01 / Post-concussion & TBI

Why Am I Still Having Concussion Symptoms Months Later? The Unresolved Skull, Neck & Brain Fluid Link

Cranial Solutions2 February 20268 min read

Concussion symptoms can linger for months or years when impact trauma creates unaddressed physical strain across four interconnected systems: sphenoid skull bone micro-locking, upper cervical (C1/C2) joint misalignment, dural membrane tension (stiffness of 28-86 MPa), and restricted cerebrospinal fluid (CSF) flow. Standard CT and MRI scans look for emergency bleeding or tissue tears, but they are not designed to detect functional membrane strain or fluid stasis. When a traumatised sphenoid bone and upper neck joints remain restricted, they may twist the brain's protective lining (dura mater) and slow the cranial pump. This can slow the brain's natural 3 to 4 times daily fluid wash (which turns over 400 to 600+ mL of fresh CSF), allowing neuroinflammatory markers (such as IL-2 and TNF-alpha) to linger. Restoring sphenoid mobility, upper neck alignment and dural balance aims to ease this fluid bottleneck, which may help with brain fog, pressure headaches, eye pain and dizziness.

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The Biomechanical Problem: Why Scans Look "Normal" While You Feel Terrible

When you suffer a concussion from a sports collision, car accident or fall, rapid acceleration and deceleration forces send a shockwave through your head and neck. Emergency evaluations rightly use CT or MRI scans to rule out life-threatening brain bleeds or skull fractures. However, these standard scans are static "photographs" of gross anatomy. They cannot measure microscopic joint restriction, subtle membrane twisting or sluggish fluid circulation.

Persistent post-concussion symptoms (PCS) may be driven by a four-part mechanical chain reaction:

01Sphenoid & skull suture micro-locking: the sphenoid bone is the butterfly-shaped keystone in the middle of your skull. Impact forces can jam or "micro-lock" the sphenoid's joints (sutures), restricting your skull's natural micro-motion.
02Upper cervical (C1/C2) misalignment: the top two neck bones - the atlas (C1) and axis (C2) - support your 5-kilogram head. Whiplash forces can push C1 and C2 into a restricted position, straining the base of your skull.
03Dural membrane tension & torsion: the dura mater is a tough, non-compliant protective sheet (stiffness of 28-86 MPa) that wraps your brain and spinal cord. When the sphenoid and upper neck twist, this lining can twist like a wrung-out towel, pulling on pain nerves and eye sockets.
04Cerebrospinal fluid (CSF) flow restriction: the sphenoid and upper neck act as a natural fluid pump. When restricted, they may disrupt the brain's 3 to 4 times daily fluid turnover (refreshing 400-600+ mL of CSF within a 150 mL space), contributing to inflammatory waste stasis.

Read how we assess these drivers on our Post-Concussion Symptoms & TBI page.

Comparison: Symptom Management vs. The 4-Part Structural & Fluid Model

Primary focus

Standard symptom relief model: Managing symptoms with medication and dark rooms.
Integrated 4-part structural & fluid model: Addressing sphenoid, neck, dural and fluid bottlenecks.

Skull bone mechanics

Standard symptom relief model: Assumes adult skull bones are completely rigid.
Integrated 4-part structural & fluid model: Addresses sphenoid bone micro-locking and sutural strain.

Upper neck role

Standard symptom relief model: Viewed as secondary muscle soreness.
Integrated 4-part structural & fluid model: Addresses C1/C2 joint alignment and myodural bridge strain.

Brain linings (dura)

Standard symptom relief model: Internal dural membrane tension is overlooked.
Integrated 4-part structural & fluid model: Addresses 28-86 MPa dural torsion and optic sheath pulling.

Fluid flow dynamics

Standard symptom relief model: Unaddressed; relies on passive resting time.
Integrated 4-part structural & fluid model: Aims to support 3 to 4 times daily CSF turnover and glymphatic clearance.

Clinical feature	Standard symptom relief model	Integrated 4-part structural & fluid model
Primary focus	Managing symptoms with medication and dark rooms.	Addressing sphenoid, neck, dural and fluid bottlenecks.
Skull bone mechanics	Assumes adult skull bones are completely rigid.	Addresses sphenoid bone micro-locking and sutural strain.
Upper neck role	Viewed as secondary muscle soreness.	Addresses C1/C2 joint alignment and myodural bridge strain.
Brain linings (dura)	Internal dural membrane tension is overlooked.	Addresses 28-86 MPa dural torsion and optic sheath pulling.
Fluid flow dynamics	Unaddressed; relies on passive resting time.	Aims to support 3 to 4 times daily CSF turnover and glymphatic clearance.

How the 4 Interconnected Pillars Drive Lingering Concussion Symptoms

The Post-Concussion Chain Reaction

Step 1: Concussive force or whiplash impact.
Step 2: Sphenoid bone micro-locking and C1/C2 upper neck misalignment.
Step 3: Asymmetric dural tension (28-86 MPa membrane twisting).
Step 4: CSF circulation stasis (reduced 3-4 times daily waste clearance).
Step 5: Lingering neuroinflammatory markers (IL-2, TNF-alpha).
Step 6: Persistent PCS - brain fog, headaches, eye pain, dizziness.

When these four systems remain restricted after a concussion, they may create distinct symptom drivers:

Pillar 1: Traumatised Sphenoid & Eye Muscle Tightness

The sphenoid bone forms the rear anchor for the eye muscles (via the Ring of Zinn) and optic nerve sheath. A restricted sphenoid may pull on eye muscle origins, contributing to laboured eye tracking, convergence fatigue and deep eye aches.

