When can you safely drive after a concussion?

Driving After a Concussion: Guidelines for Safe Return

Patients should not drive until they are completely symptom-free from concussion and have waited an additional 24-48 hours after symptom resolution before resuming driving.

Assessment of Readiness to Drive

Determining when it's safe to drive after a concussion requires careful consideration of several factors:

1. Symptom Resolution

   • Complete resolution of all concussion symptoms is the first requirement
   • Common symptoms that affect driving ability include:
     • Dizziness
     • Visual disturbances
     • Slowed reaction time
     • Impaired concentration
     • Headaches that could be distracting

2. Cognitive Function

   • Even after symptoms resolve, cognitive deficits may persist
   • Research shows slowed driving reaction times persist even after symptom resolution 1
   • Driving requires complex psychomotor and perceptual abilities that are vulnerable to impairment 2

Evidence-Based Timeline

The timeline for return to driving should follow this progression:

• Acute Phase (Symptomatic): No driving permitted
• Post-Symptom Resolution: Wait 24-48 hours after complete symptom resolution before attempting to drive
• First Driving Session: Should be brief, during daylight hours, in familiar areas, with minimal traffic

Risk Considerations

Research evidence demonstrates important safety concerns:

• Concussed individuals demonstrate significantly slower driving reaction time composite scores compared to controls even after symptom resolution (mean difference = 292.86 ms) 1
• Traditional computerized neurocognitive testing may not adequately predict driving performance 1
• Large effect sizes for driving impairment exist even when patients report being asymptomatic 1

Special Considerations

Commercial Drivers

Commercial drivers are subject to more stringent criteria with longer restriction periods, similar to guidelines for other neurological conditions 3.

Medical Documentation

Physicians should document their advice regarding driving restrictions in the patient's medical record 4. This is important for both medical and legal reasons.

Practical Recommendations

When returning to driving:

• Start with short trips in familiar areas
• Avoid rush hour, night driving, and inclement weather
• Have another licensed driver present during initial driving attempts
• Avoid distractions (phone, music, passengers)
• Stop immediately if symptoms return

Common Pitfalls to Avoid

1. Premature Return: Returning to driving too soon is the most common mistake
2. Overestimating Recovery: Patients often feel "fine" before cognitive function has fully recovered
3. Ignoring Persistent Deficits: Subtle cognitive and reaction time deficits may persist despite symptom resolution
4. Failing to Document: Physicians should document driving advice in medical records

While specific concussion driving guidelines are limited, these recommendations are based on the best available evidence and align with general principles for neurological conditions that affect cognitive function and reaction time.