Read about the wider assessment and treatment approach for persistent post-concussion symptoms.
Headache is one of the most common symptoms following concussion.
For some people it settles relatively quickly. For others, headaches continue for weeks or months — sometimes after other concussion symptoms have started to improve.
The headache does not always feel the same.
Some people describe:
- pressure or tightness around the head
- a heavy or “full” feeling inside the head
- pain beginning at the base of the skull and travelling forward
- pain around the temples, forehead or behind the eyes
- migraine-like throbbing or pulsating pain
- headaches aggravated by screens, reading, bright light or busy environments
- headaches aggravated by neck movement, posture or physical activity
- a combination of several of these patterns
Persistent headache following concussion is often described clinically as a post-traumatic headache. This describes when the headache developed — following an injury — but it does not tell us that every post-traumatic headache has the same underlying mechanism.
That distinction matters.
A concussion can affect the brain and nervous system, while the same impact may also transmit substantial force through the neck, cranial base, cranial and facial structures, jaw and surrounding connective tissues.
For some patients, several of these factors appear to overlap.
At Cranial Solutions, one of the questions we therefore ask is:
Could persistent headache after concussion involve not only the neurological effects of the injury, but also mechanical restriction left within the head, face or neck?
This is particularly relevant when the headache is accompanied by symptoms such as base-of-skull tightness, cranial or facial tension, directional eye discomfort, jaw tension, altered nasal breathing, or the feeling that the head has remained physically different since the injury.
A sensation of pressure inside the head does not necessarily mean that intracranial pressure is medically elevated.
But the way a headache feels, where it begins, what aggravates it, and what other symptoms accompany it can provide useful clues when assessing the different factors that may be contributing.
Why Can Post-Concussion Headaches Feel So Different?
A headache after concussion is not one single type of headache.
Two people can experience the same broad diagnosis of post-traumatic headache while describing very different symptoms.
Pressure, Tightness or Heaviness
Some people describe a constant or intermittent feeling of pressure, fullness, compression or tightness.
It may feel like a band around the head, pressure behind the forehead or eyes, or a sense that the entire head feels heavy or compressed.
Importantly, feeling pressure does not necessarily mean that intracranial pressure is medically elevated.
The sensation itself is real, but several different pain-sensitive structures and mechanisms may contribute to that feeling.
Pain Beginning at the Base of the Skull
For others, the headache seems to begin in the upper neck or base of the skull and then travels forward over the head.
This pattern makes the cervical spine, suboccipital tissues and occipital region particularly important to assess.
At Cranial Solutions, we also consider the mechanics of the occipital bone and its relationship with the temporal bones, cranial base, upper cervical spine and surrounding connective tissues.
Following head or neck trauma, restriction in this region may coexist with cervical muscular tension and contribute to the patient's overall mechanical pattern.
Migraine-Like Headaches
Some post-concussion headaches have much more of a migraine-like pattern.
Symptoms may include throbbing or pulsating pain, nausea, sensitivity to light or sound, visual sensitivity, and worsening with activity.
A previous history of migraine can also be relevant.
This is one reason we should not assume that every headache following concussion has a purely structural cause.
Headache With Eye Strain or Visual Activity
For some patients, headaches are strongly associated with reading, screens, bright light, tracking moving objects or sustained visual concentration.
Others notice discomfort or pulling when moving their eyes in particular directions.
These patterns may require assessment of visual and neurological function as well as the cranial, facial and cervical mechanics surrounding the eyes and cranial base.
Facial, Sinus or Jaw-Associated Headache
Headache can also occur alongside facial pressure, sinus pressure, altered nasal breathing, jaw tension or TMJ symptoms.
Because forces from an impact can travel through the facial skeleton and jaw as well as the cranium and neck, these areas may form part of the mechanical picture in some patients.
More Than One Pattern Can Be Present
These patterns are not mutually exclusive.
Someone may have a migraine-like headache and significant upper-neck restriction.
Another person may have head pressure together with eye strain, facial tension and altered nasal breathing.
