Headache after concussion (post-traumatic headache)

Headache is one of the most common symptoms after a concussion. For most people it gradually fades in the weeks following the injury, but for some it continues for months or longer. When the headache lasts more than three months, it is called persistent post-traumatic headache, also known as post-concussion headache (PCH).

The headache can feel very different from person to person. For some it resembles migraine, with throbbing or pulsating pain, nausea and sensitivity to light and sound. For others it is closer to tension-type headache, with a pressing or tightening pain. Some have a headache almost every day, while for others it comes and goes.

The headache often appears alongside other symptoms after the concussion, such as:

• fatigue and reduced energy
• difficulty concentrating or mental fatigue
• dizziness
• sensitivity to light and sound
• sleep problems
• memory problems
• reduced tolerance for physical or mental activity

This can make even ordinary activities difficult, such as working, using screens, exercising or spending time with others.

It is important to understand that a persistent headache after a concussion does not necessarily mean that the brain is still “injured”. Research suggests that changes may have occurred in the brain networks that process and regulate pain. These are precisely the networks that rTMS aims to influence.

rTMS is a treatment in which short magnetic pulses are used to stimulate specific areas of the brain. The treatment is delivered from the outside, through the scalp, and requires neither surgery, anaesthesia nor medication.

For persistent headache after concussion, the stimulation can be directed at brain areas involved in how the body regulates pain. Several studies have stimulated the motor cortex (M1), which connects to other parts of the brain that help dampen pain signals. Other studies have stimulated the prefrontal cortex, which is involved in pain processing, attention and emotional regulation.

You can think of the treatment as an attempt to influence the brain’s own volume control for pain. When the stimulation is repeated across several sessions, activity in these brain networks can change. The aim is not to treat the original concussion, but to reduce the persistent headache and the effect it has on everyday life.

The treatment itself takes place while you sit awake in a treatment chair. A magnetic coil is placed against the head, and during stimulation you typically feel a tapping or tingling sensation against the scalp.

A course of treatment usually consists of 10 sessions. The exact placement of the stimulation and the structure of the course are assessed individually.

The aim of the treatment is to reduce the headache and make it less dominant in everyday life. For some this means fewer days with headache, for others that the headache becomes milder or shorter. Improvement may also show itself in better concentration, being more active, and finding it easier to return to work, exercise or social activities.

The effect does not necessarily appear overnight. Some notice a difference during the course of treatment, while others experience a gradual improvement only after the final sessions.

A recent study from 2026 found that people with persistent headache after concussion experienced less burdensome headache and better everyday functioning after a course of rTMS. The improvements were still present in the months following treatment.

How much each person benefits from rTMS does vary. Some experience a clear improvement, while others see a more modest effect. The treatment is therefore always assessed on the basis of the individual’s symptoms, how long the headache has lasted, and which treatments have already been tried.

For people who have had persistent symptoms over a longer period, rTMS can be a way to influence the brain networks that help maintain and regulate pain.

Treatment of headache after concussion depends in part on the type of headache. Because the headache often resembles migraine or tension-type headache, many of the same treatments are used, such as pain-relieving or preventive medication.

Other parts of treatment may include physiotherapy, graded physical activity, treatment of neck problems, sleep regulation, and support for gradually resuming work and daily activities. Treatment should therefore be tailored to the individual and to the symptoms that matter most.

rTMS differs from these treatments by acting directly on activity in the brain areas and networks involved in pain processing. It may therefore be relevant as a supplement for people whose headache persists despite other treatment.

Before a course of treatment, we assess whether the symptoms are consistent with persistent headache after concussion, and whether there are any factors that make rTMS unsuitable.