The Short Answer Educational content only. Any suspected concussion warrants medical evaluation. New, severe, or changing headache after head injury warrants prompt assessment by a physician, neurologist, or headache specialist to confirm the diagnosis and exclude dangerous causes. Consult a concussion-experienced clinician for individualized care. Concussion triggers tension-type headache patterns through cervical and pericranial muscle tension, upper neck joint dysfunction, and heightened pain sensitivity that combine to produce a bilateral pressing, band-like headache (Ashina et al., 2019). Tension-type headache is the most common phenotype of post-traumatic headache. It feels like a tight band or pressure around the head, is usually on both sides, and lacks the throbbing, nausea, and severe light sensitivity of migraine. After concussion it is driven by neck muscle and joint dysfunction, sustained guarding and poor posture, and a pain system made more sensitive by the injury. Because the neck and muscle contribution is central, treatment combines cervical physical therapy, posture and breathing work, and pain-system regulation, often more than medication alone. Tension-type headache is a bilateral pressing, band-like headache. Neck muscle and joint dysfunction drive it after concussion. Cervical and pain-system treatment is central, not medication alone. What Tension-Type Headache Is Tension-type headache is defined by its quality and its lack of migraine features. The pain is pressing or tightening rather than throbbing, mild to moderate rather than severe, and usually felt on both sides as a band around the head or a weight of pressure. It does not typically worsen with routine activity, and it lacks the nausea and the combination of light and sound sensitivity that characterize migraine. Pericranial tenderness, soreness of the muscles of the scalp, temples, and neck to gentle pressure, is a common finding. After concussion, tension-type headache is the most frequent pattern. It may occur on its own or alongside migraine features in a mixed picture, and it often coexists with neck pain, reflecting the shared cervical contribution. How Concussion Produces the Tension-Type Pattern Several trauma-related mechanisms combine to produce this headache. The same event that causes the concussion commonly strains the neck, producing muscle guarding and joint dysfunction in the upper cervical spine. These upper cervical structures refer pain to the head through the trigeminocervical nucleus, the brainstem region where neck and head pain signals converge, so neck dysfunction is felt as headache. Sustained muscle tension adds to this. Protective guarding of the neck and scalp muscles, poor posture, and forward head position during recovery keep the pericranial muscles under continuous load, and this sustained tension generates and maintains the band-like ache. Overlaid on both is heightened pain sensitivity: concussion lowers the threshold of the pain-processing system, so ordinary muscle and joint input is amplified into headache. Together, cervical dysfunction, muscle tension, and sensitization produce and sustain the tension-type pattern. Why the Neck Contribution Is Central The cervical contribution is what makes post-traumatic tension-type headache respond to more than medication. Because upper cervical joints and muscles refer pain to the head, treating the neck directly reduces the headache at its source. A headache that seems purely muscular often traces back to specific upper cervical joint restrictions and muscle trigger points that reproduce the pain on examination and ease it when treated. This is why cervical physical therapy is a central rather than an optional part of care, and why a headache that resists medication frequently improves when the neck is addressed. Symptom Presentation Bilateral pressing or tightening pain, like a band around the head Mild to moderate intensity that does not throb Absence of nausea and of severe combined light and sound sensitivity Pain that does not typically worsen with routine activity Tenderness of the scalp, temple, and neck muscles to pressure Frequent coexisting neck pain and stiffness Worsening with sustained posture, stress, and fatigue Assessment A clinician diagnoses tension-type headache from its quality and the absence of migraine features, and examines the neck for the upper cervical joint restrictions, muscle tension, and trigger points that reproduce the headache. Reproduction of the familiar head pain with cervical examination points to a treatable neck contribution. The assessment identifies whether the picture is purely tension-type or mixed with migraine, since mixed pictures need both addressed, and weighs posture, sleep, mood, and medication overuse as contributors. Treatment Approach Cervical physical therapy is central. Manual therapy to the restricted upper cervical joints, release of the tense pericranial and neck muscles, deep cervical flexor retraining, and posture correction reduce the neck-driven input generating the headache. Because forward head posture and sustained tension perpetuate the pattern, postural endurance and daily mobility work protect the gains. Pain-system regulation supports recovery. Diaphragmatic breathing and graded activity lower the arousal and sensitization amplifying the pain, and managing sleep and mood raises the pain threshold. Acute medication has a role but is limited to avoid medication overuse headache, which easily complicates a frequent daily headache. When the pattern is frequent, preventive strategies are considered. The overall approach treats the neck, the muscles, and the sensitized pain system together, which typically outperforms medication alone. Post-traumatic headache often has a cervical and autonomic component that responds to daily mobility and nervous system regulation alongside medical care. Start your 3-day free trial to build a supportive routine. Supporting Mobility Routine JME 155 Diaphragmatic breathing lowers the sympathetic drive that fuels headache and supports steady cerebral blood flow. Ten slow breaths, several times daily. JME 14 Chin tucks activate deep cervical flexors and reduce the upper cervical tension that refers pain to the head. Ten repetitions with 5-second holds. JME 1 Cervical rotation restores segmental mobility at the joints that refer pain into headache through the trigeminocervical nucleus. Ten repetitions per direction. JME 15 Cervical lateral flexion addresses side-bending restriction that sustains neck-driven headache. 