Management of Headache Due to Concussion at 1-2 Months Post-Injury

Assessment and Treatment Approach

A multidisciplinary approach including graded physical exercise, vestibular rehabilitation, manual therapy, psychological treatment, and possibly oculomotor vision treatment is recommended for headaches persisting 1-2 months after concussion, based on individual symptom patterns 1, 2
Evaluate the collective burden of post-concussion symptoms, including physical, cognitive, and emotional components, to guide treatment 1, 2

Implement sub-symptom threshold aerobic exercise with gradual increase in intensity for patients with persistent headaches after concussion 1, 2
Consider spinal mobilization/manipulation for patients with concurrent neck pain and headache, as manual therapy has shown positive effects on pain reduction 1, 2

Implement vestibular rehabilitation if vestibular dysfunction is contributing to headache, including habituation exercises, adaptation exercises, and balance training administered at least once weekly for 4 weeks 1, 2

Consider oculomotor vision treatment for patients with visual symptoms accompanying headache, including vergence training, accommodative training, and eye movement exercises 4

Offer psychological treatment for emotional symptoms that may exacerbate headache, including individual or group therapy administered at least one hour weekly for a minimum of 4 weeks 1, 2

Implement coordinated treatment from at least two different healthcare disciplines, as this comprehensive approach has shown positive effects on overall symptom burden, including headache 1, 2
Recognize that headaches may have multiple contributing factors (vestibular, cervical, visual, psychological) requiring targeted interventions, and that evidence supporting these interventions ranges from very low to low certainty 2, 3
Understand that persistent symptoms at 1-2 months may indicate transition to post-concussion syndrome, affecting 15-20% of concussion patients 6