The Short Answer Educational content only. Any suspected concussion warrants medical evaluation. Persistent sensory symptoms after concussion warrant assessment by the appropriate specialist, an audiologist or ENT for hearing and sound symptoms, a neuro-optometrist or ophthalmologist for visual and eye symptoms, and a physician or neurologist to coordinate care. Consult a concussion-experienced clinician for individualized care. Specific frequencies of sound trigger post-concussion pain because the sensitized auditory system routes certain sounds into the pain pathways, so high-pitched, sharp, or sudden sounds cause genuine ear or head pain rather than mere loudness (Ashina et al., 2019). Ordinary hyperacusis makes sounds feel too loud, but when the auditory system is more severely sensitized, certain sounds genuinely hurt, a condition called noxacusis or painful hyperacusis. Particular frequencies, often high-pitched, sharp, or sudden sounds, most strongly drive the sensitized pathways and connect to the trigeminal pain network, producing stabbing or burning ear or head pain. Graded sound therapy, avoiding overprotection, and treating the underlying headache reduce it, rather than seeking silence, which deepens the sensitivity. Certain sounds cause genuine pain, not only loudness, called noxacusis. Specific frequencies most strongly drive the sensitized pain pathways. Graded sound therapy helps, and overprotection and silence deepen it. What Sound-Induced Pain Is Noxacusis, or painful hyperacusis, is a condition in which sound causes actual pain rather than simply feeling uncomfortably loud. Certain sounds produce a stabbing, burning, aching, or electric pain in the ear or radiating into the head and face, sometimes lasting well beyond the sound itself. It is a more severe form of sound intolerance than ordinary hyperacusis, and it is particularly distressing because the pain can be intense and slow to settle. Specific triggers, often high-pitched, sharp, or sudden sounds like clinking dishes, cutlery, children's voices, alarms, or squealing brakes, are worse than steady or low sounds, which is why the intolerance appears frequency-specific. Why Specific Frequencies Are Worse The auditory system is organized by frequency, with different populations of hair cells and nerve fibers tuned to different pitches. After concussion, sensitization is not always uniform across this range, so some frequencies drive the sensitized pathways more strongly than others. High-pitched, sharp, and sudden sounds carry rapid, intense energy that most strongly activates the overexcited auditory pathways and the pain fibers connected to them, so these are the frequencies that most reliably provoke pain. Steady, low, or soft sounds carry less provocative energy and are better tolerated. The connection to pain is the key feature. In noxacusis, auditory signals are routed into the pain pathways, including the trigeminal system that carries head and face pain, so sound is processed not only as loud but as painful. This is why the pain can radiate into the head and face and why it overlaps with the trigeminal pain mechanisms of post-traumatic headache. Why Overprotection and Silence Make It Worse The instinct with painful sound is intense protection, wearing ear protection constantly and retreating into silence. As with ordinary hyperacusis, this backfires and is especially counterproductive in noxacusis. When the auditory system receives less sound, it raises its gain to compensate, becoming even more sensitive, so the next sound is more painful and tolerance narrows further. Constant overprotection can deepen noxacusis over time and make recovery harder. Ear protection has a place for genuinely loud or provocative environments and for managing severe pain, but continuous use in ordinary settings sustains the sensitivity, which is why careful, graded sound exposure rather than silence is central to recovery. Symptom Presentation Certain sounds causing stabbing, burning, aching, or electric ear or head pain Pain, not only loudness, from specific sounds High-pitched, sharp, or sudden sounds as the worst triggers Pain radiating into the head and face Pain sometimes lasting well beyond the sound Frequent coexisting ordinary hyperacusis and tinnitus Worsening with overprotection and silence Assessment An audiologist assesses sound-induced pain with hearing tests and measures of loudness discomfort and pain thresholds, identifying the frequencies and sounds that provoke pain and distinguishing noxacusis from ordinary hyperacusis, which it accompanies. The assessment recognizes the connection to the pain pathways and the overlap with post-traumatic headache, and it gauges how much overprotection and silence are contributing to the sensitivity. A physician considers the broader picture, since noxacusis travels with other sensory and pain symptoms. Treatment Approach Careful, graded sound therapy is the core treatment, because it retrains the sensitized pathways, but it is applied gently in noxacusis given that sound causes pain. Under an audiologist's guidance, tolerable low-level sound is introduced and exposure is broadened slowly, staying below the pain threshold, to teach the system to lower its gain without provoking flares. This is more cautious than sound therapy for ordinary hyperacusis but follows the same principle. Reducing overprotection is essential but balanced, ear protection is reserved for genuinely provocative environments and severe pain rather than worn continuously, so the system is not starved of the input it needs to recalibrate. Treating the underlying headache reduces the shared trigeminal pain sensitization, and autonomic regulation through diaphragmatic breathing lowers the arousal that amplifies both sound sensitivity and pain. Protecting sleep raises tolerance. Because noxacusis is severe and involves pain, specialist audiology care is important, and recovery is often slower than for ordinary hyperacusis but follows the same path as the auditory system settles. Sensory symptoms after concussion improve faster when the nervous system is regulated and the neck and autonomic system are addressed alongside specialist care. Start your 3-day free trial to build a supportive daily routine. Supporting Mobility Routine JME 155 Diaphragmatic breathing lowers the sympathetic drive that amplifies sensory sensitivity and steadies the nervous system. Ten slow breaths, several times daily. JME 14 Chin tucks reduce upper cervical tension that feeds headache, dizziness, and sensory overload. Ten repetitions with 5-second holds. JME 1 Cervical rotation restores segmental mobility and supports blood flow through the vertebral arteries to the brain. Ten repetitions per direction. JME 15 Cervical lateral flexion addresses side-bending restriction that sustains neck tension and sensory strain. Ten repetitions per side. JME 16 Cervical