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Concussions and Anxiety: What’s the Connection?

R.J. Elbin, PhD, is a research analyst with the Inova Sports Medicine Concussion Program. He is also the director of the Office for Sport Concussion Research in the Department of Health, Human Performance and Recreation at the University of Arkansas.

Concussions can cause all sorts of symptoms: Physical problems like headaches and nausea. Cognitive problems that affect thinking and memory. Sleep troubles. And emotional problems, including irritability, depression and anxiety.

Recently, our research team decided to take a deeper look at anxiety. It’s not surprising that someone would feel anxious after a brain injury. But after treating lots (and lots) of patients, our concussion management team suspected there was more to the story.

Along with other members of the Inova Sports Medicine Concussion Program, I shared the results of this research at the Big Sky Athletic Training Sports Medicine Conference in February 2019.

Anxiety Increases Concussion Symptoms

When we talk about anxiety, there are two types: trait anxiety and state anxiety. Trait anxiety describes someone’s general levels of anxiety.  State anxiety, meanwhile, refers to the situations and moments when any person might feel anxious (such as during a job interview).

We looked at both types of anxiety in concussion patients. As you might expect, we found that patients who were more trait anxious were more likely to have higher states of anxiety after experiencing a concussion.

But that wasn’t all. [KT1] We also found that people with higher trait anxiety scores also experienced more concussion symptoms after the injury. It’s important for doctors to ask about anxiety, since it might influence concussion symptoms. And as a patient, it’s important to talk openly about all of your symptoms with your doctors, including your history with anxiety both before and after injury.

Anxiety Can Affect Concussion Recovery

Even if you don’t have a history of being anxious, anxiety can make a surprise appearance after a concussion. In another study, our team looked at the link between state anxiety and certain concussion outcomes that included balance problems and dizziness (vestibular dysfunction) and uncoordinated eye movements (oculomotor dysfunction).

We found people who have vestibular and ocular motor issues after a concussion often report very high levels of anxiety after the injury. What’s more striking: Among patients with those vestibular and visual symptoms, those with high state anxiety took longer to recover than those without it. In other words, anxiety serves as an additional negative “add-on” to post-concussion vestibular and ocular motor impairment — and ultimately prolongs concussion recovery.

Don’t Ignore Anxiety

So what’s the takeaway if you (or someone you love) has experienced a concussion? Don’t be afraid to bring up feelings of anxiety to your doctor. That’s true whether you have a history of an anxiety disorder or are experiencing it for the first time after your injury.   

It’s also a good idea to get a comprehensive evaluation. Make sure your doctor has checked out your vestibular and oculomotor system, since those symptoms can go hand-in-hand with anxiety — and impact your recovery. (A thorough exam of those systems should go beyond just checking your balance.)

Concussion Research Leads to Better Treatments

Thanks to research, we know a lot more about treating concussions than we did just a decade or two ago. Doctors once thought people with concussion should rest quietly in a dark room. Now, we know that recovery is usually smoother if patients gradually return to normal activities like school, work and exercise. That’s true for all patients, but we think it might be especially important for those with anxiety.

At the Inova Sport Medicine Concussion Program, we take the research seriously. That means our concussion treatments are based on the latest scientific findings. And we’re committed to pushing the science forward with research of our own.

Concerned about concussion and need help identifying symptoms or scheduling a concussion appointment? Call our 24/7 Concussion Hotline: 703-970-6427 or request an appointment with our Concussion Management Team.  

Inova Sports Medicine is the Official Sports Medicine Partner of the Washington Nationals and the Washington Redskins.


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