Concussion Headaches or “Post-Traumatic Headaches”: What They Feel Like, How Long They Last, and How to Get Rid of Them
“I feel like there’s a tight band around my head.” “My head feels like it’s blowing up like a balloon.” “I have a constant pressure headache.” “I feel like my head is being pulled apart between the eyes.”
These are comments we hear every day from patients with post-traumatic headaches (synonymous with headaches resulting from concussion or other brain injury, for our purposes). Many patients report that their post-traumatic headaches “just feel different” from a normal headache. This is because the cause and presentation of post-traumatic headaches are noticeably different from other headaches.
At CognitiveFX, we treat post-traumatic headaches every day, and our patients have many of the same questions you may be asking. We’ve put together this guide to help you understand:
- Post-Concussion Headache Locations and Causes
- What Post-Concussion Headaches Feel Like
- How Long Post-Concussion Headaches Last
- Treatment Options for Concussion Headaches
- What to Do If Your Concussion Headaches Are Getting Worse.
Post-traumatic headaches are complicated, and there’s still much work to be done in understanding why and how they happen. In the meantime, we hope you’ll find this guide useful for understanding and overcoming them.
Note: If you’re experiencing symptoms (such as headaches) that won’t resolve after a concussion, you’re not alone. 95% of our patients experience statistically verified restoration of brain function. To see if you are eligible for treatment, sign up for a free consultation.
Post-Concussion Headache Locations and Causes
Post-traumatic headaches can be pretty distinct from “normal” headaches (think dehydration-type headaches, sinus pressure headaches, etc.) and can present in various forms. In some instances, patients will report experiencing more than one type of post-traumatic headache, but they are complex in their presentation, their cause, and their treatment. We’ll explore more about their causes and presentation in the sections below. In this section of the guide, we’ve outlined some of the more common post-traumatic headache types:
- Autonomic Nervous System (ANS) and Cervicogenic Headaches
- Migrainous Headaches
- Other Concussion Headache Causes.
Cervicogenic and Autonomic Nervous System (ANS) Headaches
Cervicogenic and Autonomic Nervous System (ANS) headaches are some of the most distinctly reported headaches after a head injury. While they can sometimes be separate in cause (aka, someone with isolated issues in their cervical spine may experience headaches as a result), they can cause similar headache “types” after concussion or brain injury. Many of the patients we see in our clinic experience both.
Cervicogenic headaches are often associated with neck tension, neck pain, and a pulling feeling along the neck. They are related to the cervical spine (the neck bones and discs) and the musculature in the neck and shoulders. These can commonly be related to whiplash-associated injuries, but may also be subsequent to ANS dysfunction.
How are the cervical spine and ANS related with regard to headaches? We will explain, starting with ANS headaches.
Headaches related to autonomic nervous system dysfunction caused by a mild traumatic brain injury (mTBI) are complex due to the control the ANS has over our entire bodies (heart rate, breathing, blood pressure, temperature, the list goes on...). ANS headaches, as we will call them, are caused by vascular (i.e., blood vessel) or cerebral blood flow (i.e., occurring in your head) problems and can often be associated with feelings of pressure, as though there were a clamp or a band on your head. Cervicogenic and ANS headaches are closely connected, and many patients have both, so we assess and treat each patient’s headaches on a case-by-case basis.
ANS Headache Cause
The autonomic nervous system controls heart rate, respiration rate, vascular constriction and dilation, and many of the other bodily functions we don’t think about that keep us alive. After a concussion, the autonomic nervous system may become dysregulated, leading to a variety of common symptoms.
What is the autonomic nervous system (ANS)? It is a bodily nervous system that conducts “automatic” body processes. It has two parts, the sympathetic nervous system (SNS) and the parasympathetic nervous system (PNS). These regulate your “fight or flight” and “rest and digest” processes, respectively. Normally, these two are balanced like a set of scales so that we can respond to our environment appropriately. After head injury, however, the fight or flight system (SNS) may tend to dominate.
