Headaches after a car crash: what to record for your next appointment
Keep a short headache diary and bring clear questions about symptoms and treatment
Imagine a 29 year old line cook whose pickup was struck from behind while he waited at a light after a late shift. Six weeks later, he still gets headaches most days. At his last visit, the nurse practitioner asked how often they came. All he could say was “a lot.”
His next appointment is in two weeks, and this time he wants to walk in with something on paper. You may be in the same spot. Pain is hard to recall, and brain fog makes it harder.
This guide gives you a one page weekly diary, a monthly summary, and questions to bring. The live page on headaches after a car crash covers why they happen. Here the focus is on what to write down and what to ask.
Why a written record helps at the visit
When you sit in the exam room, your clinician has to answer a few questions fast. How often do the headaches come? How bad are they? What do you take, and does it work? A record you kept day by day answers those questions far better than memory can.
The Living Concussion Guidelines are a Canadian guideline for adults with concussion. They ask clinicians to encourage everyone with headaches after a head injury to keep a careful diary of headaches and medicines [3]. You then take it along to each follow up visit [3]. The guideline says a diary can help in five ways [3]:
- It shows how often headaches happen, how long they last and how strong they are.
- It shows which medicines you take for them, how often, and how much.
- It can point to things that set off a headache.
- It helps guide treatment choices and shows whether a treatment is working.
- It helps your clinician spot medication overuse headache.
The patient version of the same guideline says a diary or a simple calendar both work [1]. It suggests noting your symptoms, when you took medicine, and the activities that bring on or ease a headache [1].
Your record also helps your clinician sort out which kind of headache yours looks like most. The guideline asks clinicians to take a full headache history for exactly that reason [3]. A U.S. military and veterans guideline says each symptom is treated with the usual care for that condition, so naming the type matters [9].
What the terms on your chart may mean
You may see “posttraumatic headache” in your visit notes. It simply means a headache caused by an injury. The International Classification of Headache Disorders (ICHD-3) is the system clinicians use to name headaches. It ties this label to timing [10].
Under ICHD-3, the headache should start within 7 days of the head injury, or within 7 days of waking up if you were knocked out [10]. It is called persistent once it has lasted more than 3 months [10]. The classification itself calls the 7 day cutoff “somewhat arbitrary,” and it offers criteria for headaches that start later [10]. That is why the date of your first headache belongs at the top of your diary.
Whiplash has its own category
You do not need to hit your head to get a crash headache. ICHD-3 lists a separate headache caused by whiplash [6]. Whiplash means a sudden jolt that snaps the head forward and back without enough support. It can follow a low impact crash as well as a high impact one [6]. The same 7 day and 3 month time frames apply [6].
How common lasting headaches are
A U.S. veterans and military guideline says 25% to 78% of people get headaches after a mild brain injury [9]. A large U.S. study called TRACK TBI followed adults who went to an emergency department within a day of a mild brain injury and needed a head scan [2]. Of 1,594 who answered at two weeks, 60% had headaches [2]. Among the people with early headaches who were followed up, about half still had them at 3 months, 38% at 6 months and 29% at one year [2]. Women, people with fewer years of school and people with a past history of migraine were more likely to have lasting headaches [2]. The study summary does not say how people were hurt, so the group may include falls and other injuries as well as crashes.
A European study called CENTER TBI asked 2,291 hospital patients with brain injuries of all levels about headaches [11]. About 59% had them at the start [11]. Headaches usually eased over the first 3 months and then held steady, and more than a quarter still had them at one year [11]. Neck pain, fatigue and vision problems were among the factors linked to more severe headaches over time [11].
Your own diary shows you and your care team whether your headaches are slowly easing or holding steady.
Set up a short daily headache diary
Keep it simple enough that you will really use it. Fill it in once a day, at the same time, such as right before bed. Mark headache free days too. Headache days are counted per month when clinicians judge medication overuse, so a day with no headache is worth a check mark [4].
Rate pain from 0 to 10. Zero means no pain. Ten means the worst pain you can imagine. Use the same scale every day so your numbers can be compared week to week.
