Written and medically reviewed by Tae Ho Guak, MD, board-certified neurologist · Reviewed July 2026 · Editorial policy
A woman in her thirties sat across from me last month, seven months out from a low-speed car accident. Her CT in the emergency room was clean. Her family doctor had told her the concussion “should have healed by now.” But the headache never left — a daily pressure behind the eyes, worse by afternoon, with a few migraine-grade days a week. She had started to wonder if it was in her head in the other sense. It wasn’t. If your headache started after a concussion and is still here months later, the most likely reason is not brain damage that scans are missing. It is a persistent, treatable headache disorder that the injury switched on — and the good news is that the treatable part is usually the whole problem.
What post-traumatic headache actually is
Post-traumatic headache is a headache that begins within seven days of a head injury (or of regaining consciousness, or of being able to sense pain again). That’s the formal definition from the international headache classification. Most cases follow a mild injury — a concussion — not a severe one, which surprises people. You do not need to have lost consciousness, and you do not need a visible injury on imaging.
Here is the part that matters for treatment: post-traumatic headache almost never has its own unique “feel.” It borrows the pattern of a primary headache. In most of my patients it looks and behaves exactly like migraine — throbbing, light and sound sensitivity, nausea, made worse by activity. In a smaller group it looks like tension-type headache, a band of pressure without the migraine features. Naming the pattern is not academic. It tells us which medications will work, because we treat the pattern, not the accident.
The word “persistent” gets added when the headache is still present after three months. That threshold worries patients, but it is a description, not a prognosis. I have moved plenty of persistent post-traumatic headaches into remission well past the one-year mark.
Why yours hasn’t gone away
When a post-concussion headache drags on, it is rarely a mystery. It is usually one — often several — of a short list of reasons, and each one is something we can act on.
You’ve been taking painkillers most days. This is the single most common trap. After a concussion people reach for ibuprofen, acetaminophen, or combination tablets daily because the headache is daily. Past roughly ten to fifteen days a month, those same medications begin to generate headache — a self-sustaining cycle called medication-overuse headache. I see this constantly in trauma patients, and until the overused medication is unwound, nothing else works well. Breaking that cycle alone resolves a large share of “my concussion headache won’t heal” cases.
The migraine underneath was never treated as migraine. If the injury flipped on a migraine pattern and you’re only taking over-the-counter pain relief, you are undertreating it. Migraine responds to migraine-specific tools, and when a headache is happening most days it also needs a preventive — not just something to take once the pain arrives. When a post-traumatic headache starts creeping toward daily, it is following the same road as chronic migraine, and it responds to the same strategy.
Your neck took the hit too. Whiplash and concussion travel together, and the upper neck refers pain into the head convincingly. When neck movement clearly reproduces the pain, targeted physical therapy for the cervical spine often does more than any tablet.
Sleep, mood, and deconditioning are feeding it. Concussions disrupt sleep and frequently bring anxiety or low mood, and both lower the threshold for headache. Being told to rest in a dark room for weeks — outdated advice — makes the deconditioning worse. These are not signs that the headache is “psychological.” They are levers, and pulling them helps.
What the scans can and can’t tell you
Almost every patient I see with persistent post-traumatic headache has had a normal CT or MRI, and almost every one reads that result as “so they found nothing, so there’s no explanation.” That’s the wrong conclusion. Standard imaging is designed to rule out bleeding, structural damage, and other dangerous causes — and a clean scan is genuinely reassuring on that front. It was never able to show a headache disorder, because migraine and its relatives don’t leave a mark on an MRI. A normal scan is not the absence of a diagnosis; it is one important box ticked. I’ve written more on exactly what a normal MRI actually rules out if that result has been nagging at you.
How I actually treat it
The plan is unglamorous and it works. First, I count how many days a month you’re taking any acute medication, and if that number is high, unwinding the overuse comes before everything else. Second, if the pattern is migraine — and it usually is — I treat it as migraine: a proper acute medication to stop attacks early, and, because the headache is frequent, a daily preventive chosen around your other symptoms, whether that’s poor sleep, low mood, or neck pain. Third, we rebuild activity gradually rather than resting into deconditioning, and we bring in cervical physical therapy when the neck is part of the picture.
What I want you to take from this is that persistence is not the same as permanence. Post-traumatic headache has a reputation for being stubborn largely because the treatable drivers — medication overuse, an untreated migraine pattern, the neck, sleep — go unaddressed for months while everyone waits for it to “heal.” Address them and most people improve substantially, even a year or more out. If yours has been written off, that’s usually a reason to look harder, not to give up. It’s the same theme I keep coming back to in why some headaches don’t get better: the diagnosis is often right there, just not acted on.
One caution. A headache that is new or clearly worsening, that wakes you from sleep, that is triggered by coughing or straining, or that comes with fever, weakness, vision loss, confusion, or the worst headache of your life — none of that is ordinary post-traumatic headache, and it needs urgent, in-person evaluation rather than reassurance.
Next steps
- Not sure if your symptoms are a red flag? Start with my free headache red-flags checklist.
- Headache that won’t heal after a head injury? You can talk to a specialist about your case.
This article is for education and is not a substitute for a personal medical evaluation. It cannot diagnose your condition or replace care from your own physician. If you have sudden, severe, or rapidly worsening symptoms — the worst headache of your life, weakness, difficulty speaking, vision loss, confusion, or a headache after a serious head injury — go to the nearest emergency department now.
— Dr. Tae-Ho Guak, MD, board-certified neurologist. 25 years and more than 100,000 patient visits treating headache and migraine.
From the textbook. Chapter 45, “Post-Traumatic Headache and Whiplash,” of my clinical textbook Headache Medicine covers this topic in full for doctors, with the evidence and decision pathways behind it. About the book →