Most concussion headaches respond well to a combination of short-term rest, careful pain relief, and a gradual return to activity. The headache itself typically feels like a tension headache or a migraine, and the treatment approach depends partly on which pattern yours follows. The key shift in concussion care over the past several years is that prolonged rest is no longer recommended. Instead, active recovery starting within a couple of days tends to produce better outcomes.
The First 48 Hours: Relative Rest, Not Total Rest
Older advice told people to lie in a dark room for days or even weeks after a concussion. Current guidelines from the 6th International Conference on Concussion in Sport recommend relative rest for only the first 24 to 48 hours. That means you can handle basic daily activities, but you should reduce screen time and avoid anything physically or mentally demanding. Light walking that doesn’t noticeably worsen your symptoms is fine even on day one.
After those first two days, reduced screen use no longer appears to help, and staying inactive can actually slow your recovery. The goal is to start reintroducing normal activities as your symptoms allow.
Pain Relief That’s Safe After a Head Injury
For headache pain in the early days, acetaminophen (Tylenol) is the safest option. Avoid ibuprofen, aspirin, and other anti-inflammatory painkillers until a healthcare provider clears you, because these can increase the risk of bleeding inside the skull after a head injury.
There’s an important limit to how often you should reach for any painkiller, though. Using over-the-counter pain relievers more than two days a week can trigger medication-overuse headaches, sometimes called rebound headaches. These create a frustrating cycle where the pill you’re taking to stop the headache actually causes the next one. If you find yourself needing pain relief more than a couple of times a week, that’s a signal to talk to a provider about other strategies rather than increasing your pill intake.
Graduated Exercise as Treatment
One of the most effective tools for concussion headaches is controlled aerobic exercise, and clinicians now encourage it as early as 24 to 48 hours post-injury. The idea is to raise your heart rate just enough to promote recovery without triggering a spike in symptoms.
A structured approach called the Buffalo Concussion Treadmill Test helps determine your personal threshold. During the test, you exercise at increasing intensity until symptoms begin to worsen. Your safe exercise zone is then set at 80% of the heart rate you reached before symptoms flared. The prescription is straightforward: exercise at that heart rate for 20 minutes daily, without exceeding the time or heart rate limit. If symptoms return during any session, you drop back to the previous level that felt manageable.
Not everyone needs a formal treadmill test. Walking, swimming, or pedaling a stationary bike at a pace that only mildly increases your symptoms (or doesn’t increase them at all) is a reasonable starting point. The critical rule is to avoid contact sports or any activity with a risk of falling or another head impact until you’ve fully recovered.
Identifying Your Headache Pattern
Post-concussion headaches don’t have a single signature. Most resemble either tension-type headaches (a dull, pressing band around the head) or migraines (throbbing pain, often on one side, sometimes with light and sound sensitivity or nausea). Some originate from the neck, especially if the injury involved whiplash or a sudden jolt. Knowing which pattern yours follows helps guide treatment, because a neck-driven headache responds to different therapies than a migraine-like one.
Physical Therapy for Neck-Related Headaches
If your headache feels like it starts at the base of your skull or is accompanied by neck stiffness and pain, the source may be cervicogenic, meaning it’s driven by your cervical spine rather than your brain. This is common when a concussion also involves a whiplash-type mechanism.
Manual therapy techniques, including trigger point release in the neck muscles and hands-on joint mobilization, can reduce the intensity, frequency, and duration of these headaches. A physical therapist trained in concussion management can assess whether your neck is contributing and build a treatment plan around it. Many concussion rehab programs also integrate vestibular and vision therapy, using exercises for eye tracking, balance on unstable surfaces, and gaze stability training, especially when dizziness accompanies the headaches. These components are typically layered in over the first few weeks of treatment.
Sleep and Daily Habits That Help
Poor sleep makes concussion headaches worse, and concussions themselves tend to disrupt sleep. Breaking that cycle requires some deliberate structure. The CDC recommends keeping a fixed bedtime and wake-up time, sleeping in a dark and cool room, and avoiding screens and loud music before bed. Caffeine should be limited or eliminated, since it can interfere with both sleep quality and headache recovery.
During the day, build in rest breaks when you need them. If mornings are rough, consider arranging a later start time for work or school. These aren’t luxuries. They’re part of the recovery process, and most employers and schools will accommodate a short-term adjustment when a concussion is involved.
Supplements for Persistent Headaches
If your headaches continue beyond the first couple of weeks, two supplements have reasonable evidence behind them: magnesium oxide and riboflavin (vitamin B2). Both are used to prevent frequent headaches, not to treat an individual episode. The standard dose for adults is 400 mg per day (usually split into two doses), and for children it’s 200 mg per day. These are inexpensive, widely available, and carry minimal side effects, though magnesium can cause loose stools at higher doses.
When a Headache Signals an Emergency
Most concussion headaches are unpleasant but not dangerous. A small number of head injuries, however, cause bleeding or swelling that requires emergency care. Get to an emergency department if you experience any of the following after a head injury:
- A headache that keeps getting worse and won’t go away
- Repeated vomiting
- Seizures or convulsions
- Slurred speech, weakness, numbness, or loss of coordination
- One pupil noticeably larger than the other
- Increasing confusion, agitation, or inability to recognize familiar people or places
- Excessive drowsiness or inability to stay awake
For infants and toddlers, inconsolable crying or refusal to eat or nurse are additional warning signs that warrant immediate medical attention.
What Recovery Typically Looks Like
Most people see significant improvement in their concussion headaches within the first two to four weeks, especially with an active recovery approach. A smaller group develops persistent post-traumatic headaches that last beyond three months. If you’re still dealing with frequent headaches at that point, a multidisciplinary concussion clinic (combining neurology, physical therapy, and sometimes neuropsychology) offers the best path forward. Persistent headaches don’t mean something was missed on imaging. They usually reflect ongoing changes in how the brain processes pain signals, and they remain treatable with the right combination of exercise, manual therapy, lifestyle adjustments, and sometimes preventive medications.