Concussion Headaches During Exercise: Symptoms Explained

Why Exercise May Feel Different After a Concussion-Related Headache

By Dr. Alex Jimenez, DC, APRN, FNP-BC, CFMP, IFMCP, ATN, CCST

An athlete who has trained for years usually knows the difference between a demanding workout and a bad workout. Heavy legs after intervals, muscle soreness after lifting, and shortness of breath during conditioning may all be familiar signs of physical effort.

Then a concussion changes the experience.

A runner who previously handled several miles without difficulty may suddenly develop a headache after ten minutes. A soccer player may feel dizzy during footwork drills. A weightlifter may notice head pressure, fatigue, difficulty concentrating, or nausea as training intensity increases.

The natural athletic instinct is to push through it.

After a concussion-related headache, however, that approach may not be appropriate.

Headache, dizziness, unusual fatigue, visual symptoms, difficulty concentrating, and exercise intolerance can indicate that the athlete has not yet regained the ability to tolerate normal physical and neurological demands. Modern concussion management therefore focuses less on simply asking, “Does the athlete feel okay while sitting still?” and more on determining how the athlete responds when physical, visual, balance, and cognitive demands gradually increase.

Current international concussion guidelines support a progressive, symptom-guided return to activity rather than prolonged complete rest (Patricios et al., 2023).

Why Can Exercise Trigger a Headache After a Concussion?

A concussion is a mild traumatic brain injury caused by a blow to the head or by forces transmitted to the brain when the body rapidly accelerates, decelerates, rotates, or changes direction.

The athlete does not necessarily have to lose consciousness.

Following a concussion, headaches are among the most common symptoms. The Traumatic Brain Injury Center of Excellence notes that post-traumatic headache may develop after mild traumatic brain injury and may resemble migraine, tension-type headache, or headache associated with cervical involvement (TBICoE, 2024).

That distinction matters because a headache during exercise does not automatically mean that one single structure is responsible.

An athlete may be experiencing overlapping problems involving the brain’s recovery from concussion, the cervical spine, balance and vestibular systems, visual processing, migraine pathways, sleep disruption, or physical deconditioning.

For example, an athlete who suffered both a concussion and neck trauma may experience headaches when running because the exercise increases cardiovascular demand while repetitive movement also places additional demand on injured cervical muscles and joints.

Someone else may feel relatively comfortable on a stationary bicycle but become dizzy during drills that require rapid head turning and visual tracking.

The symptom pattern helps guide the assessment.

Dr. Jimenez discusses many of these overlapping symptoms in his resource on Concussions & Post-Concussion Syndrome. Concussions & Post-Concussion Syndrome

Exercise Intolerance Is Different From Being Out of Shape

Exercise intolerance following concussion refers to the return or worsening of concussion-associated symptoms during physical activity.

Research has examined whether altered cardiovascular regulation or autonomic nervous system changes may contribute to this phenomenon. However, researchers are still investigating the exact mechanisms, and symptoms alone should not automatically be interpreted as proof of autonomic dysfunction (Pelo et al., 2023).

This is another reason assessment matters.

For the athlete, the difference can feel dramatic.

Before the injury, an elevated heart rate during training may have produced nothing more than expected exertion. After the injury, increasing intensity may bring headache, dizziness, brain fog, nausea, unusual exhaustion, visual discomfort, or difficulty maintaining coordination.

Possible warning signs during training include:

• Headache or increasing pressure in the head
• Dizziness or a feeling of disequilibrium
• Nausea
• Abnormal fatigue
• Blurred vision or difficulty tracking movement
• Sensitivity to light or noise
• Brain fog or slowed concentration
• Poor balance
• Increased neck pain
• Symptoms that progressively increase as exercise intensity rises

These symptoms deserve a different response than ordinary muscle fatigue.

Why “Pushing Through” Can Be the Wrong Athletic Strategy

Athletes are often trained to tolerate discomfort.

That mindset can be extremely useful when the discomfort comes from appropriate physical conditioning. It becomes less useful when symptoms represent an incompletely recovered neurological or musculoskeletal injury.

The goal following concussion is not necessarily to avoid all symptoms forever. Modern guidelines actually discourage prolonged strict rest.

