A concussion is a mild traumatic brain injury (TBI) that temporarily alters brain function, typically caused by a jolt or blow to the head or body. Headaches are the most frequently reported symptom following this injury, affecting up to 90% of individuals. Post-concussion headaches (PCHs) are defined as any headache that begins within seven days of the injury or an existing headache worsened by the trauma. The time it takes for these symptoms to resolve can vary significantly, making it important to understand the typical recovery trajectory.
Typical Recovery Timelines
For most adults and children who experience a single, uncomplicated concussion, associated headaches resolve relatively quickly. During the acute recovery phase, the majority of individuals experience significant improvement in headache symptoms within the first two to four weeks following the injury. Most post-concussion headaches ultimately resolve within three months.
When symptoms, including headaches, persist past the expected recovery window of a few weeks to a month, the condition is often referred to as Post-Concussion Syndrome (PCS). While 10% to 20% of people may develop PCS, most individuals in this group will fully recover within a year. Headaches that last beyond three months are considered chronic, requiring a different approach to management than those experienced in the acute phase.
Different Types of Post-Concussion Headaches
A post-concussion headache is not a single type of pain but rather a symptom that can manifest in several distinct ways.
The most common presentation is the tension-type headache, which feels like a constant, dull pressure or tightness that often wraps across the forehead or affects the sides and back of the head. This type of headache is usually mild to moderate in intensity and can be related to muscle tension in the neck and shoulders.
Another frequent manifestation is a migraine-like headache, characterized by moderate to severe throbbing or pulsating pain that may intensify over several hours. These headaches are frequently accompanied by heightened sensitivity to light and sound, and occasionally, nausea or vomiting. Individuals who had a history of migraines before their injury are more likely to experience this type of post-concussion headache.
A third distinct type is the cervicogenic headache, where the pain originates from the structures of the neck, such as the muscles, ligaments, or upper cervical spine. Since the head injury often involves a whiplash-like movement, the resulting neck strain can cause pain that radiates up into the head. Understanding the specific characteristics of the headache helps healthcare providers determine the most appropriate treatment.
Factors Influencing Headache Persistence
The wide variability in headache duration is often due to a combination of pre-existing conditions and the body’s response to the initial trauma. Individuals who had a history of headache disorders, such as chronic migraines, are more prone to experiencing longer-lasting post-concussion headaches. A history of anxiety, depression, or high stress levels prior to the injury can also increase the risk of symptoms persisting beyond the typical recovery window.
Delayed or insufficient cognitive and physical rest in the early days can prolong the healing process and exacerbate symptoms. Furthermore, a disruption in the autonomic nervous system (ANS), which regulates involuntary functions like heart rate and blood flow, is a common underlying factor. This autonomic dysregulation can make headaches worse with rigorous cognitive or physical exertion.
Other systems affected by the concussion, such as the vestibular (inner ear) or visual systems, can also contribute to headache persistence. If these issues are not identified and treated, the strain they place on the brain can maintain chronic headache symptoms.
Management Strategies and Warning Signs
Initial management of a post-concussion headache focuses on supporting the brain’s natural healing process. This includes ensuring adequate sleep, maintaining good hydration, and eating nutritious meals. A period of relative rest, which limits activities that trigger symptoms, is recommended, followed by a gradual, supervised return to physical and mental activities.
Over-the-counter pain relievers like acetaminophen or ibuprofen can be used for relief, but limit their use to no more than two days per week to avoid medication overuse headaches. Relaxation techniques, such as deep breathing or mindfulness, can help manage stress and anxiety that often worsen headache frequency. Early intervention with physical therapy or vision therapy may be needed if headaches are linked to neck issues or visual strain.
Certain symptoms require immediate medical attention, as they may signal a more serious complication. You should seek prompt care if you experience a severe headache that feels like the worst pain of your life, or if your headache is progressively worsening. Other warning signs include repetitive vomiting, difficulty waking up or staying awake, new weakness or numbness in the limbs, or changes in speech or vision.