Print one copy of the table below for each week. The first row shows how the line cook filled it in.
Worksheet from Safety Behind the Wheel Foundation
Weekly headache diary
| Day and start time | Pain 0 to 10, where, how long | Medicine, how much, time taken | What was going on, and what you had to stop |
|---|---|---|---|
| Tue, 2 p.m. (example) | 6, both temples, 3 hours | Pain reliever, 1 dose, 2:30 p.m. | Hot kitchen, skipped lunch; left shift early |
| Mon | |||
| Tue | |||
| Wed | |||
| Thu | |||
| Fri | |||
| Sat | |||
| Sun |
The columns are built from the diary goals listed in the Canadian guideline [3] and its patient pages [1]. Write the date of your first headache after the crash at the top of the first page.
Add one line about your day
The Canadian guideline lists daily habits that may lower how often headaches happen [3]. Those habits make good diary notes. At the bottom of each day, jot down:
- The time you went to bed and got up.
- Any meals you skipped or ate late.
- About how much water you drank.
- Any light exercise, such as a walk.
- Stress, long screen time, or a neck that felt stiff or sore.
You do not need every detail. The American Migraine Foundation, a U.S. patient group, says there is no wrong way to keep a headache journal [12]. It suggests asking your clinician which details matter most so you skip extra work [12]. Paper, a phone app or a spreadsheet are all fine [12].
If writing feels like too much, a family member can read the columns aloud while you answer. A daily phone alarm can remind you to fill it in.
Describe what the headache feels like
Clinicians often sort headaches after a concussion into types. The Canadian guideline says most look like migraine or tension type headaches [3]. Its list also includes neck related headaches, pain from irritated nerves along the back of the skull, and headaches from medicine overuse [3]. You can have more than one type at once.
You do not need to name your type. Your job is to describe it in plain words. The table below shows patterns your clinician may ask about.
Comparison compiled by Safety Behind the Wheel Foundation
Headache patterns and what to write down
| Pattern | How it often feels | Notes that help |
|---|---|---|
| Migraine like | Throbbing, often on one side; may bring nausea or bother from light and sound | Which side; nausea; light or noise trouble |
| Tension type like | Tight or squeezing, around the head or on both sides; often milder, later in the day | Time of day; stress; screen time |
| Neck related | Starts in the neck, shoulders or back of the head; may spread over the top; neck motion can worsen it | Which neck movements set it off |
| Medicine overuse | Frequent headaches in someone who often takes pain relievers | Days each week you take any pain reliever |
Sources: TBI Model Systems factsheet [7]; Living Concussion Guidelines [3]; ICHD-3 [4]. Only a clinician can decide your headache type.
Words that help
Try to note how the pain feels: throbbing, pressing, stabbing or dull. Say where it starts and where it spreads. List what makes it worse, such as bending over, bright light, noise, screens or exercise. List what helps, such as lying down in a quiet room or a short walk.
Pay attention to your neck
Neck pain is common after a crash. The Canadian guideline asks clinicians to check the neck and to treat neck pain as a possible headache trigger [3]. In the CENTER TBI study, neck pain was one of the factors linked to worse headaches over the first year [11]. If turning your head or sitting at a desk brings on a headache, write that down. The live page on neck pain and whiplash after a car crash has more on neck care.
Count your pain reliever days
Sometimes the very medicines you take for headaches start to cause them. A TBI Model Systems factsheet notes this risk [7]. The problem is called medication overuse headache, sometimes called rebound headache.
ICHD-3 describes it as headache on 15 or more days a month in someone who already has a headache problem [4]. The person has also been using headache medicine too often for more than 3 months [4]. Both the head injury and whiplash sections say to consider it once headaches become persistent [10, 6]. Store bought medicines count too [5].
In a 2018 article, the American Migraine Foundation calls the need for headache medicine on more than two or three days a week “the first red flag” [5]. The Canadian guideline sets limits that differ by type of medicine and are counted in days per month [3]. Ask your prescriber which limits apply to you.
