Headaches After Concussion

Why do headaches persist after concussion?

Headaches are the single most common symptom after a concussion, affecting up to 90% of people in the acute phase. For most, they settle within a couple of weeks. But for a significant number, headaches continue — sometimes for months — and become the symptom that disrupts life the most.

The reason they persist is usually not that the brain is still "injured." More often, post-concussion headaches are being driven by one or more treatable causes that haven't been identified or addressed.

What's actually causing your headaches

Post-concussion headaches can have several overlapping drivers. Identifying which ones are involved changes everything about how treatment works:

Cervicogenic headaches

The most underdiagnosed cause of persistent post-concussion headache. The same force that causes a concussion often strains the cervical spine — particularly the upper neck joints and muscles. Dysfunction in the upper cervical spine can refer pain into the head, temples, behind the eyes, and across the forehead. These headaches respond well to manual therapy and targeted neck rehabilitation.

Vestibular-related headaches

When the vestibular system is disrupted, the brain works harder to maintain balance and orientation. This increased neural effort can trigger headaches — often accompanied by dizziness, nausea, or sensitivity to motion. Vestibular rehabilitation can reduce the neural load and resolve these headaches.

Oculomotor-driven headaches

Concussion can impair how your eyes track, focus, and converge. If your visual system isn't working efficiently, activities like reading, screen work, and driving create excessive strain — leading to headaches that worsen with visual tasks.

Exertion-related headaches

Some patients develop headaches during or after physical activity. This can relate to autonomic nervous system disruption affecting how blood flow to the brain is regulated. Graded exercise therapy helps recalibrate this system.

Why painkillers aren't the answer

Over-the-counter pain medication can take the edge off, but it doesn't address the cause. Worse, frequent use of painkillers for headaches can lead to medication-overuse headache — a rebound cycle that makes things harder to resolve.

The most effective path forward is identifying what's driving the headaches and treating that directly.

How we treat post-concussion headaches

Treatment starts with a thorough concussion assessment to determine the specific headache mechanism. From there, your treatment plan may include:

• Cervical spine manual therapy — addressing upper neck joint and muscle dysfunction that refers pain to the head
• Vestibular rehabilitation — reducing the neural overload that contributes to vestibular headaches
• Oculomotor exercises — improving eye tracking and convergence to reduce visual strain
• Graded exercise prescription — progressive loading that normalizes exertion responses
• Activity modification guidance — strategies to manage triggers while treatment takes effect

When should I get help for post-concussion headaches?

If your headaches aren't improving after the first week or two, or if they're limiting your ability to work, study, or function normally, it's time to get an assessment. Waiting longer rarely helps — but the right treatment often does.