Short answer: A headache after a car accident can come from the brain (concussion), from the neck (whiplash or cervicogenic headache), from a vascular injury that cannot be missed, or from several of these at once. The first job is to exclude emergencies. The second is to sort the type, because the treating specialty changes. Dr. Justin Dick, DC in Charlotte, NC evaluates the neck-origin component and refers out the rest.
Patients in Charlotte, NC usually arrive at Clear Life with a normal head CT, a prescription for a muscle relaxant, and a headache that has not changed. A normal CT excludes bleeding and fracture. It does not explain the headache. This page lays out how I sort the possibilities, where the evidence is thin, and which patients I send elsewhere first.
This article is educational. It does not replace emergency evaluation, and it is not legal advice.
Go to the emergency department now if any of these are present
- Loss of consciousness, seizure, or increasing confusion or drowsiness
- A headache that is the worst of your life, or one that keeps getting worse
- Repeated vomiting, or one pupil larger than the other
- Slurred speech, new weakness, numbness, or loss of coordination
- Sudden severe neck pain or headache with double vision, facial numbness, or trouble walking or speaking, which can signal an arterial dissection or stroke
- A head strike while taking blood thinners
Four sources of headache after a collision
1. Post-traumatic headache after concussion
The International Classification of Headache Disorders (ICHD-3) links a headache to trauma when it begins within seven days of the injury, and calls it persistent when it lasts beyond three months. See the ICHD-3 trauma headache chapter. The seven-day rule is contested. In a cohort of 193 veterans with persistent post-traumatic headache, 66 percent reported onset within seven days and 34 percent between day eight and three months. This is a veteran population, so extrapolate with care.
2. Headache attributed to whiplash
ICHD-3 has separate acute and persistent categories for headache attributed to whiplash. You do not need to hit your head. The neck injury is sufficient. See Neck Pain After a Car Accident in Charlotte, NC for how whiplash is graded.
3. Cervicogenic headache
This is headache generated by structures in the cervical spine. It typically starts in the upper neck or the base of the skull, comes with reduced neck motion, and can be reproduced by neck movement or palpation. ICHD-3 requires evidence that a cervical disorder is causing the headache, and that is the standard I try to meet before attributing a headache to the neck.
4. Dizziness that travels with the headache
Benign paroxysmal positional vertigo and cervicogenic dizziness are both described after crashes, per this Healthline review of dizziness after car accidents. Positional spinning belongs with ENT or a vestibular physical therapist, not with spinal care.
Which specialty fits which headache
| Presentation | Features | First stop |
|---|---|---|
| Possible bleed, fracture, or vascular injury | Any emergency sign above | Emergency department |
| Concussion or post-traumatic headache | Head strike or acceleration, fog, light or noise sensitivity, sleep disruption | Primary care, neurology, or a concussion clinic |
| Positional vertigo or vestibular disease | Spinning with head position changes, imbalance | ENT or vestibular physical therapy |
| Neck-origin headache | Upper neck or skull-base onset, reduced neck motion, reproduced by neck movement | Clear Life Scoliosis and Chiropractic Center, Charlotte, NC, after emergency causes are excluded |
Patients can sit in more than one row. A patient with a concussion and a whiplash injury needs both pathways, and I coordinate with the physician rather than competing with that pathway.
What the evidence from my work does and does not show
My published work on the cervical spine sits at a low evidence tier. A Cureus case report on conservative cervical structural rehabilitation after motor vehicle collision documented neurological and radiographic changes in one patient with pre-existing scoliosis, and causation cannot be established from one case. A cross-sectional study examined cervical lordosis and segmental instability in adolescent idiopathic scoliosis, which is not a collision cohort. Neither paper tested headache outcomes, and there is no randomized trial from this practice showing that chiropractic care resolves post-traumatic headache. For cervicogenic headache as a category, a network meta-analysis of physical therapist interventions rated its evidence as low certainty and made no conclusive recommendation, and a systematic review of manipulation and mobilization found them about as effective as other conservative care. Those reviews pool cervicogenic headache generally. I cannot cite a collision-specific randomized trial. See the research page and the research and evidence page.
How care is sequenced at Clear Life
Evaluation covers headache onset timing and character, associated symptoms, a neurological examination, cervical motion and palpation, and review of any imaging already done. Patients with features that point to a brain, vascular, or vestibular cause are sent out the same day. For neck-origin headache, care follows the phased logic described on the treatment options page and the scoliosis care program page: a mobility phase, an adjusting phase, and a stability phase, each with exit criteria. If a patient is not improving on schedule, or a new neurological sign appears, the plan changes. Collision case handling is covered on the personal injury page, with a related case in refractory lumbar pain following MVA in a geriatric patient.