Most people with this problem improve once the overuse stops [4]. Cutting back should happen with your clinician’s guidance [5]. Never stop, skip or change a medicine on your own. Getting better may take a while [5].
At the end of each week, copy a few numbers from your diary into this summary. It gives your clinician the big picture in seconds.
Worksheet from Safety Behind the Wheel Foundation
Monthly headache summary
| Week | Headache days | Days with any pain reliever | Days headaches cut work or plans |
|---|---|---|---|
| Week 1 | |||
| Week 2 | |||
| Week 3 | |||
| Week 4 | |||
| Month total |
Headache days and medicine days per month are the counts ICHD-3 uses for medication overuse headache [4]. Count a day once even if you took medicine more than once.
Show how headaches change your day
Pain scores are one part of the visit. The Canadian guideline also asks clinicians to judge how much headaches limit your life, and that judgment helps shape the treatment plan [3]. It also asks them to look at personal, work, school and physical factors, such as neck pain, that may add to headaches [3].
Concrete numbers about daily life tell your clinician more than general words. Compare these two ways of saying the same thing:
- Vague: My headaches are pretty bad.
- Clear: This month I left work early 5 times and missed both of my daughter’s games.
Before and now
Write a few short lines that compare life before the crash with life now. Keep them concrete:
- Work: I used to work 10 hour shifts. Now my head pounds after about 4 hours in a hot kitchen.
- Screens: After about 15 minutes on my phone, pain starts behind my eyes.
- Driving: I avoid driving after 3 p.m. because my headaches build through the day.
- Sleep: Headaches wake me up about twice a week.
- Family: I skip noisy family dinners.
Also list what you have tried and what happened. For example, you might write that lying down in a dark room helps within an hour, and a walk outside helps a little.
Before your appointment
Checklist from Safety Behind the Wheel Foundation
- Bring your weekly diary pages and your monthly summary.
- Write the date of your first headache after the crash.
- List every medicine and supplement you take, including store bought pain relievers, and how many days a week you use each one.
- Note any neck pain, stiffness or movements that set off a headache.
- Write your before and now lines about work, home, screens and driving.
- Circle any new or unusual headache symptoms to raise first.
- Pick your top three questions in case time runs short.
- Ask someone to come with you to take notes, if that helps.
When a headache needs help now
Call 911 right away, or ask someone to get you to the nearest emergency room, if you notice [8]:
- Head pain that builds and builds and never eases off.
- Weakness, numbness, loss of coordination, convulsions or a seizure.
- Throwing up over and over.
- Speech that is slurred, or behavior that seems strange.
- Pupils of different sizes, with one larger than the other.
- Trouble knowing familiar people or places, or new confusion, restlessness or agitation.
- Passing out, heavy drowsiness, or nobody can wake you.
Also get care right away for a sudden, severe headache that peaks within seconds, or any sudden, drastic change in your headaches [13].
Call your care team soon if your usual headache pattern changes a lot [13]. Do the same if a headache shifts sharply when you stand up or lie down, or comes with fever [13]. A U.S. military and veterans guideline suggests that new symptoms appearing more than 30 days after a mild brain injury be checked for other causes [9].
Questions to ask your care team
Bring these questions, grouped so you can find them fast. Cross off any your clinician answers before you ask.
About my symptoms
Question checklist from Safety Behind the Wheel Foundation
- Based on my diary, which type of headache do mine most look like, and could I have more than one?
- Could my neck injury be causing or adding to my headaches?
- Which of my daily habits, such as sleep, meals or screen time, seem to be triggers?
- Which headache changes should make me call you, and which mean I should go to the emergency room?
- If my headaches started more than a week after the crash, how does that change what you look for?
About my treatment
Question checklist from Safety Behind the Wheel Foundation
- Am I at risk of medication overuse headache, and how many days a week can I safely use my current medicine?
- What can I try that does not involve medicine, and how long should I try it before we judge it?
- If my headaches stay frequent or disabling, would a daily preventive treatment make sense for me?
- How will we measure whether treatment is working, and should I keep the diary the same way?
- If things do not improve, should I see a neurologist, a headache clinic or a concussion clinic?