Pillar 2: Upper Cervical Choke Point & Myodural Bridges

Tight suboccipital neck muscles pull on connective tissue bridges (myodural bridges) that anchor to your spinal cord lining at C1/C2. This can create a physical choke point at the base of the skull.

Pillar 3: Dural Torsion & Trigeminal Pain

Because dura mater is tough and non-yielding (28-86 MPa), twisted brain linings may pull on sensory nerve fibres from the ophthalmic nerve (CN V1), contributing to persistent vice-like pressure headaches.

Pillar 4: CSF Stasis & Brain Fog

Your brain produces roughly 400 to 600 mL of fresh CSF daily. When the sphenobasilar cranial pump is restricted, fluid turnover may slow. Inflammatory proteins (such as Interleukin-2 and TNF-alpha) can accumulate, associated with chronic brain fog and exhaustion.

Restoring Movement, Dural Balance and Daily Fluid Washes

Care for lingering post-concussion symptoms involves a coordinated approach across all four pillars:

Mobilising the sphenoid (Nasal RX): non-surgical endonasal inflation applies gentle air pressure to deep facial and sphenoid sutures, aiming to restore sphenobasilar joint micro-motion.
Realigning C1 and C2: gentle upper cervical care aims to restore positioning of the atlas and axis, easing mechanical traction on the spinal cord and myodural bridges.
Releasing dural torsion: easing the sphenoid and neck allows twisted brain linings (falx cerebri and tentorium) to relax, which may reduce optic sheath pulling and eye strain.
Supporting 3-4 times daily CSF turnover: re-establishing natural cranial and neck movement supports the physical fluid pump, helping the brain clear inflammatory waste. Individual results vary.

See how Nasal RX fits into care on our Post-Concussion Symptoms & TBI page.

Frequently Asked Questions

Why did my MRI and CT scans come back normal if I feel so unwell?

CT and MRI scans are structural imaging tools designed to detect emergencies such as brain bleeds, tumours or fractures. They take static pictures and cannot measure dynamic fluid flow, dural membrane strain or subtle sphenoid bone restriction. You can have dural torsion and fluid stasis contributing to symptoms while still having a "normal" scan. Learn more on our Post-Concussion Symptoms & TBI page.

How do the sphenoid bone and upper neck work together to control brain fluid flow?

The sphenoid bone meets the base of the skull to form the sphenobasilar joint, which acts as a fluid pump. The top neck bones (C1/C2) form the main drainage gateway down the spine. When a concussion restricts the sphenoid or misaligns C1/C2, the pump may falter and the gateway narrow, disrupting the brain's natural 3 to 4 times daily fluid wash.

Why does a concussion cause pain behind my eyes and difficulty tracking screens?

The eye muscles attach to the sphenoid bone via a fibrous ring (Ring of Zinn), and the brain's dural lining extends forward around the optic nerve to the back of the eyeball. When a concussion twists the sphenoid and dural lining, it can create mechanical pulling on the eye socket and eye muscles, making eye tracking laboured and uncomfortable.

How does restoring skull and neck movement help with brain fog?

Your brain produces 400 to 600 mL of fresh fluid daily to flush out metabolic waste. When skull and neck joints are restricted, fluid movement may slow and inflammatory chemicals (cytokines) can accumulate, associated with fog and fatigue. Restoring movement aims to support fluid turnover so the brain can clear waste. Read more on our Post-Concussion Symptoms & TBI page.

For the full overview, visit our Post-Concussion Symptoms & TBI page.

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References

01Gard A, Vedung F, et al. (2023). Cerebrospinal fluid levels of neuroinflammatory biomarkers in athletes with persistent post-concussive symptoms. PubMed / BioMed Central, 18(1): 45-52.
02Dura Mater & Migraines Synthesis Report (2025). Biomechanical stiffness (28-86 MPa), anisotropic collagen, and dural strain.
03Dural Attachment Points & Sutures Report (2025). Sphenoid crista galli, clinoid processes, and petrous temporal ridge anchor mechanics.
04Glymphatic System Review (2022). Glymphatic System a Window on TBI Pathophysiology: A Systematic Review. Brain Sciences, 12(8): 940-958.
05StatPearls: Post-Concussive Syndrome (2024). Pathophysiology, autonomic dysregulation, and cerebral blood flow changes. NCBI Bookshelf / NIH.
06NIH / PMC Fluid Production Review (2024). Mechanisms of cerebrospinal fluid production, ventricles, and 4x daily turnover dynamics. PMC / NIH, 11071066.
07Al-Khazali et al. (2022). Neck pain co-occurrence in concussion and migraine: a systematic review. Cephalalgia, 42(9): 910-921.
08Standring S. (2016). Gray's Anatomy: The Anatomical Basis of Clinical Practice (41st ed.). Elsevier. Chapter 41: Orbit and Accessory Visual Apparatus, pp. 670-672.
09Zheng N, Chung BS, Li YL, et al. (2023). The relationship between myodural bridge, suboccipital musculature, and cerebrospinal fluid dynamics. Scientific Reports, 13: 18882.
10RACGP Neuroimaging Guide (2016). Limitations of CT/MRI scans in primary headache and physical strain. Aust Fam Physician, 45(3): 120-124.

Learn how our non-surgical endonasal protocol is used to evaluate suitability for conservative management, and how cranial base structural mechanics guide an individual care plan.