Headache After Concussion: When a Mild Traumatic Brain Injury is Not So Mild

Posted on July 8th, 2026

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Many people are told they had a “mild” traumatic brain injury after a car crash, fall, sports injury, workplace accident, or blow to the head. The word “mild” can be misleading. It usually refers to the initial severity classification, not to how the person feels weeks or months later.

For some patients, the most persistent symptom after a concussion is headache. This is called post-traumatic headache. It may begin soon after the injury and then continue long after the emergency room visit is over. A CT scan may be normal. The person may look normal. Yet the headache can remain very real and very disabling.

Post-traumatic headache does not look the same in every patient. In some people, it resembles migraine, with throbbing pain, nausea, light sensitivity, and sound sensitivity. In others, it feels like pressure, tightness, stabbing pain, scalp tenderness, pain behind the eye, or pain coming from the upper neck. Some patients also have dizziness, poor sleep, fatigue, trouble concentrating, irritability, or visual sensitivity.

This is why evaluation by a neurologist matters. A neurologist does not simply ask, “Do you have a headache?” The more important question is: what type of headache is this, what brain and neck systems may be involved, and what treatment plan fits the pattern?

A concussion or mild traumatic brain injury can affect several systems at the same time. The headache may be related to irritation of pain pathways in the head and neck. It may overlap with migraine biology. It may be worsened by sleep disruption, visual strain, dizziness, cervical injury, medication overuse, anxiety, or central sensitization, which means that the nervous system becomes overly reactive to pain signals.

In our published research, we studied patients with post-traumatic headaches that had not responded well to usual medications. Many of these patients improved after targeted nerve blocks, including occipital and forehead-region nerve blocks. This does not mean that every patient with a concussion headache needs a procedure. It also does not mean that one treatment works for everyone. But it does show that persistent post-traumatic headache can have treatable mechanisms and should not be dismissed as “just stress” or “just a normal headache.”

The practical message is simple: if headaches continue after a concussion, they deserve a careful neurological evaluation. The goal is not only to reduce pain, but also to understand the pattern of injury, identify associated symptoms, and build a treatment plan that fits the patient.

For patients in Houston dealing with headaches after a mild traumatic brain injury, the most important first step is to recognize that persistent symptoms are not imaginary. A normal CT scan does not prove that the brain and nervous system are functioning normally. It only means that the scan did not show a major structural emergency such as bleeding or a fracture.

Post-traumatic headache is common, complex, and often treatable. The earlier the headache pattern is correctly identified, the better the chance of choosing the right treatment path.

Source paper: File C, Fang X, Ahmad R, Harazeen A, Jung J, Ahmed F, Ahmad N, Pappolla S, Nader R, Pappolla MA. *Efficacy of Nerve Blocks for Managing Refractory Posttraumatic Headaches.* Pain Physician. 2025;28(2):137-145. doi:10.36076/ppj.2025.28.137.