Frequently asked questions
How long should I keep a headache diary?
Start today and keep going until your next visit. The American Migraine Foundation notes that the longer you track, the more useful the record becomes [12]. A full month lets your clinician count headache days per month [4].
Is an app better than paper?
Not necessarily. Pick the method you will stick with [12]. Apps can send reminders, and paper is easy to hand across the desk.
What if my headaches started more than a week after the crash?
They may still be linked to the crash. ICHD-3 itself admits its 7 day window is somewhat arbitrary, and the classification includes criteria for later onset [10]. Tell your clinician the exact start date so they can weigh other causes too [9].
The bottom line
Recommendation from Safety Behind the Wheel Foundation
Headaches after a crash are common, and for many people they ease with time and the right care [2, 11]. Keep a short daily diary and a monthly count of headache days and medicine days. Add a few lines about daily life. Together they help your care team sort out the type and plan treatment [3].
Watch the number of days you use pain relievers, and talk with your clinician before making any change [5]. Know the emergency signs. Keep copies of your diary for your own records, and bring your grouped questions so you leave the visit with a clear next step.
Sources and further reading
- 1Living Concussion Guidelines. Post-traumatic headache (patient version). Updated July 2025. concussionsontario.org/…/post-traumatic_headache
- 2Ashina H, Dodick DW, Barber J, et al. Prevalence of and risk factors for post-traumatic headache in civilian patients after mild traumatic brain injury: a TRACK-TBI study. Mayo Clinic Proceedings. 2023;98(10):1515-1526. doi.org/10.1016/j.mayocp.2023.02.026
- 3Living Concussion Guidelines. Section 6: Post-traumatic headache. Updated August 2022. concussionsontario.org/…/post-traumatic-headache
- 4International Headache Society. International Classification of Headache Disorders, 3rd edition (ICHD-3). 8.2 Medication-overuse headache (MOH). ichd-3.org/…/8-2-medication-overuse-headache-moh
- 5American Migraine Foundation. Medication overuse headache. January 15, 2018. americanmigrainefoundation.org/…/medication-overuse-headache-3
- 6International Headache Society. ICHD-3. 5.4 Persistent headache attributed to whiplash. ichd-3.org/…/5-4-persistent-headache-attributed-to-whiplash
- 7Bell KR, Hoffman J, Watanabe T. Headaches after traumatic brain injury. Model Systems Knowledge Translation Center. 2021. msktc.org/…/headaches-after-traumatic-brain-injury
- 8Centers for Disease Control and Prevention. Symptoms of mild TBI and concussion. Updated September 15, 2025. cdc.gov/…/signs-symptoms/index.html
- 9Department of Veterans Affairs and Department of Defense. VA/DoD Clinical Practice Guideline for the Management and Rehabilitation of Post-Acute Mild Traumatic Brain Injury, version 3.0. Provider summary. June 2021. healthquality.va.gov/…/VADoDmTBICPGProviderSummaryFinal508.pdf
- 10International Headache Society. ICHD-3. 5.2 Persistent headache attributed to traumatic injury to the head. ichd-3.org/…/5-2-persistent-headache-attributed-to-traumatic-injury-to-the-head
- 11Howe EI, Andelic N, Brunborg C, Zeldovich M, et al. Frequency and predictors of headache in the first 12 months after traumatic brain injury: results from CENTER-TBI. The Journal of Headache and Pain. 2024;25(1):44. doi.org/10.1186/s10194-024-01751-0
- 12American Migraine Foundation. Headache journals: tracking your migraine. April 8, 2025. americanmigrainefoundation.org/…/headache-journals
- 13American Migraine Foundation. Changes in headache: when to see your doctor. Patient handout. 2024. americanmigrainefoundation.org/…/2203_AMF_ChangesInHeadache_WhenToSeeDoctor_V4_Digital.pdf
This article reflects the safety priorities of headache care and crash recovery education. It offers general information, not medical advice, and it cannot tell you what kind of headache you have. Check official guidance and talk with your own care team before you start, stop or change any medicine. Reviewed October 2026.
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