For example, you may initially be startled when you hear a loud sound, but you recover and rebalance when you realize it was a dish dropped on the floor. When the autonomic nervous system is dysregulated due to a concussion, the SNS can more easily dominate the PNS and prevent your body from returning to a "normal" resting state as quickly as it should. In other words, the sound of a dish falling may cause your “fight or flight” reaction to linger.
Why does this matter? It has lasting effects on your stress levels, your blood pressure, and other functions regulated by the ANS — including post-traumatic headaches.
How does this specifically come into play for post-traumatic headaches? There can be many physiological sources. Autonomic nervous system dysregulation leads to increased muscle tone and tension in the neck (along with many other places, but for headaches, we will focus on the neck). In addition, concussions can lead to disruption in the regulation of the head’s blood flow as a result of your ANS being out of balance. As a result, patients experience tension and pressure in the head.
For example, you may feel like your head is blowing up like a balloon. This tension generally starts in the back of the neck and moves up around the eyes. An important factor is how the ANS and neurovascular coupling are related through cerebral blood flow.
Neurovascular coupling (NVC) is the connection between neurons and the blood vessels that supply them with oxygen, and it is often not working correctly as a result of a concussion or brain injury. We explain more about neurovascular coupling and its connection to concussion symptoms later in the post.
Headaches from post-concussion syndrome may improve with time, but most do not resolve unless treated. Want our help in understanding your headaches? Sign up for a free consultation.
Headaches can come in many forms. Above are some examples of the patient “experience” of a headache and their potential ‘type’ or location. Patients may experience one, several, or all of these types — depending on the situation.
Autonomic nervous system headaches can present in a few different ways. They often are described as starting in the back of the neck and spreading up around the back of the head to the temples like a crown. This sensation is caused by the gradual blood flow buildup and the muscle tension from the neck muscles.
Jaw tension-type headaches can also be related to autonomic nervous system dysregulation. It often begins around the back of the jaw and can move across the face and over the top of the head. You, your family, or even friends may note increased jaw musculature or teeth grinding associated with jaw-related head pain.
ANS headaches can also feel like sinus pressure headaches, with pressure or pain present around the nose and near the bridge of your nose and cheekbones (where the sinuses are located), then spreading through the head. Unlike allergy sinus headaches, the pain is almost constant; it does not change based on the time of day or exposure to allergens. Congestion may or may not be present.
In some less common occasions, they can also be accompanied by soft spots bump(s) on the head due to excess fluid pooling in a single location — also called “edema.”
Finally, post-traumatic headaches are usually not the sole cause for the “headache” experience. Vision issues, genetic and environmental risk factors, and a multitude of other variables can make every person’s experience very different. After a concussion, people may have one, several, or all of these factors influencing their headaches.
Often, people will describe a “moving headache,” which can incorporate many of the locations and profiles of the headaches mentioned above. This can make the cause of the headache difficult to identify; however, it doesn’t mean your headache is untreatable! It just means that treatment will need to approach every aspect of your specific headache profile.
Autonomic nervous system headaches usually get worse with rigorous cognitive or physical activity. However, it is important to note that although exercise may make ANS headaches feel worse, it is extremely important to keep exercising regularly. The headaches themselves do not cause injury (that said, pay attention to your body — ANS dysregulation can cause other problems including dizziness, nausea, or vomiting, and you should be aware of your limits). Exercise is important for recovery, even if it causes your headaches to worsen temporarily.
Stress also has a significant impact on headaches. The sympathetic nervous system becomes even more over-activated during periods of stress, further exacerbating autonomic nervous system dysregulation.
Finally, although stimulants and depressants (like coffee and alcohol) may provide temporary relief from a headache, they can actually make your headaches worse over time. Use discretion when consuming them.
