Identify the Headache Type Before Treating Post-concussion headache is not one condition. It is at least three different conditions that produce head pain. Treating "headache" generically without identifying the type is why many concussion patients take medication daily without improvement. Cervicogenic headache requires cervical treatment. Migraine-type headache requires migraine management. Tension-type headache requires stress and muscular intervention. Most patients have elements of more than one type (Lucas, 2015). Headache is the most common concussion symptom, affecting 70-90% of patients in the acute phase and persisting in 30-50% of those who develop post-concussion syndrome. Effective management significantly accelerates overall recovery because headache drives secondary problems: sleep disruption, activity avoidance, medication overuse, anxiety, and functional limitation. Cervicogenic Headache (The Most Commonly Missed Type) Origin: cervical spine dysfunction, not the brain. The upper cervical spine (C0-C3) refers pain to the head through the trigeminocervical nucleus. Cervicogenic headache typically starts at the base of the skull and radiates over the head, behind the eyes, or to the temples. It is present in the majority of post-concussion headache patients but is frequently attributed to the brain injury rather than the neck. How to identify: Headache worsens or changes with neck position. Headache accompanies neck stiffness or pain. Sustained postures (computer work, driving) trigger headache. One-sided or asymmetric headache pattern. Palpation of upper cervical structures reproduces the headache. Treatment: Cervical manual therapy, targeted cervical exercises, postural correction. Response to cervical treatment is often dramatic and rapid. Patients with months of "concussion headache" sometimes experience significant relief within 1-3 treatment sessions when the cervical component is addressed. Migraine-Type Post-Concussion Headache Origin: neurovascular dysfunction. Concussion lowers the migraine threshold, allowing migraine attacks in people who never had migraines before. The headache is throbbing or pulsating, often one-sided, and accompanied by nausea, light sensitivity, and noise sensitivity. Physical activity worsens it. It tends to occur in discrete episodes rather than continuously. How to identify: Throbbing quality. Light and noise sensitivity during attacks. Nausea or vomiting. Worsening with routine physical activity. Sometimes preceded by visual aura (new onset after concussion). Discrete episodes lasting hours rather than constant pain. Treatment: Trigger identification and avoidance (sleep disruption, stress, certain foods, hormonal changes, weather). Acute treatment with triptans or NSAIDs early in the attack. Preventive medication (amitriptyline, topiramate, propranolol) if attacks are frequent (more than 2-3 per week). Regular sleep schedule and aerobic exercise reduce migraine frequency. Tension-Type Post-Concussion Headache Origin: muscular tension and stress. Bilateral pressing or tightening sensation, often described as a "band around the head." Mild to moderate intensity. Not worsened by routine physical activity. Associated with stress, anxiety, poor posture, and muscular tension in the neck, shoulders, and jaw. How to identify: Bilateral, pressing quality. Mild to moderate intensity. Not worsened by walking or light exercise. Associated with stress or anxiety. Muscular tenderness in scalp, temple, or jaw muscles. Present most of the day at a low level. Treatment: Stress management, relaxation techniques, regular exercise, sleep optimization. Muscular approaches: massage, jaw relaxation, upper trapezius stretching. Over-the-counter analgesics for acute episodes (limit to 2-3 days per week to prevent medication overuse headache). Cervical Exercises for Headache Management Since cervicogenic headache is the most treatable and most commonly missed post-concussion headache type, cervical mobility is a priority intervention: JME 1 Full-range cervical rotation. Rotation restriction directly correlates with cervicogenic headache severity. Restoring symmetric, full rotation reduces headache frequency and intensity within days of consistent practice. JME 14 Deep cervical flexor activation. Weakness in these muscles increases load on the upper cervical joints, driving cervicogenic headache. Strengthening them redistributes cervical loads and reduces headache triggers. JME 23 Upper cervical mobility targets the C0-C2 segments where cervicogenic headache originates. These are the most frequently restricted segments after concussion and the primary source of referred head pain from the cervical spine. JME 5 Cervical extension mobilizes the suboccipital region. Suboccipital restriction produces occipital headache that refers over the top of the head. Gentle extension releases this restriction and reduces referred pain patterns. Start your 14-day free trial for headache-specific cervical mobility routines. Complete Headache Management Mobility Program JME 3 Lateral cervical flexion releases the upper trapezius, a primary tension headache contributor. The upper trapezius refers pain to the temporal region when overactive. Regular lateral flexion reduces this tension pattern. JME 150 Thoracic rotation reduces the compensatory cervical demands that drive cervicogenic headache. When the thoracic spine contributes adequately to rotation, the cervical spine bears less load. JME 153 Thoracic extension corrects the forward posture that increases cervical loading. Forward head posture adds approximately 10 pounds of effective head weight per inch of forward displacement, directly increasing cervicogenic headache triggers. JME 42 Shoulder mobility breaks the tension chain from shoulders to the base of the skull. Chronic shoulder elevation maintains upper trapezius tension that contributes to both cervicogenic and tension-type headache. Manage your headaches with simplmobility's targeted mobility programming. Medication Management Avoid medication overuse headache. Using acute headache medication (acetaminophen, ibuprofen, triptans) more than 2-3 days per week produces medication overuse headache (MOH). MOH creates a cycle where the medication causes the headache it is treating. If you need daily medication, discuss preventive options with your physician. Acetaminophen is first line for acute post-concussion headache. Safe immediately after concussion. Effective for mild-moderate headache. Dose: 500-1000mg every 6-8 hours, maximum 3000mg per day. Ibuprofen after the first 24 hours. Avoid in the first 24 hours due to theoretical bleeding risk. After 24 hours, ibuprofen 400-600mg every 6-8 hours is effective, particularly for inflammation-driven headache. Limit use to 2-3 days per week. Preventive medication for frequent headache. If headache occurs more than 3 days per week, daily preventive medication reduces frequency. Amitriptyline (10-25mg at bedtime) is the most common first-line preventive for post-concussion headache. It also improves sleep quality, an added benefit. Why does my headache get worse when I exercise? Exercise-provoked headache after concussion has two common causes. Autonomic dysregulation produces exertion headache when the brain's blood flow regulation fails to match exercise demands. Cervicogenic headache worsens with exercise because running and impact activities load the cervical spine. Distinguishing these causes directs treatment: aerobic conditioning for autonomic headache, cervical treatment for cervicogenic headache. Sub-symptom exercise (intensity that does not significantly worsen headache) is appropriate and beneficial for both types. How long do post-concussion headaches last? Most post-concussion headaches resolve within 2-4 weeks as the brain heals. Headache persisting beyond 4 weeks is typically maintained by cervical dysfunction, migraine threshold changes, or medication overuse rather than ongoing brain injury. These perpetuating factors respond to targeted treatment. Post-concussion headache at 3 months is almost always treatable when the specific type is identified and addressed. Does caffeine help or hurt post-concussion headaches? Caffeine has a complex relationship with headache. Small amounts (100-200mg, one cup of coffee) provide acute headache relief through cerebral vasoconstriction and analgesic enhancement. Regular caffeine use creates dependence, and withdrawal triggers headache. After concussion, maintain your pre-injury caffeine habit (do not add or eliminate caffeine). If you did not use caffeine before, do not start. Avoid caffeine after noon to protect sleep quality. References Lucas, S. (2015). Posttraumatic headache: Clinical characterization and management. Current Pain and Headache Reports, 19(10), 48. PubMed Howard, L., et al. (2018). The effect of cervical spine treatment on headache following concussion. Archives of Physical Medicine and Rehabilitation, 99(10), e169-e170. PubMed