Post-concussion symptoms and PTSD after a car accident are real injuries that do not show on a CT. At three months, 27% of adults sent home from the ER after a crash had substantial post-traumatic stress symptoms. Yet the large majority of people with a mild brain injury are back at work within a year.
Two of the most costly injuries after a crash leave no mark on any scan. Both are often treated as if they were not injuries at all.
Do concussion and PTSD show up on a CT scan after a car accident?
A broken wrist is believed. You can see it. It has a timeline. Nobody asks if you are making it up. Lasting post-concussion symptoms and post-traumatic stress get none of that. They do not show on a CT. They have no set timeline. And the people living with them are often told they should be over it. Sometimes doctors say it. Bosses often say it. Now and then, family says it.
That disbelief is part of the injury. Patients come to us after they have stopped talking about the symptoms, because talking about them has gone badly.
What persistent concussion symptoms cost, in earnings
This is where the research is most solid. The numbers are worth knowing because they are so far from how this injury is usually treated.
A four-year cohort study followed 245 adults who were employed before a mild traumatic brain injury. Four years later, 17.3% had left the workforce or reduced their hours for reasons other than retiring or school. A further 15.5% were still experiencing limitations at work because of the injury. So about a third of people who had jobs before a mild brain injury were, four years on, working less or working with trouble.
The same study found something even more useful. The symptom that predicted lost work productivity four years later was reported at one month. These were patients who said they were taking longer to think. Nobody scans for that symptom, and most people do not think to mention it.
A separate cohort of 434 patients had brain injuries from mild to severe. Even among those with mild injury, 43% reported thinking problems and 33% reported behavior problems in the long-term phase. Each kind of problem, on its own, predicted whether someone went back to work.
How common is PTSD after a car accident?
Post-traumatic stress after a crash is more common than most people think. That includes many doctors.
The largest US study of this is the AURORA study. It signed up adults in 19 ERs as they came in, then checked the results at 11 more. It looked only at people who were discharged home after a car crash. Not the badly hurt. The ones sent home. At three months, 27% had substantial post-traumatic stress symptoms. The validation cohort found 26%.
That is about one in four people who walked out of an ER after being told they were fine.
What that looks like in a life is specific, and people rarely talk about it. Not being able to drive the road where it happened. Bracing at every set of brake lights. Snapping at a partner over nothing and not knowing why. Lying awake replaying two seconds of it. Avoiding the car, then the errands that need the car, then the people at the end of those errands. It shrinks a life quietly. None of it sounds like a car accident symptom, so it goes unreported for months.
How do you tell post-concussion symptoms from PTSD?
Concussion and post-traumatic stress after a crash are hard to tell apart, and each makes the other worse. Poor sleep, poor focus, a short temper and low mood belong to both. So a patient with one can get the other’s label. Or they get neither, and are told they are stressed.
The medical reason to tell them apart is that the treatments differ. The reason to treat both is that neither clears up reliably while the other goes untreated.
There is a third thread we look for: is the headache coming from the brain or from the neck? Cervicogenic headache (headache that starts in the neck) after whiplash looks almost the same as post-concussion headache. But it can be treated in a way the brain injury cannot. Patients treated for post-concussion for months sometimes get better within weeks once the neck is treated.
Do most people recover from a concussion after a car accident?
None of the above predicts what will happen to you. It would be dishonest to say it does.
A prospective study (one that followed people forward in time) looked at previously healthy adults after a mild traumatic brain injury. It found that 96% returned to work or normal activities within a year. By six months, the group as a whole did not differ from injured controls on thinking, fatigue and mental health.
The same study found something useful about the few who did not recover. Many of them had a modifiable psychological risk factor identifiable at one month: depression, traumatic stress, or low resilience. Not a fixed trait. Something you can treat and spot early, in the window where treating it changes the outcome.
That is why you should speak up at the first visit, not the fourth.
What we do about it here
We ask. Concussion and traumatic stress symptoms are part of the exam after any crash. They are not an add-on, because patients almost never bring them up on their own.
We sort out where the headache comes from. When the cervical spine (the neck) plays a part, we treat it. That is often, and it is the part we can treat directly.