flexion and extension restore sagittal mobility restricted by suboccipital guarding. Eight slow repetitions. JME 2 Cervical retraction reinforces a neutral head position that reduces the postural strain feeding sensory symptoms. Ten repetitions per set. JME 150 Thoracic rotation restores mid-back motion needed for full diaphragmatic breathing and relaxed upright posture. Eight repetitions per direction. JME 227 Overhead reach opens the thoracic spine and rib cage, supporting the deep breathing that calms an overloaded nervous system. Ten repetitions with controlled tempo. Start your 3-day free trial for joint-specific mobility programming that supports the nervous system regulation behind sensory recovery after concussion. Common Mistakes Wearing ear protection constantly, which raises gain and worsens the pain Retreating into silence rather than using careful graded sound therapy Applying aggressive sound exposure that pushes past the pain threshold Treating the sound pain without addressing the underlying headache Managing severe noxacusis without specialist audiology care Progression Assessment identifies the provocative frequencies and pain thresholds and distinguishes noxacusis from ordinary hyperacusis. Careful graded sound therapy retrains the pathways while staying below the pain threshold, overprotection is reduced but balanced, and the underlying headache and autonomic arousal are treated. Recovery is often slower than for ordinary hyperacusis but follows the same path as the auditory system settles. Why do certain sounds hurt after a concussion? When the auditory system is severely sensitized, sound signals are routed into the pain pathways, including the trigeminal system that carries head and face pain, so certain sounds cause genuine pain rather than only feeling loud. This is called noxacusis or painful hyperacusis, and high-pitched, sharp, or sudden sounds are the worst triggers. What is noxacusis? Noxacusis, or painful hyperacusis, is a condition in which sound causes actual pain, a stabbing, burning, aching, or electric pain in the ear or radiating into the head, rather than simply feeling too loud. It is a more severe form of sound intolerance than ordinary hyperacusis and can be intense and slow to settle. Why are high-pitched sounds the worst? The auditory system is organized by frequency, and after concussion sensitization is often uneven across it. High-pitched, sharp, and sudden sounds carry rapid, intense energy that most strongly activates the overexcited pathways and the pain fibers connected to them, so these frequencies most reliably provoke pain, while steady, low, or soft sounds are better tolerated. Should I wear ear protection for sound-induced pain? Only in a balanced way, for genuinely provocative environments and severe pain rather than continuously. Constant overprotection starves the auditory system of input, so it raises its gain and becomes more sensitive, deepening the pain over time. Careful graded sound therapy under an audiologist, not silence, retrains the system. Can sound-induced pain be treated after a concussion? Yes, though recovery is often slower than for ordinary hyperacusis. Careful graded sound therapy retrains the sensitized pathways while staying below the pain threshold, overprotection is reduced but balanced, and the underlying headache and autonomic arousal are treated. Specialist audiology care is important given the severity and the pain involved. Why Sensory Symptoms Happen After Concussion Sensory symptoms after concussion arise from disrupted sensory processing rather than damage to the sense organs alone. Concussion strains the connections between brain regions, alters the balance of excitation and inhibition, and leaves the nervous system in a sensitized, hyperexcitable state (Silverberg et al., 2020). In this state the brain turns up the gain on incoming signals, so ordinary light, sound, smell, taste, and touch are amplified, distorted, or perceived as threatening. Some symptoms also reflect direct injury to sensory nerves. Most sensory symptoms improve over weeks to months as the brain recovers and the gain settles, and structured management speeds the process. Graded Exposure and Avoiding Overprotection A common trap in sensory recovery is total avoidance. Completely shielding from light, sound, touch, or activity feels protective, but sustained avoidance makes the nervous system more sensitive over time, narrowing tolerance further. The better approach is graded exposure: staying within a tolerable range while gradually and deliberately increasing exposure as tolerance grows, never pushing far past the point where symptoms flare. This retrains the nervous system to accept normal sensory input. Extreme protection, such as constant dark glasses indoors or avoiding all textured clothing, tends to worsen sensitivity and is used sparingly and strategically rather than continuously. Managing Sensory Overload Reduce competing sensory input by handling one channel at a time Take planned breaks in a calm, low-stimulation environment before overload builds Use diaphragmatic breathing to lower the arousal that amplifies sensitivity Pace demanding sensory environments rather than avoiding them entirely Protect sleep, since fatigue lowers sensory tolerance Treat coexisting headache, since pain and sensory sensitivity feed each other When to Seek Specialist Assessment Persistent or worsening sensory symptoms, symptoms that interfere with work or daily life, and any symptom with concerning features warrant specialist assessment. Visual and pattern symptoms are evaluated by a neuro-optometrist or ophthalmologist. Hearing and sound symptoms are evaluated by an audiologist or ENT. Smell symptoms are evaluated by an ENT. Touch, temperature, and pain sensitivity are evaluated by a physician or neurologist, who can also coordinate care and exclude other causes. New neurological symptoms, sudden sensory loss, and rapidly worsening symptoms need prompt evaluation rather than watchful waiting. The Autonomic and Cervical Contribution Sensory symptoms rarely stand alone after concussion. Autonomic dysregulation keeps the nervous system in a heightened, sympathetic-dominant state that amplifies sensitivity, and cervical dysfunction feeds headache, dizziness, and sensory strain through shared brainstem pathways. Regulating the autonomic nervous system with diaphragmatic breathing and graded activity, and addressing the neck with mobility and manual therapy, lower the background arousal on which sensory symptoms ride. This is why calming the nervous system as a whole often eases sensory symptoms that specialist treatment alone does not fully resolve. References Ashina, H., et al. (2019). Post-traumatic headache: epidemiology and pathophysiological insights. Nature Reviews Neurology, 15(10), 607-617. PubMed 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