking on this began to change nearly two decades ago. “We realized the active approach helps people get better significantly faster,” he says.
For example, UPMC Sports Medicine runs a Saturday Morning Injury Clinic each fall for kids injured in Friday night football games and other sports — and they often see concussion symptoms there. “Sometimes, we’ll have our athletes running on the treadmill Saturday morning.”
This exposure/recovery model leans into the idea that you can’t get better if you avoid the activities of daily life. “I tell my patients, be social, exercise, use screens,” he says. “Depending on the type of concussion you have, feeling the symptoms can be essential to the recovery process.”
What About Anxiety and “Post-Concussion Syndrome?”
Post-concussion syndrome and post-concussive disorder are terms that get tossed around a lot. People sometimes use them interchangeably with concussion.
Post-concussion syndrome refers to chronic symptoms after a concussion and is more aptly characterized as “persisting symptoms after concussion.” Post-concussion syndrome suggests these symptoms may be permanent, which can be demoralizing for patients.
Seek Concussion Care Right Away
“Our research has shown that if you see us within a week, you can reduce recovery time by half,” Dr. Burley says.
UPMC Sports Medicine Concussion Program experts now see patients at nine locations throughout western Pa. The Greensburg and Erie locations are the newest. Virtual visits are also an option in some cases.
Because UPMC Sports Medicine is renowned for its concussion program, people come from all over. “Sometimes, we can treat vestibular or ocular concussions quickly, and it helps,” he says. “Other times, people have been overtreated and feel like they will never get better.”
But they can get better. It’s all about getting to the root issue, he says. “In my mind, there is not a concussion that cannot be treated with the right treatment plan.”