We bring you back to activity step by step, not with rest. Complete rest drags out concussion recovery. The evidence favors starting below the level that brings on symptoms and building up.
And when post-traumatic stress is there, we say so plainly and refer you for treatment that works. It is outside our specialty. Naming it is not outside our job. Pain treatment tends to work less well in someone with untreated traumatic stress. That is a medical reason as well as a human one.
When to get help immediately
Go to an emergency department for a headache that keeps getting worse, repeated vomiting, seizure, weakness or numbness on one side, slurred speech, confusion or growing drowsiness. If you are having thoughts of harming yourself, call or text 988 — the Suicide and Crisis Lifeline — or go to an emergency department. Post-traumatic stress is treatable, and the point at which it feels unsurvivable is the point at which it most needs treating.
If any of this sounds familiar, say so when you call. It is part of the exam, not a side note. Call or text us. See also concussion and head injury and cervicogenic headache.
Common questions
The CT after my crash was normal. Can I still have a concussion?
Yes. A normal CT is expected. A CT looks for bleeding and broken bone. Concussion is an injury to how the brain works, not its shape, so routine scans look normal.
Concussion and Head Injury covers how concussion shows up and what usually gets missed.
Is it normal to be frightened of driving months later?
It is common and it is treatable. Avoidance is a core part of post-traumatic stress. It tends to spread over time, not settle on its own.
Will this affect my ability to work long term?
For most people, no. The large majority are back at work within a year. A few have lasting trouble. The strongest early sign is thinking problems reported in the first month. That is a reason to mention them now, not later.
Concussion and Head Injury covers what to expect over time.
Do you treat PTSD here?
No. We check for it, we say plainly when we see it, and we refer you for treatment that works. We also treat the physical injuries alongside it, because untreated pain makes the mental recovery harder.
I feel like I am making too much of this.
That is the most common thing patients say right before they describe something significant. Being told you look fine is not the same as being fine.
How long does a concussion last after a car accident?
For most people it passes. In a study of previously healthy adults with a mild brain injury, 96% were back at work or normal activities within a year. By six months, the group did not differ from injured controls on thinking, fatigue and mental health. Those who did not recover often had depression, traumatic stress or low resilience that showed at one month.
How is a concussion treated after a car accident?
Not with complete rest, which drags out recovery. We start activity below the level that brings on symptoms and build from there. We also check whether the headache comes from the neck, because cervicogenic headache after whiplash looks almost the same and can be treated directly. When post-traumatic stress is there, we name it and refer you for treatment that works.
What are the signs of PTSD after a car accident?
Not being able to drive the road where it happened. Bracing at every set of brake lights. Snapping at a partner over nothing. Lying awake replaying the crash. Avoiding the car, then the errands that need it, then the people at the end of them. Poor sleep, poor focus and a short temper overlap with concussion, so we check for both.
Sources
Every figure on this page comes from a named study, with the population stated. Retrieved via PubMed.
- Theadom A, et al. Work Limitations 4 Years After Mild Traumatic Brain Injury: A Cohort Study. Arch Phys Med Rehabil. 2017;98(8):1560-1566. doi:10.1016/j.apmr.2017.01.010
- Jones CW, et al. Derivation and Validation of a Brief Emergency Department-Based Prediction Tool for Posttraumatic Stress After Motor Vehicle Collision. Ann Emerg Med. 2022;81(3):249-261. doi:10.1016/j.annemergmed.2022.08.011
- Losoi H, et al. Recovery from Mild Traumatic Brain Injury in Previously Healthy Adults. J Neurotrauma. 2015;33(8):766-776. doi:10.1089/neu.2015.4070
- Benedictus MR, et al. Cognitive and behavioral impairment in traumatic brain injury related to outcome and return to work. Arch Phys Med Rehabil. 2010;91(9):1436-1441. doi:10.1016/j.apmr.2010.06.019
Hurt in an accident? Start here.
You do not need a lawyer, a police report or a referral to be seen. Bring your symptoms and we will work out the rest.
Monday–Friday, 8:00 a.m. – 4:00 p.m. Same-day appointments are often available for new accident and injury patients.