Post-Concussion Headaches That Won't Go Away: Why They're Not Brain Injuries

Written by Dr. Rob Letizia, PT, DPT - 25+ years treating post-concussion athletes and patients in Wayne, NJ.

If your head has been hurting for weeks or months after a concussion and no medication seems to work, you are not alone - and you are not crazy. Post-concussion headaches affect 85% of patients, and the reason they do not respond to Tylenol, ibuprofen, or prescription migraine medication is that most are not actually brain-origin headaches at all.

They are coming from your neck. And once you treat the real source, most of them resolve in weeks rather than dragging on for months.

The Post-Concussion Headache Diagnosis Most Doctors Miss

When a concussion happens, the brain gets jostled inside the skull. But the same force that produced the concussion also whipped the head and neck. The cervical spine - especially the upper cervical region (C1, C2, C3) and the suboccipital muscles at the base of the skull - almost always takes damage at the same time.

This is a concurrent whiplash injury in 50%+ of concussions. When it heals badly, the result is cervicogenic headache: head pain that originates from cervical spine dysfunction but feels to the patient like it is coming from inside the skull.

Cervicogenic headaches typically:

• Start at the base of the skull or high in the neck, then radiate forward over the top of the head or behind the eye
• Are often one-sided
• Worsen with neck movement, prolonged sitting, screen time, or reading
• Have associated neck stiffness and reduced neck range of motion
• Do not respond to standard headache medications
• Respond dramatically to cervical manual therapy

Why Medications Do Not Work on Post-Concussion Headaches

Pain medications reduce the pain signal - they do not address the source. If your headache is coming from a locked-up C1-C2 segment, irritated suboccipital muscles, and a cervical facet joint that is not moving properly, then:

• Tylenol will mask the pain for a few hours while the dysfunction continues
• NSAIDs reduce the inflammation but the mechanical problem is still there
• Prescription migraine medications do not target cervical spine problems - they target vascular or neurogenic pain pathways. Wrong target, no response.
• Cortisone injections at the occipital nerve can help temporarily but do not fix the underlying joint and soft tissue problem

The only way to fix a cervicogenic headache is to fix the cervical spine dysfunction driving it.

How Dr. Rob Treats Post-Concussion Cervicogenic Headaches

The evaluation identifies the specific cervical segments, muscles, and movement patterns contributing to the headache. Treatment combines:

Upper Cervical Manual Therapy

Specific Maitland mobilization of the occipito-atlantal (C0-C1) and atlanto-axial (C1-C2) joints - the most common headache drivers. These are the joints that produce the "base of skull" headache pattern when they get stuck.

Suboccipital Release

The suboccipital muscles (rectus capitis posterior major and minor, obliquus capitis) refer pain into the top of the head in a classic headache pattern. Sustained pressure, deep tissue work, and targeted stretching resolve these in most patients within 2-4 visits.

Trigger Point Work in the Cervical Paraspinals

Upper trapezius and levator scapulae trigger points refer pain to the temples and behind the eye. Dry needling or manual release addresses these.

Cervical Stabilization Retraining

Deep neck flexor activation (longus colli, longus capitis) is almost always inhibited after whiplash. Without these, the superficial muscles overwork, triggers return. Stabilization exercises are a critical part of preventing recurrence.

What to Expect in Treatment

Visits 1-3 (Week 1-2)

Initial pain reduction. Most patients report 40-50% headache reduction by visit 3. Home exercise program starts.

Visits 4-6 (Week 2-4)

Restoring full cervical mobility, addressing compensatory patterns, starting strengthening. Many patients report headache-free days for the first time in months.

Visits 7-10 (Week 4-6)

Return to full activity including screens, reading, driving, and sports. Remaining sessions focus on preventing recurrence.

Most post-concussion cervicogenic headache patients are discharged within 8-12 visits.

When It Is NOT Cervicogenic

Some post-concussion headaches are genuinely migraine, tension-type, or have other drivers (autonomic dysregulation, vestibular origin, medication-overuse headache from excessive OTC pain med use). A proper evaluation distinguishes these.

At Spectrum Therapeutics, if your evaluation suggests a primarily non-cervicogenic headache, Dr. Rob will refer you to the right specialist (neurology for migraine, for example) and we coordinate care. But in our experience, 70-80% of persistent post-concussion headaches have a significant cervical component that responds to this treatment.

The Bottom Line

If you have had headaches for more than a few weeks after a concussion and medication is not working, the answer is probably not a stronger medication. The answer is probably a thorough cervical spine evaluation by a clinician who specializes in post-concussion care.

Read more about our Post-Concussion Syndrome Treatment program in Wayne, NJ, or call (973) 689-7123 to schedule.