What is the recommended management for headaches due to concussion that occurred 1-2 months ago?

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

For headaches persisting 1-2 months after concussion, a multidisciplinary approach including graded physical exercise, vestibular rehabilitation, manual therapy, psychological treatment, and possibly oculomotor vision treatment is recommended based on individual symptom patterns. 1, 2

Assessment of Symptom Generators

• Evaluate the collective burden of post-concussion symptoms, including physical (headache, dizziness), cognitive, and emotional components 2
• Assess for vestibular dysfunction that may contribute to headache and dizziness 1, 2
• Perform visual/oculomotor assessment to identify vergence, accommodative, or eye movement dysfunction that may exacerbate headaches 2
• Evaluate the cervical spine for potential cervicogenic contributions to headache 1, 2
• Screen for psychological factors including depression, anxiety, and post-traumatic stress that may intensify headache symptoms 2

Physical Interventions

Graded Physical Exercise

• Implement sub-symptom threshold aerobic exercise with gradual increase in intensity 1
• Begin with low-intensity exercise that doesn't provoke symptoms and gradually increase duration and intensity 1, 2
• Physical exercise has demonstrated positive effects on overall symptom burden, including headache reduction 2

Manual Therapy

• Consider spinal mobilization/manipulation for patients with concurrent neck pain and headache 1
• Manual therapy of the neck and back has shown positive effects on pain reduction and may address cervicogenic components of post-concussion headache 1, 2

Vestibular Rehabilitation

• Implement vestibular rehabilitation if vestibular dysfunction is contributing to headache 1
• Include habituation exercises, adaptation exercises, and balance training administered at least once weekly for 4 weeks 1
• Vestibular rehabilitation has demonstrated positive effects on overall symptom burden, including headache 2

Visual/Oculomotor Intervention

• Consider oculomotor vision treatment for patients with visual symptoms accompanying headache 1, 2
• Treatment may include vergence training, accommodative training, and eye movement exercises 2
• Clinical experience suggests improvements in visual symptoms, headache, and fatigue with oculomotor vision treatment 1, 2

Psychological Interventions

• Offer psychological treatment for emotional symptoms that may exacerbate headache 1
• Implement individual or group therapy administered at least one hour weekly for a minimum of 4 weeks 1
• Psychological treatment is associated with positive effects on overall symptom burden, including headache 2

Interdisciplinary Approach

• Implement coordinated treatment from at least two different healthcare disciplines 1
• This comprehensive approach has shown positive effects on overall symptom burden, including headache 2
• Treatment should be administered at least once weekly for a period of 4 weeks 1

Common Pitfalls and Caveats

• Avoid complete rest beyond the acute phase as it may prolong symptoms 1, 3
• Recognize that headaches may have multiple contributing factors (vestibular, cervical, visual, psychological) requiring targeted interventions 2, 4
• Be aware that online resources often provide inconsistent and potentially outdated information about concussion management 1
• Understand that evidence supporting these interventions ranges from very low to low certainty, but recommendations are consistent across guidelines 1, 2
• Consider that persistent symptoms at 1-2 months may indicate transition to post-concussion syndrome, affecting 15-20% of concussion patients 1