Migrainous Headaches or “Migraines”
Another commonly reported type of post-traumatic headache is a migrainous headache. These typically present as an extreme, stabbing pain on one side of the head (or the other), generally near the top of the head. However, the term migraine can be thrown around and used to describe the feeling of any extreme headache. Just know that migrainous, severe, unilateral (i.e., on one side) headaches caused by a concussion often occur in individuals who have a predisposition to, or a family history of, migraines. That said, they can also occur in individuals who do not have any history of migraines.
If you’ve ever experienced an “aura” before your headache, it’s probably migrainous. About 30% of people who suffer from migraines experience an aura (a sensory change or disturbance) right before the migraine manifests.
For example, an aura could show up as black or white spots in your vision, a strange smell, or tingling hands. An aura can be a good warning for some people to take their migraine pills or move to a safe area. These sensory disturbances may make a person extremely sensitive to light, touch, or smell.
Although the exact cause of migraines is unknown, the neurovascular components of a migraine and a concussion are quite similar. For this reason, it is understandable that the physiological effects of a concussion can increase the frequency or intensity of migraines, especially for someone who is already predisposed to them.
In addition, the similarities between migraine and ANS headaches make it VERY difficult to discern what a patient has. In some cases, it takes years of testing and experimentation with medication to determine what a patient has. And it is very possible a patient has both chronic migraines and ANS headaches.
But that doesn’t mean it’s not worth working with your doctor to determine if your headaches are migrainous or not. Family history of migraines, the effectiveness of migraine medication on your severe headaches, initiating factors, and aura will help your doctor understand what you might have.
Other Concussion Headache Causes: Vision and the Eyes
In addition to ANS headaches and migraine headaches, patients can experience a few other types of post-traumatic headaches.
One main type is related to vision. These headaches are common if you experience vision problems after a concussion (things like light sensitivity, peripheral vision problems, or difficulty focusing). The strain created by trying to overcompensate for any new vision issues leads to tough, pulsing headaches. These headaches generally involve the area around the eyes, and your eyes may feel like they are inflamed or pained. Often, we’ve found vision therapy after concussion may make vision-associated symptoms worse — or simply not solve vision issues and vision-related headaches after brain injury. The reason for this can be related to the changes in neurovascular coupling (NVC), which we discuss later in the post.
What Do Post-Concussion Headaches Feel Like?
Many concussion patients will say that post-traumatic headaches "just feel different," or they "just know when they have one." The exact feeling of a post-traumatic headache can vary from person to person and from headache to headache. Often, patients can experience a few of the post-traumatic headaches outlined above. Let’s just summarize here:
Concussion headaches can have a feeling of tension, tightness, and/or pressure. The feeling of increasing pressure in the head is often indicative of an autonomic nervous system headache. Patients will describe these headaches as though there is a clamp tightening around their head or as though their head is a balloon that is being blown up. If a patient is suffering from an ANS headache, the tension might start in the neck and spread up to the top of the head.
With headaches caused by eye strain, the pressure might start behind the eyes and spread to the back of the head.
A sharp, stabbing pain might be indicative of a migrainous headache. These often feel similar to a normal migraine, but increase in frequency and intensity after a concussion.
Since there isn’t just one type of post-traumatic headache and the headaches vary from person to person, it is difficult to fully describe what a post-traumatic headache feels like. If you’re wondering if your headaches are post-traumatic headaches, start tracking them. Keep a daily journal and notate the details of your headaches, including location, cause, sensation, remedies, pain rating, and length. The visual illustration we introduced earlier will be helpful here:
These are the most common headaches our concussion patients experience.
In identifying the type of headache you’re experiencing, it’s important to note the causes and any remedies. For example, a “normal” headache could be caused by not drinking enough water (and thus be remedied by drinking more water). But an autonomic nervous system headache may not respond to normal remedies, including medication, may persist longer than a normal headache (sometimes lasting weeks), and may worsen with exercise or cognitive activity. Writing down differences in what helps to alleviate headaches can help you understand the cause of the headache.
