Concussion Headache — Vancouver Physiotherapy
Headache is the most common symptom after a concussion. It is also the symptom that most often persists past the expected 7–14 day recovery window. Most post-concussion headaches are not actually coming from the brain — they are driven by the upper cervical spine, the vestibular system, or migraine pathways that have been sensitised by the injury.
Envision Physiotherapy is a Complete Concussions Management (CCMI)-certified clinic with two Vancouver locations. Our physiotherapists identify which mechanism is driving your headache and treat it specifically — most patients see meaningful improvement within 3–6 sessions when the right driver is targeted.
No referral required. Direct billing to most extended health, ICBC.
Three drivers of post-concussion headache
Cervicogenic (neck-driven) headache. The same forces that cause a concussion almost always also injure the upper cervical spine. The C1–C3 segments share neural pathways with the trigeminal nerve in the face and head — irritation here refers pain into the back of the head, behind the eyes and into the temples. Manual therapy, dry needling and specific cervical exercise reliably reduce this headache pattern.
Vestibular / oculomotor headache. Strain on the inner-ear and visual systems creates a pulling, behind-the-eyes ache that worsens with screen use, reading or busy visual environments. Vestibular rehabilitation (gaze stabilisation, habituation, oculomotor retraining) targets the actual deficit and resolves the secondary headache.
Migraine-pattern headache. A concussion can sensitise central pain pathways, triggering a migraine-like response in someone with no prior migraine history (or worsening pre-existing migraine). Sub-symptom-threshold aerobic exercise plus pacing strategies are first-line; we coordinate with your physician if pharmacological co-management is needed.
How we treat it at Envision
Your assessment covers cervical range and segmental mobility, vestibular function (VOR, dynamic visual acuity, balance), oculomotor screening (smooth pursuit, saccades, convergence), and Buffalo Concussion Treadmill Test to determine your safe aerobic threshold. We identify which driver(s) are active and build a 4–8 week treatment plan around them.
Treatment typically combines manual therapy and dry needling for the cervical contribution, gaze and balance retraining for the vestibular contribution, and structured sub-symptom-threshold cardio for migraine-pattern headache. Patients are taught self-management strategies for screens, sleep, hydration and pacing.
When to come in
If your concussion headache has not resolved within 7–10 days of injury, individualised assessment is recommended. Early intervention is one of the strongest predictors of full recovery — there is no benefit to waiting.
Common Questions
Why does my headache persist weeks after my concussion?
Three drivers most commonly cause persistent post-concussion headache: cervicogenic (upper-neck) referral, vestibular and oculomotor strain, and migraine-pattern sensitisation. Each requires a different treatment approach — that is why a physiotherapy assessment is critical. Persistent headache beyond 7–10 days warrants targeted assessment.
Will painkillers help my post-concussion headache?
Painkillers may mask the symptom temporarily but do not address the underlying driver. Repeated use of over-the-counter analgesics can also create medication-overuse headache. Physiotherapy targeted to the actual mechanism (neck, vestibular or migraine pathway) provides longer-lasting relief.
Do I need a referral or imaging first?
No referral is required to book physiotherapy at Envision. Most post-concussion headaches do not require imaging — we screen for red-flag symptoms during assessment and refer back to your physician if imaging is indicated.
How many sessions will I need?
Most cervicogenic and vestibular post-concussion headaches improve substantially within 3–6 sessions when the correct driver is targeted. Migraine-pattern headache may take longer (8–12 weeks) and is often co-managed with your physician.
Connected services
Concussion Management
Full CCMI pathway — vestibular, visual, manual and return-to-play.
Learn more →Vestibular Rehabilitation
Gaze stabilisation and balance retraining for dizziness and motion sensitivity.
Learn more →Concussion Symptoms Guide
What's normal, what's not, and when to get help.
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Same-week assessments at South Granville and False Creek. No referral required.
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