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 headache. Ten repetitions per set. JME 150 Thoracic rotation restores mid-back motion needed for full cervical range and relaxed upright posture. Eight repetitions per direction. JME 227 Overhead reach opens the thoracic spine and reduces the compensatory upper cervical extension that drives headache. Ten repetitions with controlled tempo. Start your 3-day free trial for joint-specific mobility programming that addresses the cervical and autonomic contributors to post-traumatic headache. Common Mistakes Treating the headache with medication alone while ignoring the neck Missing the upper cervical joint and muscle contribution on examination Allowing medication overuse to convert it into a daily headache Overlooking a mixed picture with coexisting migraine features Neglecting posture, sleep, and stress that perpetuate the pattern Progression Assessment confirms the tension-type quality, examines the neck for a reproducible contribution, and identifies any mixed migraine features. Treatment centers on cervical physical therapy, posture and breathing work, and pain-system regulation, with limited acute medication and preventive strategies when frequent. Managing sleep, mood, and medication overuse supports recovery. The tension-type pattern often improves as the neck and sensitized pain system settle. What does a tension-type headache feel like after concussion? It feels like a tight band or steady pressure around the head, usually on both sides, mild to moderate and not throbbing. It lacks the nausea and severe combined light and sound sensitivity of migraine and does not typically worsen with routine activity. Scalp and neck muscle tenderness is common. Why does my neck cause my headache after a concussion? The upper cervical joints and muscles refer pain to the head through the trigeminocervical nucleus, the brainstem region where neck and head pain signals converge. Concussion often strains the neck, so the resulting joint dysfunction and muscle tension are felt as headache. Treating the neck reduces the headache at its source. How is post-traumatic tension-type headache different from migraine? Tension-type headache is bilateral, pressing rather than throbbing, mild to moderate, and lacks nausea and severe light and sound sensitivity, without worsening on routine activity. Migraine is often one-sided, throbbing, more severe, and brings these associated features. The two can coexist in a mixed picture that needs both addressed. Why does cervical physical therapy help this headache? Because the upper cervical joints and muscles refer pain to the head, treating them directly reduces the headache. Manual therapy, muscle release, deep cervical flexor training, and posture correction reduce the neck-driven input generating the pain. A headache that resists medication frequently improves when the neck is addressed. Can medication make a tension-type headache worse? Frequent use of acute headache medication can cause medication overuse headache, converting an intermittent tension-type headache into a daily one. Because post-traumatic headache drives frequent medication use, acute treatment is limited and guided by a clinician, with preventive strategies and non-medication treatment of the neck and pain system used instead. Red Flags Requiring Urgent Evaluation The following warrant same-day emergency evaluation rather than routine care. Sudden severe headache that peaks within seconds to minutes Headache with fever, neck stiffness, or rash New weakness, numbness, slurred speech, or facial droop New vision loss, double vision, or a persistent visual change Progressive worsening headache over days to weeks Headache with confusion, drowsiness, or repeated vomiting Headache with seizure or loss of consciousness Sudden severe neck pain with neurological symptoms, suggesting arterial dissection These features can indicate a dangerous cause and take priority over any headache-specific diagnosis. Absence of red flags supports outpatient evaluation and management. Medication Overuse Headache Frequent use of acute headache medication can produce medication overuse headache, where the treatment itself sustains a daily or near-daily headache. This is common after concussion, when frequent pain drives frequent medication use. As a general guide, using simple analgesics on 15 or more days per month, or triptans, combination analgesics, or opioids on 10 or more days per month, raises the risk. Preventive treatment and careful limits on acute medication, guided by a clinician, break the cycle. Recognizing medication overuse is essential, because it can mimic or worsen any post-traumatic headache pattern. Why a Precise Diagnosis Matters Post-traumatic headache is not one condition. It takes on the features of recognized primary headache disorders, and each has a specific, sometimes highly specific, treatment. Some headaches respond dramatically to one particular medication, others need targeted preventives, and others improve with cervical and autonomic treatment. A precise diagnosis by a physician, neurologist, or headache specialist, using the criteria of the International Classification of Headache Disorders, directs the person to the treatment most likely to work and avoids prolonged trial and error. Multidisciplinary Care and the Cervical Contribution Post-traumatic headache frequently has more than one driver. A cervical contribution from the neck is common, since the upper cervical joints and nerves refer pain to the head through the trigeminocervical nucleus, the same brainstem region where neck and head pain signals converge. Autonomic dysregulation, sleep disturbance, mood, and medication overuse each add to the picture. Coordinated care works best: a headache specialist or neurologist for diagnosis and medication, a physical therapist for the cervical and postural contribution, and attention to sleep, mood, and autonomic regulation. Treating the neck and nervous system alongside medical management improves many post-traumatic headaches that medication alone does not fully control. References Ashina, H., et al. (2019). Post-traumatic headache: epidemiology and pathophysiological insights. Nature Reviews Neurology, 15(10), 607-617. PubMed Headache Classification Committee of the International Headache Society (IHS). (2018). The International Classification of Headache Disorders, 3rd edition. Cephalalgia, 38(1), 1-211. 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