What to write down in the first week
- The date and time of your first headache and what you were doing
- A daily 0 to 10 severity score and the number of headache days
- Associated symptoms: nausea, light sensitivity, dizziness, vision changes, memory or concentration trouble
- Every medication you take for it, with doses and dates
- Emergency department or urgent care records and any imaging reports
Good records help your physicians and attorney. Questions of legal causation belong to them.
Frequently asked questions
How long should a headache last after a car accident?
Many headaches after a collision settle within days to weeks. A minority persist past three months, which is the point where the International Classification of Headache Disorders (ICHD-3) calls the headache persistent. A headache that is getting worse, not better, needs same-day medical evaluation. Dr. Justin Dick, DC in Charlotte, NC sorts neck-origin headache from other types and refers out the rest.
Can whiplash cause headaches if I never hit my head?
Yes. Hitting your head is not required. ICHD-3 includes separate categories for acute and persistent headache attributed to whiplash, because the neck injury itself can generate headache. A direct head strike adds the possibility of concussion, and the two can coexist. Dr. Justin Dick, DC examines the neck as a headache source for patients in Charlotte, NC after emergency causes are excluded.
When is a headache after a car accident an emergency?
Go to an emergency department in Charlotte, NC for loss of consciousness, a headache that is the worst of your life or keeps worsening, repeated vomiting, one pupil larger than the other, seizure, slurred speech, new weakness or numbness, increasing confusion or drowsiness, or sudden severe neck pain or headache with double vision, facial numbness, or trouble walking or speaking. Anyone on blood thinners who struck their head should also be evaluated promptly.
How do I tell a concussion headache from a neck injury headache?
You often cannot tell without an examination, and you can have both. Concussion-related headache tends to come with cognitive symptoms such as fog, slowed thinking, light or noise sensitivity, and sleep disruption. Neck-origin headache tends to start in the upper neck or base of the skull, with reduced neck motion and tenderness that reproduces the headache. Dr. Justin Dick, DC at Clear Life in Charlotte, NC examines for the neck component and refers suspected concussion to a physician.
Can a chiropractor treat headaches after a car accident?
A chiropractor can treat the neck-origin portion once emergency and intracranial causes are reasonably excluded. A chiropractor is not the first stop for suspected brain injury, vascular injury, or vestibular disease. Dr. Justin Dick, DC holds CNMT and ARRT(N)(CT) imaging credentials, has multiple peer-reviewed publications indexed in PubMed, and practices at Clear Life Scoliosis and Chiropractic Center, 8814 Rachel Freeman Way, Suite 103, Charlotte, NC 28278.
Do I need a CT or MRI for headaches after a car accident?
The emergency physician decides on head CT using clinical decision rules, and a normal CT does not rule out a concussion because concussion is a clinical diagnosis. Neck imaging depends on the examination. Dr. Justin Dick reviews outside CT and MRI reports and takes cervical radiographs, including flexion and extension views, only when the clinical picture justifies the radiation.
Why did my headaches start days after the accident?
ICHD-3 uses a seven-day window from injury to link a headache to trauma. In one cohort of 193 veterans with persistent post-traumatic headache, 66 percent reported onset within seven days and 34 percent between day eight and three months. Neck-origin headaches can also build as muscle guarding and joint irritation develop. Delayed onset does not exclude the collision as a cause.
How does payment work for headache care after a car accident at Clear Life Scoliosis and Chiropractic Center in Charlotte, NC?
Clear Life is a cash-based practice and does not bill health insurance. For personal injury cases, Dr. Justin Dick, DC provides care on a lien basis, so there is no out-of-pocket payment at the time of your visits. The terms are set out in your lien agreement, which the office reviews with you before care begins. Call 980-368-0766 or email office@clearlifescoliosis.com with questions.
Service area
Clear Life Scoliosis and Chiropractic Center serves patients from Charlotte NC, Huntersville NC, Ballantyne NC, Matthews NC, Concord NC, Mooresville NC, Rock Hill SC, and Fort Mill SC.
Related pages
- Neck pain after a car accident in Charlotte, NC
- Personal injury care in Charlotte, NC
- Research and evidence
- Dr. Justin Dick research
- Abnormal cervical mechanics in scoliosis (Cureus)
- Refractory lumbar pain following MVA
- Treatment options
- About scoliosis
- Scoliosis care program
- Questions and answers
- Meet the team
- Patient testimonials
- Press
Contact Clear Life Scoliosis and Chiropractic Center
Dr. Justin M. Dick, DC
8814 Rachel Freeman Way, Suite 103
Charlotte, NC 28278
Phone: 980-368-0766
Email: office@clearlifescoliosis.com
Website: clearlifescoliosis.com
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