Headache after a car accident
A headache that starts after a collision and looks exactly like a migraine is still a headache that started after a collision.
Post-traumatic headache is classified by its temporal relationship to the injury rather than by a distinctive phenotype. Most cases resemble migraine or tension-type headache, which is why they are so often reattributed to a primary headache disorder the patient is then said to have always had.
Classified by timing, not by appearance
The defining feature is onset in close temporal relation to the head or neck injury. Lyons and colleagues systematically reviewed the phenotypic patterns of post-traumatic headache and found the presentations largely overlap with primary headache types.
The consequence for a case is direct: a reviewing expert who argues the headache “is just migraine” has described the phenotype, not addressed the classification. The question is when it started and what changed.
The cervical contribution
A substantial share of headache after a collision is cervicogenic — generated by upper cervical structures and referred to the head. That is testable rather than assumable, with occipital or cervical medial branch blocks, and a positive response localizes the source in a way no imaging can.
Where a client had occasional headaches before and frequent disabling ones after, the change in frequency and disability is the evidence, and it is usually documented better in work and pharmacy records than in the chart.
What we will not claim
We will not assert that a pre-existing migraine disorder was transformed by the collision without a documented change in frequency, severity or character. And we will not attribute a headache to the neck without a block that supports it. This practice is not aligned to a side. Its obligation runs to the patient’s health and safety, which is the same reason it is not beholden to any position that would keep it from seeing what is actually there. We do not offer opinions on liability, we do not accept a referral or a review conditioned on reaching a particular conclusion, and we will say plainly when the evidence does not support the claim — whichever party was hoping otherwise.
Common questions
If it looks like migraine, is it migraine?
Phenotype does not determine classification here. Onset in temporal relation to the injury does.
How is a cervical source confirmed?
By diagnostic block of the suspected structure, recorded against timed measurements — see diagnostic nerve blocks.
What if the patient had headaches before?
Then the case is about change in frequency, severity and disability, documented across a date.
Does normal brain imaging matter?
It excludes structural emergencies. It does not address post-traumatic headache, which is a clinical classification.
Related reading
- Traumatic brain injury
- Whiplash and cervical injury
- Diagnostic nerve blocks
- Causation and apportionment
- Central sensitization
Ask whether the neck was ever tested as the source
In headache-after-collision files, it usually has not been.
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Sources
- Lyons HS et al. Evaluating the phenotypic patterns of post-traumatic headache: a systematic review. Military Medicine, 2025. PubMed 39028222
- Marincowitz C et al. A systematic review of clinical outcome trajectories from 3 to 12 months following mild traumatic brain injury. Journal of Neurotrauma, 2026. PubMed 42433081
- Cohen SP et al. Multicenter, randomized, comparative cost-effectiveness study comparing 0, 1, and 2 diagnostic medial branch block treatment paradigms before lumbar facet radiofrequency denervation. Anesthesiology, 2010. PubMed 20613471
- Raja SN et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain, 2020. PubMed 32694387