Headaches After a Car Accident

Post-crash headaches usually fall into one of two categories:

• Cervicogenic headaches — pain that starts in the upper neck and refers up into the back of the skull, behind the eye, or to one temple. The neck joints and small suboccipital muscles at the base of your skull are the usual culprits.
• Post-concussive headaches — pain after a mild traumatic brain injury, even one without loss of consciousness. These often come with fogginess, light or sound sensitivity, and trouble concentrating.

The two overlap more than people realize. Many patients have both a whiplash injury to the neck and a mild concussion from the same crash, and the headache pattern is a blend.

A few simple clues help separate the two — though only an evaluation can give you a firm answer:

• Triggered by neck movement — turning, looking up, or holding your head still for long stretches reproduces or worsens the pain → suggests cervicogenic
• Triggered by mental effort or screens — concentrating, scrolling, or driving in heavy traffic brings on the headache → suggests post-concussive
• One-sided, base-of-skull origin → typically cervicogenic
• Generalized, "pressure" or "fog" quality with light sensitivity → typically post-concussive

If you ever lost consciousness — even briefly — or have memory gaps from around the time of the crash, treat the headache as post-concussive until a clinician tells you otherwise.

Most post-crash headaches are uncomfortable, not dangerous. The following symptoms, however, warrant immediate medical evaluation:

• The "worst headache of your life," sudden and severe
• Repeated vomiting
• Vision changes, double vision, or new difficulty focusing
• Slurred speech, weakness on one side of the body, or facial drooping
• Seizure, confusion, or unusual sleepiness that you cannot shake
• Clear fluid draining from the nose or ear

For cervicogenic headaches, physical therapy is the first-line treatment in most clinical guidelines. The plan usually includes:

• Hands-on mobilization of the upper cervical joints (C0–C2), which are the source of most referred head pain
• Suboccipital soft-tissue release — those small muscles at the base of the skull that knot up after whiplash
• Deep neck flexor retraining to take load off the irritated upper joints
• Postural and ergonomic adjustments for your phone, computer, and pillow

For post-concussive headaches, the approach is gentler and more graded. A PT trained in concussion care helps with vestibular and balance work, sub-symptom-threshold aerobic activity, and a controlled return to screens, driving, and exercise. The two approaches are commonly combined when a patient has both injuries.

Headaches that are managed early — within the first weeks after a crash — usually settle faster and are less likely to become chronic. The longer a daily headache continues, the more the nervous system "learns" the pattern, and the harder it becomes to switch off. Early, targeted PT shortens that window.

As with any other post-crash symptom, Florida's 14-day PIP rule applies. Getting evaluated by a qualified medical provider within two weeks of the crash keeps your full medical benefits available for headache care, imaging if needed, and physical therapy.