Concussion symptoms are supposed to fade in 7–10 days. When they don’t — when headaches, brain fog, dizziness, and neck tension linger for weeks or months — the answer may not be in your brain. Growing research shows it’s often in your upper neck.
Why Concussion Symptoms Persist
Roughly 10–15% of concussion patients develop Post-Concussion Syndrome (PCS) — persistent symptoms lasting more than 10 days beyond the initial injury. The frustrating part for both patients and providers: even after brain imaging comes back clean and standard concussion protocols are followed, symptoms remain.
The under-recognized reason: the same force that causes a concussion almost always injures the upper cervical spine at the same time. The mechanism is nearly identical to whiplash — rapid acceleration and deceleration of the head puts significant stress on the atlas (C1) and axis (C2) vertebrae. Even when the brain heals, the cervical component often doesn’t — because it was never treated.
A 2015 review in The Physician and Sportsmedicine called this “another potential, and very treatable, cause of this chronic condition.” A 2017 retrospective study found cervicogenic components in 69.5% of patients with persistent post-concussion symptoms.
Is Your Post-Concussion Presentation Cervical?
Common signs the cervical spine is contributing to your persistent symptoms:
- Symptoms worse with head position changes or sustained neck postures
- Neck pain, stiffness, or tension accompanying the “brain” symptoms
- Headaches at the base of the skull or radiating from the neck
- Dizziness that isn’t purely spinning (more of a feeling of imbalance or disorientation)
- Symptoms persist despite completed vestibular rehab or brain-focused concussion protocols
- The initial injury involved whiplash-type mechanics (car accident, fall, sports collision, contact impact)
- Standard concussion recovery timeline has passed but symptoms haven’t
The NUCCA Approach
NUCCA (National Upper Cervical Chiropractic Association) is a precision technique focused specifically on the alignment of the atlas (C1) and axis (C2) — the exact region that most commonly sustains injury during a concussion mechanism.
Rather than the general spinal manipulation many patients associate with chiropractic care, NUCCA uses precise 3D imaging to measure the exact misalignment before delivering a gentle, low-force correction. There is no twisting, cracking, or high-velocity manipulation — an important distinction for patients who are still symptomatic and sensitive.
Dr. Justin Schallmann has practiced NUCCA in Redmond for over 18 years and is one of approximately 300 NUCCA-credentialed doctors in the United States. This is the specific technique the case series and controlled trials on cervical involvement in PCS describe. Learn more about our NUCCA approach.
Symptoms and Presentations We See
- Persistent headaches after concussion — often at the base of the skull or radiating forward
- Brain fog, difficulty concentrating, and mental fatigue
- Cervicogenic dizziness — a feeling of imbalance rather than true vertigo
- Neck pain, stiffness, or tension that developed alongside the concussion
- Light and sound sensitivity that hasn’t resolved
- Sleep disruption and fatigue disproportionate to activity
- Post-concussion syndrome months or years after the original injury
- Return-to-play or return-to-work delays for athletes and workers
What to Expect
Care at Back In Balance follows a structured three-stage process. This is intentional — post-concussion patients benefit from a clear plan, and rushing straight to correction without proper assessment doesn’t serve you.
First Visit — Consultation & Examination (45–60 minutes)
- In-depth health history and consultation, including your concussion history and prior workups (imaging, neurology, vestibular therapy)
- Comprehensive spinal exam
- X-rays if necessary — precise upper cervical imaging is what allows accurate NUCCA correction
Second Visit — Report of Findings & First Correction (45–60 minutes)
- Report of findings from your first visit — what we identified and how it relates to your persistent symptoms
- Your first upper-cervical (NUCCA) spinal correction — gentle, precise, based on the measurements from your imaging
- Post-adjustment measurements of postural changes to confirm the correction landed
Follow-Up Care (5–20 minutes per visit)
- Measurement of postural alignment or distortion
- Tracking of symptoms and response to care
- Additional upper-cervical (NUCCA) corrections as necessary
- Coaching on how to eliminate habits that weaken alignment
- Advice on nutrition and lifestyle practices that support results (Eat, Move, and Think)
Follow-up visit duration varies with the scope of care needed that day. Cervical involvement in post-concussion syndrome often responds within the first several corrections, though every case is different.
When NUCCA May Not Be the Right Fit
Post-concussion care is complex and multidisciplinary. Upper cervical chiropractic addresses one component — a common and under-recognized one, but not the only one. You should complete or continue medical care first if you have an acute concussion (within the first 7–10 days) not yet cleared by a physician, neurological red flags (worsening headaches, vision changes, seizures, focal weakness, or altered consciousness), suspected structural brain injury or hemorrhage, or any symptom pattern that hasn’t been evaluated by a physician.
Where medical workup has been completed, imaging is unremarkable, and symptoms remain — that’s often where cervical involvement becomes worth investigating. We work alongside your primary care physician, neurologist, or concussion clinic, not in place of them.
What the Research Shows
The evidence for cervical spine involvement in post-concussion syndrome has grown substantially over the past decade. Below are the primary studies relevant to how we practice.
Marshall CM, Vernon H, Leddy JJ, Baldwin BA.
The role of the cervical spine in post-concussion syndrome.
The Physician and Sportsmedicine. 2015;43(3):274–284.
A landmark review that introduced cervical spine dysfunction as a potentially treatable cause of persistent post-concussion symptoms. Includes a case series of five PCS patients with favorable outcomes following cervical spine-focused treatment.