The useful question is therefore not simply:
“What type of headache is this?”
It is also:
“Which neurological, cervical, cranial and craniofacial factors appear to be contributing to this person's headache?”
What Is a Post-Traumatic or Concussion Headache?
A headache that develops following a concussion or other head injury is generally described clinically as a post-traumatic headache.
The name describes when the headache began rather than identifying one single mechanism responsible for it.
Research shows that persistent post-traumatic headaches can take different forms. Many resemble migraine, while others have tension-type characteristics, and some patients have overlapping features.
This means two people can sustain apparently similar concussions yet experience very different headaches.
One may develop throbbing pain and light sensitivity.
Another may experience constant pressure across the forehead or temples.
Another may feel pain and tension beginning in the neck or base of the skull.
Understanding what is contributing to the individual headache is therefore more useful than assuming every post-concussion headache is the same.
Why Can a Concussion Cause Headaches That Persist?
A concussion exposes the head and often the neck to rapid acceleration, deceleration or rotational forces.
Those forces can affect several systems at once.
The neurological effects of concussion can alter pain processing and sensory sensitivity.
At the same time, the physical forces involved in the injury are transmitted through the cervical spine, cranial base, skull, facial structures and surrounding connective tissues.
This matters because the head, face and neck do not function as isolated structures.
The upper cervical spine has anatomical relationships with the cranial base and surrounding connective tissues. The dura mater — the strong membrane surrounding the brain — has important attachments within the skull and cranial base and contains sensory nerve fibres capable of contributing to head pain.
For some patients, persistent headache may therefore involve a combination of neurological sensitivity and identifiable mechanical restriction.
Why Does My Headache Feel Like Pressure?
Many patients describe their post-concussion headache less as sharp pain and more as:
- pressure inside or around the head
- a tight band or “vice-like” sensation
- heaviness in the forehead or behind the eyes
- pressure around the temples
- tightness extending from the base of the skull over the head
- a feeling that the head has remained physically different since the injury
The sensation of pressure does not necessarily mean that intracranial pressure is medically elevated.
This distinction is important.
A pressure-like headache can occur through several pain mechanisms, including tension and sensitisation involving the neck, muscles, connective tissues, trigeminal system and pain-sensitive structures associated with the dura.
At Cranial Solutions, we are also interested in the mechanical environment in which these structures function.
The Dura and Headache
The brain itself does not sense pain in the same way that many surrounding tissues do.
Structures associated with the meninges — including the dura — have sensory innervation involving the trigeminal and upper cervical systems.
These relationships are relevant to headache because mechanical and chemical stimulation of meningeal pain pathways can contribute to head pain.
The dura is also mechanically connected to specific areas of the cranial cavity and cranial base.
This creates an interesting question following concussion:
Could some patients have persistent mechanical restriction within the cranial, facial or cervical system that remains relevant to their headache?
That is one of the questions we investigate during a Cranial Solutions assessment.
The Neck Can Be Part of the Headache
The cervical spine should not be overlooked after concussion.
The same impact that accelerates the brain inside the skull can also place considerable force through the neck.
Research has identified cervical symptoms as an important component of persistent post-concussion presentations.
This is particularly relevant when headache is associated with:
- neck stiffness or restricted movement
- pain or tightness at the base of the skull
- headache beginning in the neck and travelling forward
- symptoms aggravated by prolonged posture
- tenderness through the upper cervical or suboccipital region
At Cranial Solutions, cervical assessment and treatment are therefore integrated into our post-concussion approach.
We do not automatically assume that a persistent concussion headache is coming from the neck — but we do not ignore the neck either.
What About Cerebrospinal Fluid and Fluid Dynamics?
The brain exists within a continuously changing fluid environment.
Blood enters and leaves the cranial cavity, while cerebrospinal fluid (CSF) circulates around the brain and spinal cord. Meningeal lymphatic and glymphatic pathways are also involved in fluid exchange and waste clearance.
Research is continuing to investigate how traumatic brain injury affects cerebral blood flow, CSF dynamics and glymphatic function.
