A headache is the most common symptom reported after a concussion, also known as a mild traumatic brain injury (TBI). When a new headache develops within seven days of the injury, or an existing pattern worsens, it is medically classified as a post-traumatic headache (PTH). These headaches occur because the trauma temporarily disrupts the brain’s normal function. Managing these headaches is an important part of the overall recovery process.
Typical Recovery Timeline for Concussion Headaches
The duration of a post-traumatic headache is variable, but most cases follow a predictable timeline toward resolution. For the majority of people, the acute phase of concussion symptoms, including headaches, resolves within a few weeks. Children and adolescents often recover slightly faster, while adults typically see resolution within two to three weeks. This expected recovery window establishes the definition of an acute post-traumatic headache, which lasts for less than three months. Symptoms that persist beyond this initial period affect a significant minority of patients.
Understanding Persistent Post-Concussion Headaches
When post-traumatic headaches continue for three months or longer after the initial injury, they are formally reclassified as a persistent post-traumatic headache (PPTH). This transition marks the boundary between expected recovery and a more chronic condition requiring specialized management. Persistent headaches are also a defining feature of Post-Concussion Syndrome (PCS), where symptoms linger beyond the expected recovery time. Approximately 10 to 20 percent of individuals develop PPTH. While the persistence of headaches can be concerning, the prognosis is generally favorable, as most people see symptoms improve or resolve within a year.
Categorizing Headache Types After Concussion
Post-concussion head pain often mimics established headache disorders, which is important for guiding treatment.
Tension-Type Headaches
The most common presentation is a tension-type headache, characterized by mild to moderate, constant dull pressure or tightness. This pain often wraps across the forehead or affects the back and sides of the head.
Migraine-Like Headaches
Another frequent type is the migraine-like headache, which is typically more severe, throbbing, and often localized to one side of the head. These episodes can be debilitating and are frequently accompanied by sensitivity to light (photophobia) and sound (phonophobia), as well as nausea or vomiting.
Cervicogenic Headaches
Headaches can also be cervicogenic, meaning the pain originates from the neck or cervical spine, often due to the whiplash effect of the injury. This pain usually starts in the neck or shoulder region and radiates upward, often worsening with specific neck movements.
Treatment Approaches for Ongoing Headaches
Managing persistent post-traumatic headaches involves a multidisciplinary strategy addressing both the pain and underlying concussion-related dysfunctions.
Non-Pharmacological Interventions
Foundational interventions include strict adherence to sleep hygiene, regular, nutritious meals, and avoiding known headache triggers like stress. A gradual, sub-symptom threshold return to physical activity and exercise is also recommended as a core part of treatment.
Pharmacological Options
Pharmacological options are used for symptom relief and prevention. Over-the-counter medications like ibuprofen or acetaminophen treat acute pain, but overuse must be avoided to prevent rebound headaches. For chronic, frequent headaches, a provider may prescribe preventive medications, such as certain antidepressants or anticonvulsants, which may take one to three months to show improvement.
Specialized Care
Multidisciplinary care often incorporates specialized therapies. These include physical therapy for neck-related pain, vestibular therapy for dizziness, and cognitive behavioral therapy (CBT) to manage associated anxiety and stress.
Red Flags: When to Seek Immediate Medical Help
While most post-concussion headaches are not signs of a medical emergency, certain symptoms require immediate evaluation to rule out a more serious complication, such as intracranial bleeding or swelling. Seek emergency medical attention if the headache rapidly worsens, becomes severe, or is described as the “worst headache of your life.” Repetitive or severe vomiting is another serious warning sign. Other red flags include new or increasing confusion, difficulty waking up, or excessive drowsiness. Any new neurological deficits, such as slurred speech, weakness or numbness on one side of the body, or convulsions and seizures, also warrant an immediate trip to the emergency room. A doctor should also evaluate vision changes, such as one pupil being larger than the other.