Schneider KJ, Meeuwisse WH, Nettel-Aguirre A, et al.
Cervicovestibular rehabilitation in sport-related concussion: a randomised controlled trial.
British Journal of Sports Medicine. 2014;48(17):1294–1298.
Randomized controlled trial of patients with prolonged post-concussion symptoms comparing combined cervical and vestibular rehabilitation against standard rest-and-graded-exertion protocol. The treatment group showed dramatically faster medical clearance.
Kennedy E, Quinn D, Tumilty S, Chapple CM.
Clinical characteristics and outcomes of treatment of the cervical spine in patients with persistent post-concussion symptoms: a retrospective analysis.
Musculoskeletal Science and Practice. 2017;29:91–98.
Retrospective review of 45 patients with persistent post-concussion symptoms. Found that 69.5% (32 of 45) had a cervicogenic component contributing to their symptoms.
Ellis MJ, Leddy JJ, Willer B.
Physiological, vestibulo-ocular and cervicogenic post-concussion disorders: an evidence-based classification system with directions for treatment.
Brain Injury. 2015;29(2):238–248.
Proposes an evidence-based classification system separating persistent post-concussion symptoms into three treatable categories: physiological, vestibulo-ocular, and cervicogenic — each with different management approaches.
These studies use physical therapy techniques rather than NUCCA specifically. What they establish is that cervical spine involvement in PCS is real, common, and treatable — and that addressing it improves outcomes. NUCCA is one specific approach to cervical treatment, differentiated by its precision-imaging and low-force approach that many post-concussion patients tolerate well.
Frequently Asked Questions
What is post-concussion syndrome?
Post-concussion syndrome (PCS) refers to concussion symptoms that persist beyond the expected 7–10 day recovery window. Approximately 10–15% of concussion patients develop PCS. Common symptoms include headaches, dizziness, brain fog, fatigue, sleep disturbance, light and sound sensitivity, mood changes, and neck pain.
Why do concussion symptoms persist for months or years?
Multiple factors can prolong symptoms, but recent research shows one of the most common — and most treatable — is cervical spine involvement. The mechanism that causes a concussion (rapid acceleration-deceleration) almost always injures the upper neck at the same time. Once the brain heals, unaddressed cervical dysfunction can perpetuate symptoms like headaches, dizziness, and cognitive fog indefinitely.
Can chiropractic care help post-concussion syndrome?
A specific type of chiropractic — upper cervical, specifically NUCCA — has direct relevance to PCS based on published research on cervical spine involvement. General chiropractic adjustments to the low back or mid-back are not designed for this. NUCCA focuses precisely on the atlas and axis vertebrae, which are the exact area most commonly injured during a concussion mechanism.
Is my brain fog and dizziness from my brain or my neck?
Often both, and disentangling them is part of what a good concussion evaluation should do. Signs the cervical spine is a significant contributor: symptoms worsen with head position or sustained neck postures, neck pain accompanies the “brain” symptoms, dizziness feels more like imbalance than true spinning, and symptoms persist despite completed vestibular and brain-focused protocols. The research suggests the cervical contribution is present in the majority of persistent PCS cases.
How is NUCCA different from a concussion clinic’s approach?
Concussion clinics typically focus on brain rehabilitation — cognitive rest, graded exertion, vestibular therapy, oculomotor training. NUCCA addresses the cervical spine component specifically. The two approaches are complementary, not competing. Many post-concussion patients benefit most from a combination: concussion clinic protocols for the brain and cognitive elements, upper cervical care for the neck component driving persistent symptoms.
Should I see a neurologist first?
Yes, for the initial concussion diagnosis and to rule out serious structural injury. NUCCA is not a replacement for neurological evaluation. Where NUCCA fits: after medical workup is complete, imaging is unremarkable, and symptoms remain despite standard concussion protocols. That’s typically when cervical involvement becomes worth investigating.
Can NUCCA help with post-concussion headaches?
Cervicogenic headaches — headaches originating from cervical spine dysfunction — are one of the most common persistent post-concussion complaints. They typically present at the base of the skull, may radiate forward, and often worsen with neck positions. This pattern is a strong indicator that atlas alignment is contributing, and it’s one of the presentations upper cervical care most consistently addresses.
What if my concussion was years ago?
Cervical dysfunction from an old injury doesn’t heal on its own — it often develops compensatory patterns that mask it for years before symptoms emerge or worsen. Patients often present with persistent post-concussion symptoms months or years after the original injury, and cervical treatment can still produce meaningful improvement. The time since injury matters less than the presence of untreated cervical involvement.
How long until I see improvement?
This varies by patient and by how long symptoms have been present. Some patients notice changes after the first correction; others need several visits before the cervical component stabilizes. We reassess alignment and symptom response at every visit and are transparent about progress.
Do I need to have a diagnosed concussion to benefit from care?
Not necessarily. Many patients have symptoms consistent with post-concussion syndrome after an event they didn’t consider serious enough to seek medical attention — a fall, a minor car accident, a sports collision without loss of consciousness. If symptoms match the PCS pattern and imaging has been completed to rule out structural concerns, upper cervical evaluation may still be appropriate.
Located in Redmond, WA. Serving patients across the Eastside — Bellevue, Kirkland, Sammamish, Woodinville, and Bothell.