These are important areas of concussion science, but they should not be oversimplified.
It has not been established that a pressure-like post-concussion headache means CSF has become physically “backed up” behind a restricted cranial joint.
What interests us clinically is the relationship between these fluid systems and the physical anatomical environment in which they operate.
The cranial base, dura, cervical region, blood vessels and craniofacial structures all occupy and interact within this environment.
This is one reason Cranial Solutions assesses cranial mobility and mechanical restriction alongside cervical function in patients with persistent headaches.
Where Does NasalRx Fit?
NasalRx gives us a way of working with the craniofacial system from a direction that conventional external manual techniques cannot reproduce.
The procedure uses brief, controlled pressure within the nasal passages to influence movement and restriction through the internal nasal and craniofacial structures.
Our objective is to improve mobility through this system and reduce mechanical restriction involving the cranial and facial complex and its relationships with the deeper cranial environment.
For patients with persistent post-concussion headache, NasalRx is not used because we assume every headache is caused by one particular cranial restriction.
It is used when the history, symptom pattern and examination suggest that cranial, facial or internal nasal restriction forms a meaningful part of the presentation.
Where cervical findings are also relevant, cervical treatment can be incorporated alongside NasalRx.
What Changes Do We Look For?
Headache and head pressure are two of the symptoms we monitor particularly closely during treatment.
Patients may report changes such as:
- reduced headache intensity
- reduced head pressure or tightness
- reduced base-of-skull tension
- less facial or cranial tension
- improved tolerance of light or visual activity
- improved mental clarity
- improved nasal breathing
Responses vary between individuals.
The important clinical question is whether symptoms change in a meaningful and consistent way as the mechanical findings identified during assessment are addressed.
When Should a Post-Concussion Headache Be Assessed?
A new or worsening headache following head injury requires appropriate medical assessment, particularly when accompanied by neurological changes or other red-flag symptoms.
For people who have already received appropriate medical assessment but continue to experience headaches as part of persistent post-concussion symptoms, a broader assessment may be useful.
At Cranial Solutions, we look at the relationship between:
- the original mechanism of injury
- the pattern and location of the headache
- cervical spine function
- base-of-skull and suboccipital tension
- cranial and facial mechanics
- internal nasal restriction
- associated symptoms such as light sensitivity, brain fog, head pressure and nasal breathing changes
The aim is to determine whether there is a mechanical component that can reasonably be addressed as part of the patient's wider concussion recovery.
Frequently Asked Questions
Why does my headache feel like pressure after a concussion?
Pressure or tightness is one way post-concussion headache can be experienced, but the sensation does not necessarily indicate medically raised intracranial pressure. Neck and cranial tension, trigeminal and meningeal pain pathways, neurological sensitisation and other post-concussion changes can all contribute.
Why does my concussion headache get worse with exercise?
Post-traumatic headaches can be aggravated by physical activity for several reasons, and exercise intolerance can form part of a wider post-concussion presentation. A headache that consistently worsens with exertion should be assessed in the context of the person's other symptoms rather than assumed to have one mechanical cause.
Can my neck cause headaches after concussion?
The neck can be an important contributor. Concussion mechanisms frequently expose the cervical spine to substantial force, and cervical symptoms are common in people with persistent post-concussion symptoms. This is why Cranial Solutions assesses the cervical spine alongside the cranial and craniofacial system.
Can NasalRx help post-concussion headaches?
NasalRx is considered when assessment identifies relevant restriction within the nasal and craniofacial system. Many Cranial Solutions patients report changes in headache or head pressure following treatment, but individual responses vary and NasalRx is not automatically appropriate for every post-concussion headache.
Persistent Headaches After Concussion?
If your headaches have continued after the initial concussion recovery period, the next step is to understand what may still be contributing to them.
Cranial Solutions assesses the cervical, cranial, facial and internal nasal components of persistent post-concussion presentations and determines whether cervical treatment, NasalRx, or a combination of both is appropriate.
Post-Concussion Assessment is available at Cranial Solutions in Auckland and Christchurch.