The Short Answer Educational content only. Any suspected concussion warrants medical evaluation. Consult concussion specialists and treating providers before starting any new therapy. Cervical physical therapy is effective for post-concussion headaches driven by cervical dysfunction (Schneider et al., 2014). Cervicogenic contribution affects 40-60% of persistent post-concussion headaches. Whiplash-associated disorders commonly co-occur with concussion. Cervical treatment includes manual therapy, joint mobilization, motor control training, deep cervical flexor training, postural correction, and cervical proprioception exercises. Randomized controlled trials support cervical physical therapy for concussion-related headaches. Symptom improvement common within 4-12 weeks. Referral to cervical-trained physical therapist with concussion experience recommended. Cervical PT reduces post-concussion headaches. Evidence supports cervical treatment. Cervicogenic contribution common in PCS headaches. 40-60% affected. Cervical-trained PT recommended. Specialized training required. Why Cervical Treatment Helps Concussion Headaches Whiplash mechanism common in concussion. Acceleration-deceleration injures cervical spine. Upper cervical dysfunction refers pain to head. C1-C3 dysfunction refers to head. Trigeminocervical nucleus convergence. Cervical afferents converge with trigeminal. Suboccipital muscle tension. Suboccipital tension refers to head. Cervical proprioception dysfunction. Cervical proprioception dysfunction affects balance. Deep cervical flexor weakness. Deep cervical flexor weakness common. Cervical joint hypomobility. Cervical joint hypomobility common. Cervical muscle guarding. Cervical muscle guarding common. Cervical Physical Therapy Techniques Manual therapy. Manual therapy for cervical mobility. Joint mobilization. Joint mobilization for cervical joints. Soft tissue release. Soft tissue release for cervical muscles. Trigger point release. Trigger point release for cervical muscles. Deep cervical flexor training. Deep cervical flexor training essential. Motor control training. Motor control training. Postural correction. Postural correction. Cervical proprioception exercises. Cervical proprioception exercises. Cervical stabilization exercises. Cervical stabilization exercises. Dry needling (where available). Dry needling for trigger points. Cervicogenic Headache Characteristics Unilateral headache common. Unilateral headache typical. Occipital pain radiating forward. Occipital pain radiating. Pain reproduced by cervical movement. Cervical movement reproduces pain. Pain reproduced by cervical palpation. Cervical palpation reproduces pain. Reduced cervical range of motion. Reduced cervical ROM common. Cervical tenderness on palpation. Cervical tenderness common. Pain triggered by sustained postures. Sustained postures trigger. Pain improved by cervical treatment. Cervical treatment improves pain. Assessment for Cervical Contribution Cervical range of motion testing. Cervical ROM testing. Cervical flexion-rotation test. Flexion-rotation test for C1-C2. Craniocervical flexion test. Craniocervical flexion test. Cervical palpation for tenderness. Cervical palpation. Joint mobility assessment. Joint mobility assessment. Muscle length testing. Muscle length testing. Neurological screening. Neurological screening. Red flag screening. Red flag screening essential. Evidence Supporting Cervical Treatment Schneider et al. (2014) landmark trial. Cervicovestibular rehab reduced symptom persistence. Randomized controlled trials support. RCTs support cervical treatment. Reduced headache frequency. Reduced headache frequency. Reduced headache intensity. Reduced headache intensity. Improved cervical function. Improved cervical function. Reduced medication use. Reduced medication use. Faster return to activity. Faster return to activity. Program Structure Initial evaluation 60-90 minutes. Initial evaluation 60-90 minutes. Sessions 1-2 times per week. Sessions 1-2 times per week. Home exercise program essential. Home exercise program essential. Program duration 4-12 weeks common. Duration 4-12 weeks. Progression based on symptom response. Progression based on response. Manual Therapy Safety Considerations Cervical instability screening essential. Instability screening essential. Vertebrobasilar insufficiency screening. VBI screening essential. Trained PT essential. Trained PT essential. Grade appropriate mobilization. Grade appropriate mobilization. High-velocity thrust considerations. High-velocity thrust considerations. Red flag symptoms warrant referral. Red flag symptoms warrant referral. Combined Cervicovestibular Treatment Combined treatment often superior. Combined treatment often superior. Vestibular and cervical dysfunction commonly co-occur. Commonly co-occur. Integrated approach recommended. Integrated approach recommended. PT trained in both approaches ideal. Combined training ideal. Supporting Mobility Routine These exercises support cervical rehabilitation and headache management. JME 155 Diaphragmatic breathing supports vagal tone and parasympathetic regulation during concussion recovery. 10 breaths every 60-90 minutes. JME 14 Chin tucks reduce upper cervical tension common in concussion injury. 10 repetitions with 5-second holds. JME 1 Cervical rotation supports cerebral blood flow and nervous system regulation. 10 repetitions each direction. JME 150 Thoracic rotation restores breathing depth shallow during concussion recovery. 8 repetitions per direction. Start your 3-day free trial for joint-specific mobility programs that support nervous system regulation through concussion recovery. Common Mistakes About Cervical Treatment Not identifying cervical contribution. Cervical contribution missed. Passive treatment only. Active exercise essential. Not completing home program. Home program essential. Seeing PT without cervical training. Cervical training essential. Stopping treatment after initial improvement. Complete program. How do I know if my headaches are cervicogenic? Cervicogenic headaches often unilateral, radiate from occipital region forward, reproduce with cervical movement, reproduce with cervical palpation, worsen with sustained postures, and improve with cervical treatment. Reduced cervical range of motion and cervical tenderness common. Physical therapy evaluation with cervical flexion-rotation test and craniocervical flexion test identifies cervicogenic contribution. What is whiplash-associated disorder and how does it relate to concussion? Whiplash-associated disorder (WAD) results from acceleration-deceleration forces injuring cervical spine. WAD commonly co-occurs with concussion because both result from same acceleration-deceleration mechanism. WAD produces cervical pain, headache, dizziness, and cognitive symptoms overlapping with concussion. Cervical treatment addresses WAD contribution to persistent symptoms. Is cervical manipulation safe after concussion? Cervical manipulation safety depends on individual assessment. Cervical instability screening and vertebrobasilar insufficiency screening essential before manipulation. Trained physical therapist or chiropractor essential. Grade-appropriate mobilization safer than high-velocity thrust in acute concussion. Discuss risks and benefits with treating provider. How often should I do cervical exercises for concussion headaches? Deep cervical flexor training and cervical proprioception exercises daily. Cervical range of motion exercises 2-3 times daily. Postural correction throughout day. Home exercise program prescribed by physical therapist essential. Progression based on symptom response and functional improvement. Should I see a chiropractor or physical therapist for post-concussion headaches? Both provide cervical treatment. Physical therapist provides comprehensive rehabilitation including cervical treatment, exercise prescription, motor control training, and integration with other concussion treatments. Chiropractor provides spinal manipulation and adjustment. Concussion-trained provider essential regardless of profession. Concussion clinic referral supports appropriate provider selection. References Patricios, J. S., et al. (2023). Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport, Amsterdam, October 2022. British Journal of Sports Medicine, 57(11), 695-711. PubMed Silverberg, N. D., et al. (2020). Management of concussion and mild traumatic brain injury: a synthesis of practice guidelines. Archives of Physical Medicine and Rehabilitation, 101(2), 382-393. PubMed