Living with post-traumatic headache (PTH) can be an overwhelming challenge, affecting not only one’s physical well-being but also mental health. Post-traumatic headache (PTH), a type of headache that occurs for the first time in close timeframe following a traumatic brain injury or head/neck trauma. Concussion is a mild traumatic brain injury (mTBI) and many can suffer from PTH. Headache can occur in isolation to a trauma or in combination of other associated symptoms such as dizziness, nausea, sensory sensitivities, cognitive challenges and emotional distress. Generally, PTH emerge within sevens days post injury and can persist up to three months post injury. However, it can persist more than three months developing into a chronic type.

For more information on what other symptoms people can experience after a concussion, read our blog post about 8 domains of a concussion.

Causes of Post-Traumatic Headache

The aetiology of post-traumatic headache is attributed to a combination of injury-related factors and subsequent behavioural/functional and structural changes post-trauma. Potential contributors include:

• Inflammatory responses: Post-injury inflammation in the brain and surrounding tissues may exacerbate headache development.
• Musculoskeletal responses such as whiplash: Neck and shoulder muscle stiffness, often stemming from head trauma, can amplify headache severity.
• Psychological influences: Emotional distress, anxiety, and depression may exacerbate headache intensity and frequency.

How can my neck relate to my head pain?

Interestingly, even though our brain is amazingly clever, with such a complex web of nerves coming together for processing, it can often get the signals wrong. Pain messages from the neck can be read incorrectly by the brain which thinks it is head pain, eye, jaw, or even sinus pain. A similar scenario would be when a patient experiencing a heart attack will complain of arm pain – the problem is in the heart not the arm! The brain can get confused.

Treatment of Post-Traumatic Headache

An individual may present differently to one another, therefore a personalised program will give people the best outcome after a thorough examination. Treatment options can include:

• Neck treatment: Sydney Concussion Centre uses the Watson Headache® Approach which focuses on addressing the underlying mechanical dysfunctions in the upper neck that can be dialling up sensitivity in the brainstem, causing post traumatic headache. Skilled physiotherapists trained in the Watson Headache® Approach utilise specific manual techniques to assess and treat dysfunctions in the cervical spine and related structures. These techniques aim to restore normal movement and reduce the sensitisation of the nervous system, potentially providing relief from migraine symptoms.
• Lifestyle adjustments: Adopting healthy habits such as adequate sleep, dietary changes, stress management, exercise and learning to manage potential triggers can improve headache frequency and severity.
• Medications: discuss with your doctor or a local pharmacist to see what is available to manage your head symptoms

The program carried out at Sydney Concussion Centre uses best practice techniques, established by the latest research to assess each individual’s case. This involves a wide range of assessments to determine where your headaches are originating. Once the areas of dysfunction are determined, a specific treatment and exercise program is developed to address the issues and expedite recovery.

Many people have heard of migraine but are not sure of what vestibular migraine is all about. It is a migraine event where vertigo is the main symptom. It is one of the common causes of episodic vertigo in children and adults. Episodes can last for minutes or up to a few days. 

Vertigo – a sense of spinning either the room or yourself, can be sitting still (no trigger, spontaneous) or when changing positions (triggered by positional change, head movement)

Nausea and Vomiting

Headache – during or after the episode 

Disequilibrium – rocking, tilting, swaying, unstable on feet, floor under feet feels like it is moving

Visual Motion Sensitivity – feel nauseous or unwell with vision not matching up with surrounds

Anxiety – fear avoidance of certain movements of head, body. Panicked feeling, shortness of breath.

Dissociation symptoms – disconnection from your body or from the environment around you

Dissociation symptoms – disconnection from your body or from the environment around you

Light / Sound/ Smell Sensitivity – sensitive to light such as light coming through trees, car lights, fluorescent lights in office; sensitivity to sounds such as loud noises, busy restaurants, concerts or muffled hearing or ear pressure; sensitivity to certain smells like strong perfumes, cooking smells.

The assessment

Practitioners at Sydney Headache and Migraine Centre take a thorough medical history of our patients and then perform a physical examination of the Vestibular System, Balance and Cervical Spine. 

We use specialised goggles that detect any abnormal eye movements known as nystagmus (jerky eye movements). These eye movements can mimic conditions like BPPV, Meniere’s disease or Vestibular Neuritis. These conditions can also coexist with Vestibular Migraine making it complicated.