Instead, clinicians generally recommend a short period of relative rest followed by gradually increasing physical activity that remains within an appropriate symptom threshold.

The Amsterdam International Consensus Statement recommends relative, rather than strict, rest during approximately the first 24 to 48 hours after a sport-related concussion. Light activity such as walking may then be introduced as tolerated while activities involving risk of another head impact, collision, or fall are avoided (Patricios et al., 2023).

That represents an important change from older concussion management approaches.

The athlete is not being told to “do nothing.”

The athlete is being taught to load the recovering system strategically.

Exercise Can Become Part of Rehabilitation

When medically appropriate, carefully prescribed aerobic exercise may actually become part of concussion rehabilitation.

Subsymptom-threshold exercise means identifying an exercise intensity below the level that produces a significant or prolonged worsening of symptoms. Exercise can then be gradually progressed while monitoring the athlete’s response.

International guidelines report benefits of supervised aerobic activity during concussion recovery and recommend progressively increasing exercise based on symptoms and clinical findings (Patricios et al., 2023).

The CDC similarly uses a graduated return-to-play process. Each stage generally requires at least 24 hours, and an athlete should not progress when new symptoms appear. Recurrence of symptoms suggests that the current workload may be too demanding and should prompt reassessment of the progression (CDC, 2025).

Dr. Jimenez’s Rehabilitation Exercises After Head Injuries: Step-by-Step Plan also discusses adjusting exercise when headache or dizziness increases during rehabilitation. Rehabilitation Exercises After Head Injuries

The Athlete May Feel Fine at Rest but Not Be Ready for Competition

This is one of the most important lessons in sports concussion rehabilitation.

Feeling normal while sitting in a clinic is not the same as being ready for unrestricted athletic performance.

Competition may demand sprinting, jumping, acceleration, deceleration, rapid eye movements, quick head rotation, balance, decision-making, reaction time, communication, and contact with other athletes—all occurring at once.

The Amsterdam consensus therefore distinguishes symptom resolution at rest from complete symptom resolution during and after maximal physical and cognitive exertion (Patricios et al., 2023).

Consider a basketball player who reports no headache while sitting at home.

Walking may feel normal.

Light stationary cycling may also feel normal.

But when shuttle runs are introduced, a mild headache appears. During ball-handling drills involving rapid visual scanning, dizziness develops.

That athlete has learned something important.

The brain and body may tolerate one level of activity but not yet handle the demands of competition.

That information is useful. It helps the rehabilitation team determine what needs further evaluation and training.

Headache, Dizziness, and the Neck Can Overlap

Not every post-concussion headache originates from the same mechanism.

The Department of Defense’s 2024 clinical recommendation recognizes migraine-like, tension-type, and cervicogenic presentations after mild traumatic brain injury. Cervical examination may identify restricted motion, tenderness, or muscular involvement in some patients (TBICoE, 2024).

International concussion guidelines also recommend cervicovestibular rehabilitation when symptoms such as headache, neck pain, dizziness, or balance problems persist (Patricios et al., 2023).

This is where an integrated sports rehabilitation approach can become particularly valuable.

A medical assessment can evaluate the neurological injury and identify indications for additional testing or specialist referral. Rehabilitation assessment can examine exercise tolerance, balance, cervical mobility, coordination, movement control, and functional performance.

When appropriate, chiropractic and musculoskeletal rehabilitation may address cervical or biomechanical contributors to symptoms. Chiropractic treatment should not be presented as “treating the concussion itself”; rather, it may be incorporated when examination identifies musculoskeletal problems occurring alongside the concussion.

Dr. Jimenez explores this relationship further in Sports Head Injuries: Chiropractic’s Role. Sports Head Injuries: Chiropractic’s Role

Why Medical and Rehabilitation Assessment Matters

Persistent headache during exercise should not automatically be blamed on poor conditioning.

Clinicians may need to consider concussion recovery, post-traumatic headache phenotype, cervical injury, vestibular dysfunction, visual or oculomotor problems, sleep disturbance, medication effects, migraine history, previous concussions, physical deconditioning, and other medical conditions.

The evaluation becomes even more important when symptoms are not steadily improving.

