Cervicogenic Headaches After Concussion

A concussion can do more than just disrupt your cognitive functions, it can also trigger persistent neck and head pain. One common, yet often overlooked, type of post-concussion pain is the cervicogenic headache. In this blog post, we’ll explore what cervicogenic headaches are, how they develop after a concussion, and what treatment options can help you get back on track.

 
What Are Cervicogenic Headaches?

Cervicogenic headaches are a type of secondary headache that originates from dysfunction in the cervical (neck) region. Unlike primary headaches (such as migraines or tension-type headaches), cervicogenic headaches are directly linked to issues in the cervical spine or soft tissues surrounding it. Typically, the pain begins in the neck and radiates to the head, often affecting one side more than the other. Patients might notice that certain neck movements or sustained postures trigger or worsen the pain.

 
The Concussion Connection

After a concussion, the forces involved in the injury aren’t limited to the brain alone. Concussive impacts - often combined with whiplash or sudden acceleration-deceleration forces - can strain the muscles, ligaments, and joints in your neck. When these structures become injured or develop abnormal tension patterns, the result can be a cervicogenic headache.

In many cases, what starts as a typical post-concussion headache evolves into a cervicogenic headache when the underlying neck injury isn’t fully addressed. When the joints or muscles in your neck aren’t moving quite right, whether from stiffness, tension, or small changes in position, they can send extra “noise” to the part of the brainstem (the trigeminocervical complex) that processes signals from both your neck and your head. Because these signals share the same pathways, your brain can sometimes mix them up, making pain that starts in your neck feel like it’s coming from your head.This phenomenon explains why even after other concussion symptoms have improved, the headache may persist.

 
Recognizing the Symptoms

Identifying a cervicogenic headache involves paying attention to a few key features:

Pain Originating in the Neck: Unlike migraines that often start in the head, cervicogenic headaches typically begin in the neck or shoulder area and then travel upward.
Unilateral Pain: The pain is usually one-sided, and its intensity can range from mild to severe.
Worsening With Neck Movement: Activities that involve turning or extending your neck, or even sitting in the same position for too long, can intensify the pain.
Associated Neck Stiffness: You might also notice reduced range of motion or a feeling of tightness in your neck muscles.
Absence of Migraine Features: Unlike migraines, these headaches generally aren’t accompanied by nausea, aura, or extreme sensitivity to light and sound.
Recognizing these signs is important for you and your healthcare provider to determine whether the headache is indeed cervicogenic in nature.

 
Diagnosis and Evaluation

If you’ve had a concussion and continue to suffer from persistent headaches, your doctor or physical therapist may suspect a cervicogenic component. The evaluation typically involves:

Detailed History: Your healthcare provider will ask about the onset of your symptoms, any neck pain or stiffness, and what movements or positions worsen your headache.
Physical Examination: A thorough examination of your cervical spine, including range-of-motion tests and palpation of neck muscles, can help identify areas of dysfunction.
Special Tests: Techniques such as the cervical flexion-rotation test can assess movement restrictions between the first and second cervical vertebrae, a common site of dysfunction in cervicogenic headaches.
Imaging: Although not always necessary, imaging studies like X-rays or MRI can rule out other causes of neck pain and help pinpoint structural issues.
This careful, step-by-step approach helps ensure that the treatment plan targets the root cause of your pain.

 
Treatment and Rehabilitation Options

Manual Therapy and Joint Mobilization
Many patients find relief through manual therapy techniques. A skilled physical therapist may perform:

Joint Mobilization or Manipulation: Focusing on the upper cervical spine, these techniques can help restore normal joint movement and reduce pain.
Soft Tissue Therapy: Techniques such as massage or myofascial release help relax tight muscles and relieve trigger points that refer pain to the head.
Therapeutic Exercise: Restoring proper function to your neck muscles is a key part of recovery.

Specific exercises include:

Craniocervical Flexion Exercises: These gentle, controlled movements help strengthen the deep neck flexor muscles while reducing overactivity in superficial muscles like the sternocleidomastoid. This type of exercise not only stabilizes your neck but also can decrease headache frequency and intensity.
Postural Correction: Improving your posture - especially during activities like desk work or screen time - can reduce strain on your cervical spine.
Stretching and Strengthening: A comprehensive program that includes stretching tight muscles and strengthening weak ones can restore balance in the neck and shoulder region.

Addressing Autonomic and Visual Components

Concussions can sometimes affect blood flow (dysautonomia) and visual systems. In some cases, these issues may contribute to or exacerbate headache symptoms. Approaches such as:

Graded Aerobic Exercise: Guided by tools like the Buffalo Concussion Treadmill Test, moderate exercise can help restore normal autonomic function.
Vestibular and Vision Therapy: If your concussion has affected your visual tracking or balance, these therapies can help retrain your system, reducing secondary headache symptoms.

Multidisciplinary Care

Because cervicogenic headaches after concussion can involve multiple systems, a multimodal approach is often the most effective. This may include:

Physical Therapy: To address neck and upper back mobility, muscle tension, and posture.
Occupational Therapy: To support daily activities, improve ergonomics, and help you adapt your work or home environment to reduce strain.
Neuro-Optometry: To assess and treat vision problems that may be contributing to headache symptoms.
Medical Management: Over-the-counter pain relievers may offer temporary relief, but they are usually combined with other therapies for long-term results.
Education and Lifestyle Adjustments: Learning to recognize triggers, improving posture, and making small daily changes can help prevent symptoms from returning.

Self-Care Strategies

In addition to professional treatment, there are several self-care tips that can help manage cervicogenic headaches:

Mind Your Posture: Make a conscious effort to maintain good posture throughout the day. Ergonomic workstations and regular breaks from screen time can help.
Apply Heat or Cold: Experiment with moist heat packs or cold compresses on your neck to see which provides better relief.
Practice Gentle Neck Exercises: Incorporate simple stretches and movements into your daily routine to keep your neck muscles flexible.
Stay Hydrated and Manage Stress: Adequate hydration and stress management techniques, such as deep breathing or meditation, can improve overall neck health.
Regular Physical Activity: Light aerobic exercise can help maintain blood flow and prevent stiffness.

Prevention and Long-Term Outlook

Preventing cervicogenic headaches after a concussion begins with early intervention. Following a concussion, adhere to your healthcare provider’s recommendations regarding physical and cognitive rest. As symptoms begin to improve, gradually reintroduce neck exercises and physical activity under professional guidance.

With proper management, including manual therapy, targeted exercises, and lifestyle modifications,

most patients experience significant improvement. In many cases, symptoms can resolve within a few months. However, chronic cases might require ongoing maintenance therapy and self-care strategies.

 
Conclusion

Cervicogenic headaches after concussion can be both frustrating and debilitating. By understanding that these headaches are often rooted in neck dysfunction, you and your healthcare team can take a proactive, multimodal approach to treatment. With the right combination of manual therapy, therapeutic exercises, and self-care strategies, you can reduce pain, restore function, and improve your quality of life.

If you’re struggling with persistent headaches following a concussion, consider consulting with a specialized physical therapist or concussion specialist. Early intervention not only speeds up recovery but also helps prevent long-term complications.

Take control of your recovery and remember-your neck is the gateway to your head. Addressing its health is key to alleviating cervicogenic headaches and getting back to the activities you love.