How Long Does a Post-Concussion Headache Last?
Sadly, there isn’t just one answer. The length of a post-traumatic headache is highly dependant upon a number of risk factors, including genetic predisposition, how your body specifically reacted to the injury, and what types of post-traumatic headaches you’re getting. Contrary to popular belief, loss of consciousness or memory loss at the time of head trauma does not indicate the severity or longevity of post-concussive symptoms.
If you are still experiencing what you think are post-traumatic headaches and it has been some time since your injury, then it is unlikely your headaches will resolve on their own. There are ways to alleviate headache pain in some situations, but with post-traumatic headaches, even if the headaches start to decrease in frequency and severity, it is not likely they will fully resolve without treatment. Some patients go through “good” periods when their chronic headaches aren’t as bad, but any event that taxes the brain and autonomic nervous system can almost immediately bring back the headaches.
The length of a post-traumatic headache can vary greatly from patient to patient, but if you are experiencing post-traumatic headaches, you should seek treatment from a professional to ensure the source of the headache is being treated, not just the pain. Concussion headaches are unlikely to fully resolve without concussion treatment.
If you’re suffering from post-traumatic headaches, we can help. Sign up for a free consultation with our team.
Treatment for Concussion Headaches
The best treatment for post-traumatic headaches is to treat the concussion itself rather than medicate the pain. For example, ANS headaches won’t completely resolve until the autonomic nervous system is re-regulated, but this doesn’t just happen with time. Many people will speak with their healthcare professionals about medication options, and these may help with symptoms (potentially effective in the case of migraine medication) but may also not effectively reduce all headache pain. Or, the medications used may come with concerning side effects.
Below, we’ve provided a brief explanation of potential post-traumatic headache treatment options.
Medications are often prescribed as a first-pass treatment for post-traumatic headaches, but most of them do not treat the source of the issue. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen sodium can help with decreasing swelling and therefore improve blood flow and reduce muscle tension. Acetaminophen is another over-the-counter pain relief medicine that can help alleviate the pain. However, pain medication is only treating the symptom, not the cause.
Amitriptyline is also commonly prescribed for treating migraines or other headache symptoms. Amitriptyline can help with migraines, depression, and sleep — all areas that may be impacted by a concussion — but many patients find the drug to be ineffective. Beta blockers can affect blood flow and are sometimes prescribed for post-post-traumatic headache treatment. But again, these do not resolve the source of the issues (dysregulated autonomic nervous system and neurovascular coupling), may come with undesirable side effects, and can leave the patient susceptible to medication overuse and dependence. Make sure to discuss with your doctor EVERY aspect of a medication you may take, and also consider the following: Is there a way to treat the source of the headache, not just the pain?
Post-Traumatic Headache Treatment: The ANS & Neurovascular Coupling
With post-traumatic headaches, it’s important to address the source of the issues, not just the symptoms. We provide our patients with therapy designed to promote neuroplasticity (the brain’s ability to change and to heal itself and the body) in the affected regions of the brain.
At Cognitive FX, patients go through a week-long, intense therapy regimen designed to kick-start neuroplasticity. Therapy begins with cardiovascular exercise to improve blood flow and oxygen to the brain and prepare the brain for cognitive exercises. After cognitive exercise, the brain needs to have recovery time before returning to exercise and cognitive activity. This continual exposure to various exercises, tailored for each individual, helps disrupted pathways recover and improve neurovascular coupling.
As we mentioned earlier in the post, neurovascular coupling (NVC) is the connection between neurons and the blood vessels that supply them with oxygen, which is often damaged as a result of concussion. Improving NVC is important for recovering from a concussion since vascular issues are so connected to ANS dysfunction and post-traumatic headaches.