The treatment

Treatment involves Vestibular Rehabilitation exercises to improve dizziness and imbalance. These exercises may not prevent an episode of vestibular migraine occurring, but they help reduce the symptoms and improve daily functioning.

Migraine-specific neck treatments, using the highly renowned Watson Headache® Approach, is an exceptional treatment option for headache and migraine conditions. This involves physically assessing the Upper Cervical Spine (UCS) for stiffness and pain, with particular interest in referral of pain from the neck into the head. It is particularly effective in treating those with dizziness as the main migraine symptom.

Treatment for coexisting BPPV or other vestibular dysfunction will be done based on assessment findings as well as balance training to reduce falls risk.

Management of lifestyle factors such as diet, hydration, alcohol, sleep, exercise tolerance, managing stress and anxiety can also be very useful. We have a strong referral network should patients require specialised care in more specific areas.

For many people, the after-effects of a concussion are severe and life-altering. Symptoms may vary for each individual but will likely include headache, dizziness, light sensitivity and sleep difficulties. One extremely common and deleterious symptom, following a concussion, is headache. 

At first, a headache doesn’t sound too bad – we all experience them at some point. However, moving from the occasional headache to constant, intense headaches is a huge transition. Many people report their constant headache has the ability to significantly affect their career, relationships and general quality of life. 

So, what happens during a concussion that causes a person to have long-standing headaches?

And more importantly, how can these headaches be treated?

The good news is that these long-standing headaches are often due to factors other than the concussion itself. The reason for this is that symptoms attributed directly to the concussion typically last just seven to ten days. If a headache has been lasting longer, it can usually be inked to a secondary injury, usually sustained at the same time as the concussion. Thankfully, once the cause has been identified by a skilled practitioner, these headaches can be successfully treated.

 Following full brain recovery there are typically five other reasons why headaches may be persisting. These are:

• Exercise intolerance 
• Visual/Vestibular disturbances
• Hormonal/inflammatory disturbances
• Psychological concerns
• Neck Dysfunction

This blog will focus on how neck dysfunction may masquerade as the exact same symptoms of a concussion which can include persistent headaches. Unfortunately, after a concussion, the neck can be underappreciated as a driver of ongoing symptoms, but it certainly can be a common beast! This frequently overlooked structure can be an easily treatable cause of symptoms. 

Injury or dysfunction of the neck has been shown to cause symptoms such as headache, migraines, dizziness, brain fog, cognitive impairments and visual disturbances. In short, the exact same symptoms that acute concussion will yield! But why is it that a neck injury can bring on things such a persistent headache? There are a few reasons for this but the most current frame on thought is an increase in brainstem sensitivity.

Headaches and migraines are a result of an increase in brainstem sensitivity. As the sensitivity increases, the more magnified the response becomes. A sensitised brainstem can be considered similar to an amplifier, causing normal input to the brain to become increased – normal sensations become painful, a normal light source becomes incredibly bright, or the dull street noise becomes extremely loud. In some people the increased input to the brain can be so magnified it has a hard time processing everything, leading to brain fog and difficulty concentrating.

So, we know that a dysfunction in the neck can manifest as a headache, but how can a neck injury occur with a concussion?

But what about timeframes?

How long will it take for the neck and the headaches to recover? 

 In the early stages, following the injury, it is almost impossible to distinguish between a concussion and a neck injury. It is, therefore, always recommended to err on the safe side and assume it is a concussion until proven otherwise. Following a fall or a hit, and with ANY concussion-like symptoms, a concussion diagnosis should be made. Gradual cognitive and exercise re-integration principles should apply, along with a temporary removal from high-risk sports. Appropriate treatment of structures such as the neck should also be given to reduce the likelihood of a neck injury really ‘taking hold’.  In these early stages and with appropriate management the majority of people will be fully recovered with all their symptoms within seven to ten days.

However, if headaches have been lingering for a while it may take a little bit longer. Despite long standing headaches, manual therapy to the neck is one of the top evidence-based treatments following concussions. The research below shows that, even if your headaches have been lingering for months or years, the neck is still an excellent area to treat to achieve real results.

Practitioners at Sydney Concussion Centre understand the frustration of long-standing headaches and general concussion symptoms. We can provide a clear and tangible plan to move forward and diminish your headaches. With the right strategy, headaches can be significantly changed. 

If you feel you need some help with your concussion, give us a call on 1800 CONCUSSION  |  1800 266 287