For many people, the after-effects of a concussion are severe and life-altering. Symptoms may vary for each individual but will likely include headache, dizziness, light sensitivity and sleep difficulties. One extremely common and deleterious symptom, following a concussion, is headache.
At first, a headache doesn’t sound too bad – we all experience them at some point. However, moving from the occasional headache to constant, intense headaches is a huge transition. Many people report their constant headache has the ability to significantly affect their career, relationships and general quality of life.
So, what happens during a concussion that causes a person to have long-standing headaches?
And more importantly, how can these headaches be treated?
The good news is that these long-standing headaches are often due to factors other than the concussion itself. The reason for this is that symptoms attributed directly to the concussion typically last just seven to ten days. If a headache has been lasting longer, it can usually be inked to a secondary injury, usually sustained at the same time as the concussion. Thankfully, once the cause has been identified by a skilled practitioner, these headaches can be successfully treated.
Following full brain recovery there are typically five other reasons why headaches may be persisting. These are:
- Exercise intolerance
- Visual/Vestibular disturbances
- Hormonal/inflammatory disturbances
- Psychological concerns
- Neck Dysfunction
This blog will focus on how neck dysfunction may masquerade as the exact same symptoms of a concussion which can include persistent headaches. Unfortunately, after a concussion, the neck can be underappreciated as a driver of ongoing symptoms, but it certainly can be a common beast! This frequently overlooked structure can be an easily treatable cause of symptoms.
Injury or dysfunction of the neck has been shown to cause symptoms such as headache, migraines, dizziness, brain fog, cognitive impairments and visual disturbances. In short, the exact same symptoms that acute concussion will yield! But why is it that a neck injury can bring on things such a persistent headache? There are a few reasons for this but the most current frame on thought is an increase in brainstem sensitivity.
How does brainstem sensitivity cause migraine?
Headaches and migraines are a result of an increase in brainstem sensitivity. As the sensitivity increases, the more magnified the response becomes. A sensitised brainstem can be considered similar to an amplifier, causing normal input to the brain to become increased – normal sensations become painful, a normal light source becomes incredibly bright, or the dull street noise becomes extremely loud. In some people the increased input to the brain can be so magnified it has a hard time processing everything, leading to brain fog and difficulty concentrating.
There is a certain threshold of brainstem sensitivity that needs to be reached in order to set off a migraine attack. This is different for each person but, quite often, it is driven by a person’s genetics.
We know, from research, that noxious(painful) input from the neck can increase brainstem sensitivity, therefore setting off a migraine or headache episode. By treating the dysfunction within the neck, we can dramatically decrease brainstem sensitivity therefore reducing the intensity, duration and frequency of headache/migraine episodes.
So, we know that a dysfunction in the neck can manifest as a headache, but how can a neck injury occur with a concussion?
Well, the answer lies within the mechanics of the injury. Both a concussion and neck injury are sustained from a rapid acceleration or deceleration injury. Concussion is due to acceleration or deceleration of the brain, whilst whiplash is due to acceleration or deceleration to the neck. In a Canadian study looking at junior athletes, 100% of those who sustained a concussion ALSO showed signs of a neck injury. The reason for this is simple. Approximately 60 G’s of rotational force is required to induce a concussion whereas for a mild whiplash injury only 4.5 G’s of rotational force is required. Therefore, it is conceivably impossible to sustain a concussion without some form of neck injury.
To some degree, following a concussion, there will be some sort of strain or sprain injury to the neck. With that, the symptoms of concussion and a whiplash injury are exactly the same, with the same mechanism of injury. It is important that concussion patients undergo a thorough neck examination by a skilled practitioner to rule out the neck as an influencer of persistent headaches.
But what about timeframes?
How long will it take for the neck and the headaches to recover?
In the early stages, following the injury, it is almost impossible to distinguish between a concussion and a neck injury. It is, therefore, always recommended to err on the safe side and assume it is a concussion until proven otherwise. Following a fall or a hit, and with ANY concussion-like symptoms, a concussion diagnosis should be made. Gradual cognitive and exercise re-integration principles should apply, along with a temporary removal from high-risk sports. Appropriate treatment of structures such as the neck should also be given to reduce the likelihood of a neck injury really ‘taking hold’. In these early stages and with appropriate management the majority of people will be fully recovered with all their symptoms within seven to ten days.
However, if headaches have been lingering for a while it may take a little bit longer. Despite long standing headaches, manual therapy to the neck is one of the top evidence-based treatments following concussions. The research below shows that, even if your headaches have been lingering for months or years, the neck is still an excellent area to treat to achieve real results.
Practitioners at Sydney Headache and Migraine Centre understand the frustration of long-standing headaches and general concussion symptoms. We can provide a clear and tangible plan to move forward and diminish your headaches. With the right strategy, headaches can be significantly changed.
If you feel you need some help with your headaches, give us a call on 1300 MYHEADACHE | 1300 266 287