Head Pressure After a Concussion: Causes and When to Worry

Is It Normal to Feel Pressure in Your Head After a Concussion, and How Long Does It Last?

People describe it to our team as a fullness, a tightness, a head that feels pushed on from the inside. Whether the pressure inside the skull is actually raised hasn't been measured in enough people to say how often. A systematic review found 9 studies worth including out of 1,067 screened, and concluded that there may be increased pressure after a mild traumatic brain injury; in animals the pressure rises for days and then returns to baseline, in step with recovery (Haider, 2018). Brain swelling peaks 36 to 72 hours after a moderate injury and is thought to be uncommon after a mild one (Sabo, 2018).

Our team didn't find a study that follows head pressure over time after a concussion, so there's no honest number for how long it lasts. The pattern decides when to get it checked. In our team's view, pressure that keeps going for weeks or months without easing, pressure that gets worse when you lie flat, or pressure that arrives with a change in your vision or a pulsing sound in your ears is worth a pressure check.

A head injury raising blood pressure is a different question. Blood pressure is the force in your arteries, read on an arm cuff, and head pressure here means the pressure inside the skull. If your heart races or your blood pressure shifts when you stand up after a concussion, that's covered in can a concussion cause POTS.

What Causes the Pressure Feeling? The 3 Routes Our Team Checks

Our team's starting point is that the pressure may have little to do with the concussion itself. A hit to the head, a car accident or a whiplash moves more than the brain: it loads the joint between the skull and the top of the neck, and in our team's view the feeling can come from the relationship between those 2 structures and how well they let fluid leave the head. 3 things fill the skull: brain tissue, spinal fluid and blood. In the classic picture of the skull as a closed box, pressure builds when the tissue swells, or when either fluid can't leave as fast as it arrives.

Route 1 is swelling of the brain itself. In the first hours and days after a significant injury, swollen tissue takes up room inside a box that can't expand, and the hospital's CT or MRI is what finds it, sometimes as a shift of the midline. That's the hospital's job in the first days. Swelling is thought to be uncommon after a mild injury (Sabo, 2018), so for someone weeks out from a concussion with a clear scan, our team looks to the other 2 routes. The intensive-care research on raised pressure describes patients with a severe brain injury, monitored in an ICU.

Route 2 is spinal fluid. Cerebrospinal fluid (CSF) is made inside the brain, circulates around the brain and down around the spinal cord, and is absorbed back into the veins. The research on idiopathic intracranial hypertension describes the problem as a dysregulation of CSF dynamics and venous sinus pressure (Wang, 2022). Our team's working model adds a mechanical piece: when the skull and the first neck vertebrae have shifted, or something at that junction is compressed, the fluid is still being made at the top but can't circulate past the junction the normal way, and pressure builds behind the pinch. That model comes from the exam room, and no study has tested it. One of the first places the exam can see raised pressure is the optic nerve, which travels from the brain to the eye inside a sleeve of CSF: on the eye exam the nerve head looks swollen, and on OCT the nerve fiber layer thickens. Those eye findings show that pressure is up without showing why. How neck problems reach the brain more broadly is covered in neck problems and the brain.

Route 3 is venous blood. Blood that has been through the brain leaves through the venous sinuses and then down the internal jugular veins, 1 on each side of the neck. When the veins can't carry it out fast enough, pressure rises behind them. This route has supportive evidence on the IIH side, from a small uncontrolled series. Of 46 people with suspected IIH, 15 had an isolated narrowing of an internal jugular vein with nothing abnormal inside the skull, and after the vein was stented, headache, tinnitus, papilledema and measured pressure were all significantly better at about 2 weeks (Zhou, 2018). A case report describes a 12-year-old whose intracranial pressure rose when he turned his neck, because the jugular vein was pinched between the first vertebra and the styloid process, a bony spike below the ear (Mooney, 2020), and a hypothesis paper argues that the jugulars are prone to compression along their whole course in the neck, including at C1 (Fargen, 2026). How neck position squeezes the jugulars is also covered in ear fullness and popping. That a whiplash or a head injury is what pinches the veins is our team's view, and no study has tested it.

Draining CSF narrowed Vein narrowed Swelling

Replay

Brain tissue sits inside a skull that can't expand. Spinal fluid is made in the ventricles and circulates down through the opening at the base of the skull into the canal that runs through the neck vertebrae, and the skull-neck junction is where that channel passes between bone and bone. Venous blood leaves through the internal jugular veins, which run down the front of the neck on each side. In our team's model, narrowing either fluid route slows the flow above the pinch, the pressure in the skull rises, and the optic nerve head, which sits in the same fluid, is one of the first places the exam can see a change.

When Could It Be Raised Pressure Inside the Skull? The Signs That Need a Physician This Week

3 signs are reported in raised pressure, and our team treats each as a reason to get checked. The first is pressure or headache that gets worse lying flat: in the headache of IIH, pain that worsens in the recumbent position and frequent waking late in the night with a severe headache are described as the specific complaints (De Simone, 2020). The second is pulsatile tinnitus, a whoosh in 1 or both ears in time with your heartbeat, which sits alongside headache and vision loss among the primary symptoms of IIH (Markey, 2016; Wang, 2022). If fullness or popping in your ears is the main complaint, ear fullness and popping covers that. The third is any change in vision: the IIH guideline lists brief episodes of dimmed vision, blurred vision and double vision (Mollan, 2018). If your pressure runs the other way, worse when you're upright and eased lying flat, that pattern points to low pressure and is covered in headache when standing up.