At our concussion treatment center, we work with patients whose symptoms didn’t go away with rest and time. Neuroplasticity is at the center of their recovery journeys. The brain’s ability to heal with physical therapy and cognitive therapy brings hope to our patients and to anyone else who has sustained a brain injury. Even those without injury or trauma can find improved quality of life through neuroplasticity.
Note: If you’re experiencing post-concussion symptoms six weeks after injury, it is highly unlikely the headaches will resolve without treatment. On average, our patients improve by 75% after treatment. To see if you are eligible for treatment, sign up for a free consultation.
Tips and Tricks for Immediate Concussion Headache Symptom Relief
There are some simple things you can do to help alleviate or reduce the pain of headaches after a mild TBI.
One of the first things we recommend is to try not to rely on stimulants or depressants, such as alcohol and caffeine. Although these may provide temporary relief, they can also exacerbate the underlying cause of your headaches.
For autonomic nervous system headaches, reducing stress is a very important part of any post-traumatic headache treatment plan. For example, you can practice mindful breathing daily, breathing in and out with a focus on your breath. Breathing in this manner helps to decrease the sympathetic nervous system and improve blood flow, along with many other benefits. Other stress reducers, including using essential oils, practicing self-care, and practicing mindfulness on a daily basis can all help alleviate post-traumatic headaches.
For persistent sinus pain and pressure, using a hot pad on the sinuses can help to open up the blood vessels and reduce the pressure. Adding in peppermint oil may also help to relieve congestion and help with relaxation.
With spine-related cervicogenic headaches, simply stretching the neck can help to alleviate some of the muscle tension and pain. For vision headaches, completing vision therapy and practicing good screen hygiene may reduce post-traumatic headaches.
For post-traumatic headache treatment, it is important to stay healthy overall. Eat healthy, take supplements and vitamins as needed, and stay active. Although exercise may immediately make your headache worse, consistent exercise can help to alleviate your headaches over time by improving your cardiovascular health and ANS balance.
Finally, flavonoids have been shown to improve cardiovascular health and reduce headaches. Other supplements that help with overall health and decreasing stress can help as well.
What to Do If Your Concussion Headaches Are Getting Worse
Any time your symptoms are consistently worsening, seek medical attention from your healthcare provider. Your headaches may oscillate a bit in intensity day-to-day, but if your symptoms are progressively getting worse, this is a red flag.
Progressively worsening symptoms often means there are multiple unresolved issues that you need to pay attention to. Sometimes, a head injury is accompanied by a neck injury. Cervical spine abnormalities are one such cause for worsening pain in the head or neck.
For example, if your headaches are getting worse, it could be caused by muscle tension and a disc issue, which, if untreated, could cause spine damage. Contact a healthcare professional about your worsening symptoms.
If you are experiencing post-traumatic headaches and want to resolve their underlying cause, schedule a free consultation to see if our treatment can help you. On average, our patients see a 75% improvement after treatment at our center specializing in neuroplasticity-driven therapy.
About Dr. Jaycie Loewen
Dr. Jaycie Loewen is a Clinical Neuroscientist who received her Doctorate of Neuroscience at the University of Utah. Her background includes the study of basic and clinical brain injury, including the publication of research regarding mechanisms of epilepsy pathophysiology. Her work has elucidated the role of glial and neuronal cell profiles in viral-induced brain injury and acute seizures. Dr. Loewen is further a Howard Hughes Medical Institute Scholar, with a Master's in Clinical Investigation awarded in 2018, as well as a recipient of the Higher Education Teaching Specialist Certificate. Through these degrees, she obtained experience with patient care and education as well as an understanding of the necessity of respecting patient experience and symptoms. Dr. Loewen’s focus is firstly patient care and education. She also provides literature analysis and aids in the publication of Cognitive FX’s research. Her goal is to improve Cognitive Fx’s ability to help patients through equal interaction and communication, as well as the furthering of concussion and mild traumatic brain injury treatment and science.