CDC guidance recommends contacting a healthcare provider when symptoms fail to resolve or worsen after returning to regular activity.

Medical evaluation is also essential when an athlete develops emergency warning signs such as a rapidly worsening headache, repeated vomiting, seizures, increasing confusion, unusual behavior, weakness or numbness, significant deterioration in consciousness, or difficulty speaking or walking.

Athletes should not attempt to “train through” those symptoms.

A Multidisciplinary Approach in El Paso

• Dr. Jimenez’s Injury Medical Chiropractic and Functional Medicine Clinic in El Paso uses a multidisciplinary model designed to evaluate injuries from several clinical perspectives.
• Dr. Maria Guadalupe Cardenas, MD, a board-certified internal medicine physician, serves as medical director, clinical director, and collaborative physician.
• Dr. Jimenez practices as both a Doctor of Chiropractic and board-certified Family Nurse Practitioner, allowing the clinic to integrate medical assessment with musculoskeletal and rehabilitation evaluation. The clinical team also includes nurse-practitioner-level assessments focused on soft-tissue and injury-related conditions.

The clinic describes this integrated structure as one of the relatively few multidisciplinary injury-care models in El Paso that provide these combined services. The clinic’s published provider information lists Dr. Cardenas as medical director and collaborative physician.

For an athlete recovering from concussion-associated headaches, that coordination can help connect medical evaluation, neurological screening, cervical assessment, movement rehabilitation, exercise progression, and referral when specialty neurological, vestibular, visual, or other care is needed.

Athletes can also review Dr. Jimenez’s Chiropractic Athlete Rehabilitation Care for Sports Injuries for more information about integrated sports injury recovery. Chiropractic Athlete Rehabilitation Care for Sports Injuries

Recovery Is Training—Just With Different Rules

For competitive athletes, rehabilitation can feel frustrating because slowing down seems opposite to everything sports has taught them.

But concussion recovery is not about becoming passive.

It is about learning when and how to increase the load.

A recovering athlete may start with comfortable daily activity, progress to light aerobic work, advance to moderate exercise, introduce more demanding sport-specific movement, and eventually return to non-contact and contact training when medically appropriate.

The progression is individualized.

A symptom flare is not necessarily failure. It can provide useful information about the current threshold.

The athlete’s responsibility changes from “How much discomfort can I tolerate?” to “How much appropriate activity can my recovering nervous and musculoskeletal systems tolerate today?”

That is a much more useful question.

The strongest athlete after a concussion may not be the one who pushes hardest.

It may be the athlete who understands the difference between ordinary training discomfort and an injury-related signal, works closely with the medical and rehabilitation team, and progresses deliberately until both symptoms and athletic function demonstrate readiness for unrestricted sport.

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References

Centers for Disease Control and Prevention. (2025). Managing return to activities. CDC: Managing Return to Activities

Centers for Disease Control and Prevention. (2025). Returning to sports. CDC HEADS UP: Returning to Sports

Centers for Disease Control and Prevention. (2025). What to do after a mild TBI or concussion. CDC: Mild TBI and Concussion Recovery

Patricios, J. S., Schneider, K. J., Dvorak, J., Ahmed, O. H., Blauwet, C., Cantu, R. C., Davis, G. A., Echemendia, R. J., Makdissi, M., McNamee, M., Broglio, S., Emery, C. A., Feddermann-Demont, N., Fuller, G. W., Giza, C. C., Guskiewicz, K. M., Hainline, B., Iverson, G. L., Kutcher, J. S., … Meeuwisse, W. (2023). Consensus statement on concussion in sport: The 6th International Conference on Concussion in Sport–Amsterdam, October 2022. British Journal of Sports Medicine, 57(11), 695–711. Consensus Statement on Concussion in Sport

Pelo, R., et al. (2023). Autonomic dysfunction and exercise intolerance in concussion: A scoping review. Clinical Autonomic Research. PubMed: Autonomic Dysfunction and Exercise Intolerance in Concussion

Traumatic Brain Injury Center of Excellence. (2024). Assessment and management of headache following concussion/mild traumatic brain injury: Guidance for the primary care manager. U.S. Department of Defense.