Our team's explanation for the lying-flat sign comes from the venous route: lying down lets blood flow into the head more easily, and if the jugular veins are narrowed it can't leave as fast, so the pressure and the whoosh both get louder. That's the clinic's explanation, and the sign itself is what matters.

A pseudotumor-like picture after a mild head injury does exist in the literature. A case series described 6 children seen 48 to 120 hours after a mild traumatic brain injury with new or changed symptoms in headache, vision, hearing, balance and thinking; the findings included papilledema, and lumbar puncture documented raised CSF pressure with no infection (Sabo, 2018). That series is 6 children, and it shows the picture can follow a mild injury without saying anything about how often it does.

If you have any of those 3 signs, our team's advice is an exam of the back of the eye that week through a physician, with imaging if the physician orders it. Intracranial hypertension and POTS covers when vision changes need urgent care. 1 line applies to every head injury: pressure that's getting worse together with confusion, repeated vomiting or new loss of vision is an emergency, and the place for it is an emergency department.

How Is Raised Pressure Checked? Fundus, OCT, Imaging, Then the Needle

The confirming test is a lumbar puncture: a needle into the spinal canal in the lower back, with the pressure of the fluid measured as it comes out. The diagnostic criteria (Friedman, 2013) and the opening-pressure cut-off are on intracranial hypertension and POTS. The reason the needle comes last is the leak. After a dural puncture some people develop a postdural puncture headache, may be bedridden for several days, and may need an epidural blood patch to seal the hole (Schyns-van den Berg, 2023). Our team's order starts at the other end, with the 2 checks that need no needle.

The fundus exam looks at the optic nerve head, the disc, through the pupil. A healthy disc is a well-circumscribed circle with sharp edges. The nerve travels from the brain to the eye inside a sleeve of CSF, so when the pressure in that fluid is too high it squeezes the nerve, the disc goes from flat to bulging, and its borders blur. That's papilledema, and it's graded by how far it has gone; the jugular stenting series scored it on the Frisen scale (Zhou, 2018). When the disc and OCT are normal, raised pressure becomes less likely, though the criteria allow for raised pressure without papilledema (Friedman, 2013).

Optical coherence tomography (OCT) scans the retina with light, with no radiation and no needle. It produces slices of the retina and the disc fine enough to measure whether the nerve fiber layer is thickened or thinned. In 21 people with IIH compared with 27 controls, optic nerve head volume on OCT was increased and correlated with CSF pressure, and the swelling went with a loss of nerve fiber volume around the macula, which the authors put down to the nerve being jammed at the disc (Albrecht, 2017). Ultrasound of the optic nerve sheath through the closed eyelid is another check without a needle, and it has become a point-of-care tool in IIH (Stolz, 2022).

Imaging has 1 job first: to exclude other causes of raised pressure, such as a clot in the brain's veins or a mass. It can also show the marks of long-standing pressure: an empty sella, flattening of the back of the eyeballs, a protruding optic nerve head, distended optic nerve sheaths and narrowing of the transverse venous sinuses (Bidot, 2015). None of those alone confirms raised pressure, which is why the opening pressure still sits at the end of the ladder.

The checking ladder, in our team's order

Step	What it shows	Spinal needle?	Source
1. Fundus exam	The optic disc. Under too much CSF pressure it bulges and its borders blur: papilledema, graded by degree.	No	Zhou 2018 (Frisen grade)
2. OCT	Slices of the retina and disc. In IIH, optic nerve head volume rises with CSF pressure, and swollen fibers can later thin.	No	Albrecht 2017, 21 IIH vs 27 controls
3. Imaging	Rules out other causes. Can show long-standing signs: empty sella, flattened globes, distended nerve sheaths, narrowed venous sinuses.	No (a venogram may use IV contrast)	Bidot 2015
4. Lumbar puncture	Opening pressure, the confirming measurement. Risk of a CSF leak headache, days in bed, sometimes a blood patch.	Yes	Friedman 2013; Schyns-van den Berg 2023

Healthy disc Papilledema

In the video our team runs the order in reverse, from the needle that confirms the pressure back to the 2 checks that come first.

What Does Our Team Examine, and What Does the Work Look Like?

In the clinic the pressure question runs alongside the rest of the concussion exam. Our team looks at the back of the eye and runs OCT, examines the skull-neck junction, and tests the autonomic and vestibular systems, because a concussion disrupts networks across the brain. None of those findings proves where the pressure comes from on its own, and what happens next depends on what they show.

When the exam points to a narrowed vein, or the eye findings call for an opening pressure, the next step runs through a physician. Stenting of a narrowed jugular vein is reported in the IIH series (Zhou, 2018); it's a physician's decision in a selected patient, and it isn't something our team recommends for or against. What our team does about the rest of post-concussion syndrome, including the rest window, is on post-concussion syndrome treatment.

Head Pressure After a Concussion: FAQ