A concussion, a traumatic brain injury, frequently results from a rapid acceleration and deceleration of the head. This movement often creates a whiplash mechanism, straining the soft tissues and joints of the cervical spine (neck). The resulting discomfort is called cervicogenic pain, meaning it originates from the neck structures. Addressing this pain is important because neck dysfunction can complicate concussion recovery, often contributing to symptoms like headaches and dizziness.
Immediate Care and Professional Assessment
Following a head injury, initial self-care involves relative rest, meaning avoiding activities that worsen symptoms for the first 24 to 48 hours. Applying ice or heat can offer immediate comfort; ice is generally preferred for acute injuries and heat for muscle tension. Gentle, non-straining movement is better than complete immobilization, but any activity that sharply increases pain should be stopped.
It is important to seek professional medical assessment immediately if neck pain is severe, rapidly worsens, or is accompanied by neurological symptoms like weakness in the limbs, severe stiffness, or numbness. A physician or physical therapist can perform a thorough evaluation to rule out serious structural injuries, such as fractures or ligament instability, which require specialized intervention. If neck pain, headaches, or dizziness persist beyond 10 days, a referral for specialized cervicovestibular rehabilitation is often recommended.
Physical Rehabilitation and Exercise
Active, structured physical rehabilitation, often guided by a physical therapist, is a core component of treating post-concussion neck pain. The focus shifts from acute rest to restoring strength, mobility, and the neck’s proprioception (its sense of position in space). Proprioceptive signals from the neck’s small muscles and joints are often disrupted after injury, contributing to balance issues and dizziness.
Specific exercises target the deep neck flexor muscles, which are small stabilizing muscles often inhibited after injury. An exercise like the “chin tuck” helps to gently strengthen these muscles without engaging the larger, superficial muscles that can easily compensate. Beginning with three sets of 20-second holds is a common starting point to build endurance and proper muscle activation.
Range of motion exercises are introduced slowly and deliberately to restore movement without aggravating symptoms, focusing on smooth and controlled movements rather than forceful stretching. Manual therapy, which includes techniques like mobilization or manipulation, can be performed by a trained therapist to reduce joint restriction and tension in the soft tissues of the upper cervical spine.
When neck symptoms are linked to balance or dizziness, vestibular rehabilitation exercises are integrated into the treatment plan. This therapy involves specific head and eye movements designed to retrain the brain’s connection with the inner ear and neck. The goal is improving overall stability, reducing cervicogenic dizziness, and re-establishing neuromuscular control.
Managing Pain with Medication and Adjunctive Therapies
Pharmacological management for post-concussion neck pain requires careful consideration due to the sensitivity of the recovering brain. Over-the-counter medications like acetaminophen can be used for mild to moderate pain, but non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen are generally avoided immediately after the injury. This initial avoidance is due to the theoretical risk that blood-thinning effects could increase the chance of intracranial bleeding.
Long-term, the frequent use of any pain reliever, including acetaminophen and NSAIDs, is cautioned against as it can lead to medication-overuse or rebound headaches, complicating the recovery process. For persistent muscle tension or neuropathic pain, a physician may prescribe muscle relaxers or nerve-calming agents, such as tricyclic antidepressants, which can also help manage chronic post-traumatic headaches. However, there are no medications specifically approved to treat post-concussion syndrome itself, so prescriptions target specific symptoms.
Adjunctive therapies provide supplemental relief from neck pain and muscle stiffness alongside active rehabilitation. These passive modalities include therapeutic massage, which targets soft tissue tension and spasms. Applying moist heat or a warmed gel pack for 10 to 15 minutes can temporarily relax muscles and ease discomfort. Other treatments include acupuncture or transcutaneous electrical nerve stimulation (TENS) units, which use electrical currents to interrupt pain signals.
Long-Term Recovery and Posture Correction
Sustained recovery from cervicogenic pain involves integrating behavioral changes that minimize recurring strain on the neck. Poor posture is a common contributor to persistent pain, especially after an injury has made the neck structures more vulnerable. Consciously maintaining a neutral neck position throughout the day, where the ears are aligned over the shoulders, helps reduce constant muscle load.
Ergonomic adjustments in the workspace are essential, such as positioning computer monitors at eye level to prevent the head from tilting forward (“tech neck”). When sitting, taking short breaks every 10 to 15 minutes to adjust position or perform gentle stretches prevents muscle fatigue and stiffness. Sleeping posture also impacts neck health. Side sleepers should use enough pillows to keep the head aligned with the spine, while back sleepers can use a small pillow under the neck’s nape.
A gradual return to sport or high-impact activities must be carefully managed to avoid re-injury or relapse of symptoms. This process should follow a medically supervised progression that ensures the neck has regained sufficient strength and stability to handle the forces involved. Recognizing early signs of symptom recurrence, such as increased headache frequency or stiffness, allows for timely adjustments to activities and continued maintenance of neck health.