Introduction: Not Just “Normal” Headaches
Headaches are the most common symptom after a concussion, often lingering for days, weeks, or even months. But here’s the key: not all post-concussion headaches are the same.
Understanding the underlying cause of a patient’s headache is critical—because the treatment must match the type.
Let’s break down the most common types of headaches after concussion, what causes them, and how to treat them effectively.
Why Do Concussions Cause Headaches?
Concussions are complex. They don’t just affect the brain—they also impact:
- The neck and cervical spine
- The visual system (eye movement control)
- The autonomic nervous system
- Blood flow regulation and pain sensitivity
Each of these systems can trigger or worsen headache symptoms.
Concussions disrupt how the brain interprets input from the body, and headaches are often the result of dysfunction in systems outside the brain itself.
Common Types of Post-Concussion Headaches
1. Cervicogenic Headaches
- Origin: Dysfunction in the upper cervical spine
- Symptoms: Pain at the base of the skull, neck stiffness, headache worsened by neck movement
- Often misdiagnosed as migraines
Common after whiplash injuries or poor posture following concussion
2. Migraine-Like Headaches
- Origin: Neurological and metabolic changes in the brain
- Symptoms: Throbbing pain, light/sound sensitivity, nausea
- Often aggravated by screens, stress, or fatigue
3. Tension-Type Headaches
- Origin: Muscular tension, stress, emotional strain
- Symptoms: Mild to moderate, band-like tightness across the forehead or scalp
- Often triggered by prolonged screen time, poor posture
4. Visual-Related Headaches
- Origin: Oculomotor dysfunction (difficulty with eye teaming, focus, or tracking)
- Symptoms: Pain behind the eyes, worsens with reading, scrolling, or fluorescent lighting
- Can be misinterpreted as migraine or sinus pain
5. Exertional Headaches
- Origin: Poor autonomic regulation (heart rate, blood flow)
- Symptoms: Headache during or after physical activity
- May be a sign the patient isn’t ready for aerobic exercise yet
How to Tell the Difference
Key clues to identifying the headache source:
- Location of pain (base of skull vs. forehead vs. behind eyes)
- What makes it worse (neck movement? screens? exercise?)
- What improves it (rest, meds, neck treatment?)
Proper classification leads to faster, more targeted treatment.
Treatment Options by Headache Type
| Headache Type | Most Effective Treatments |
| Cervicogenic | Manual therapy (targeting deep neck flexors and suboccipitals), postural correction, cervical spine mobilization, dry needling, trigger point therapy, and DNF retraining[1] |
| Migraine-like | Anti-inflammatory diet (based on dietary inflammatory index), gut-brain axis interventions to reduce chronic neuroinflammation, sleep regulation, hydration, stress management, and graded aerobic exercise[2] |
| Tension-type | Soft tissue release (trapezius, SCMs, levators), stress reduction, postural rehab, and integrative techniques including acupuncture and relaxation strategies[5] |
| Visual-related | Neuro-optometric assessment, oculomotor retraining, home- and clinic-based vision therapy, lens tints or prism glasses, and progressive screen reintroduction[3] |
| Exertional | Sub-symptom threshold aerobic training based on Buffalo Concussion Treadmill Test (BCTT), HRV regulation via breathwork, mindfulness, cold exposure, and parasympathetic stimulation[4] |
When to Refer for Help
You should refer a patient for further evaluation if:
- Headaches persist beyond 2–4 weeks
- Symptoms are getting worse instead of better
- The patient struggles with screens, reading, or focusing
- Headaches are triggered by physical exertion
Multisystem rehab (vision, vestibular, cervical, autonomic) is often required to resolve these cases fully.
What You Can Do Next:
🧠 Watch the Free Concussion Patient Workshop
Understand the top 3 reasons symptoms like headaches persist—and what to do about them.
📲 Use the Concussion Tracker App
Track headache triggers, symptom trends, and connect with a local certified clinic.
🏥 Find a Certified Concussion Clinic
Get assessed for vision, neck, vestibular, and autonomic issues driving headaches.
References
- Schneider KJ, et al. Cervicovestibular rehabilitation in sport-related concussion: a randomized controlled trial. Br J Sports Med. 2014;48(17):1294-1298.
- Leddy JJ, et al. A physiological approach to prolonged recovery from sport-related concussion. J Athl Train. 2007;42(3):370–375.
- Master CL, et al. Vision Diagnoses Are Common After Concussion in Adolescents. Clin Pediatr (Phila). 2016;55(3):260–267.
- Gallaway M, et al. Vision therapy for post-concussion vision disorders. Optom Vis Sci. 2017;94(1):68–73.
- Silverberg ND, Iverson GL. Etiology of the post-concussion syndrome: Physiogenesis and psychogenesis revisited. NeuroRehabilitation. 2011;29(4):317–329.