What is concussion?
A concussion, also called a mild traumatic brain injury (TBI), is a temporary disturbance in brain function caused by a bump, blow, or jolt to the head or body. Any sudden movement that causes the brain to bounce around in the skull can cause a concussion, disrupting the signalling pathways in the brain and the ability of brain cells to function normally.
Most people with concussion do not lose consciousness.
Concussion is common in sports, falls and motor vehicle accidents.
Symptoms include headache, confusion, memory problems, dizziness, blurred vision, nausea and vomiting, fatigue, irritability, sleep difficulties, sensitivity to noise and light.
See a health professional as soon as possible if you have or think you have a concussion and rest for 24–48 hours.
How common is headache after concussion?
Headache is one of the most common symptoms after concussion with 90–95% of people experiencing headache in the first few days or weeks. Many people with headache after a concussion (post-traumatic headache) have migraine-like symptoms including:
- throbbing or pulsating pain
- pain worsened with physical activity
- sensitivity to light or sound
- touch perceived as painful
- nausea
- fatigue
- mood changes
- visual disturbance, including aura.
How long does a post-traumatic headache last for?
For many people, the post-traumatic headache will resolve within a few days or weeks. In 30–50% of people, it can persist beyond three months, when it’s known as ‘persistent post-traumatic headache’. This persistent headache often has migraine-like symptoms.
See your doctor if headaches are severe, worsening or not improving after a few weeks.
What’s the difference between post-traumatic headache and migraine?
Researchers aren’t sure to what extent post-traumatic headache and migraine share the same underlying mechanisms. There seem to be some areas of the brain and aspects of brain function that are similarly affected in both conditions, but also some differences, especially when post-traumatic headache becomes persistent. Concussion might trigger migraine attacks in someone who has a genetic predisposition to migraine or worsen pre-existing migraine.
A history of frequent migraine attacks is a risk factor for developing persistent post-traumatic headache, as is a previous brain injury.
Treatment and support
There aren’t evidence-based treatment guidelines for post-traumatic headache but the general approach is to treat post-traumatic headache with migraine-like symptoms in the same way as migraine, with acute and preventive medications.
Acute medications, to treat symptoms when they occur, include paracetamol, non-steroidal anti-inflammatory drugs, triptans and anti-nausea drugs. Pain relievers and triptans should not be used every day for more than three months or this may induce a medication overuse headache. After three months, if you still need to take these medications more than two or three times a week, then you should talk to your doctor about other treatment options and about starting a preventive medication.
The same types of preventives are used for both migraine and post-traumatic headache and there is emerging evidence for use of anti-CGRP medications.
If these don’t work, then other treatments may be tried. Physiotherapy may help with neck strain and returning to physical activity. Psychological and behavioural therapies can help with stress, anxiety, depression and managing memory and cognitive difficulties. Other symptoms like insomnia or vertigo/dizziness may also need specific treatment.
For everyone with post-traumatic headache, strategies like regular sleep and meals, healthy food, avoiding alcohol and caffeine, limiting screen time, gradual return to activities and exercise and managing stress are important interventions.
Personal stories
Many people in Aotearoa New Zealand experience migraine after concussion. Read about Lizzie Marvelly and Steve Devine’s experience with concussion and migraine here:
Inside singer Lizzie’s marvellous life
Former All Black on NZ’s concussion problem: ‘More needs to be done’ and in the Neurological Foundation’s Headlines magazine (winter edition 2025).
If you’d like to share your story about concussion, migraine and post-traumatic headache, please email us: info@migrainefoundation.org.nz
More information and resources about brain injury and concussion in Aotearoa New Zealand
- Brain Injury NZ
- AUT Traumatic Brain Injury Network
- Headway Brain Injury Auckland
- Sport Concussion in NZ: ACC Guidelines
Further post-traumatic headache references
- Ashina H, Dodick DW. Post-traumatic Headache: Pharmacologic Management and Targeting CGRP Signaling. Curr Neurol Neurosci Rep. 2022 Feb;22(2):105-111. doi: 10.1007/s11910-022-01175-w.
- Blumenfeld A, McVige J, Knievel K. Post-traumatic headache: Pathophysiology and management – A review. Journal of Concussion. 2022;6. doi:10.1177/20597002221093478
- Schwedt TJ. Post-traumatic headache due to mild traumatic brain injury: Current knowledge and future directions. Cephalalgia. 2020;41(4):464-471. doi:10.1177/0333102420970188
