How Headaches Impact Cognition

We’ve all experienced a headache at some point in our lives. Other than experiencing headaches when we are sick, some people may have a medical condition that causes them to have chronic headaches. Headaches may also result from experiencing a stroke or brain injury as the brain recovers. Headaches can be disruptive: we may not be able to focus, move, or think because we are experiencing intense pain. Headaches may also disrupt cognitive functioning. In this blog post, we discuss the effects of headache on clinical measures of neurocognitive function.

Concussion and Headaches

Sports related concussions are a common cause of headaches in young adults. In fact, 86% of patients with concussions report experiencing a headache as a symptom. Oftentimes, headaches are dismissed and treated with over the counter pain medications. For some individuals with concussion, headaches may be persistent and can cause cognitive, physical, and mental health disruption as these headaches can be debilitating.

Because headaches are a symptom of signal disruption in the brain, it is important to understand how they impact clinical measures. To study this, researchers recruited 247 athletes across different high schools and colleges that played contact sports which consisted of soccer, American football, lacrosse, and basketball. Athletes were assessed to get a baseline understanding of their concussion symptomatology at the beginning of the sports season and again at the end of the season. The athletes were assessed for neurocognitive problems using a simple reaction time task, continuous performance test, math processing test, the Sternberg memory test, and the match to sample test. These tests assessed athletes on reaction time, working memory, mental processing, and concentration. These assessments were done at baseline and at the end of the sports season.

In analyzing the data, researchers found that athletes who had experienced 3+ concussions preseason were more likely to report experiencing a headache during the baseline assessment. The athletes who reported experiencing headaches during the baseline assessment had increased headache severity and frequency than the athletes who did not report experiencing a headache during the baseline assessments. No significant effects were found in examining the effect of headache at baseline on the neuropsychological tests performed. However, the researchers did find that post-traumatic headache did have an interaction with the scores of the different neuropsychological measures, in that athletes who reported more severe headaches performed poorly in comparison to other athletes with milder headaches or no headaches.

What Does This Mean For My Client Who Experiences Headaches?

When working with someone who experiences headaches, it is important to understand the cause. It may be of interest to evaluate your client to see if they may have had a concussion if they have no other existing medical problems that are knowingly contributing to their headache. If your client reports experiencing headaches, you may want to monitor their frequency and intensity of pain as this may be indicative of a need for further evaluation. Cognitively, you may want to spend time with your client working closely on working memory, reasoning, reaction time, attention, executive functioning, and cognitive endurance tasks. Sometimes, clients may experience screen sensitivity if you choose computer based activities. Clients may opt to try screen dimmers, light filters, or special glasses that may make the screen light less bright. Alternatively, therapists may use good cognitive worksheets with their clients to help them practice these cognitive skills.


Headaches can be physically, mentally, and cognitively disruptive for people with and without concussion. Oftentimes, headache is dismissed as a symptom of concussion by healthcare providers and caregivers alike as headaches can be caused from a variety of different ailments and conditions. Clinical providers working with clients who report experiencing frequent headaches may want to have their client assessed for concussion if there is no other known medical cause, as headache is a common symptom of concussion. If your client reports experiencing more frequent and intense headaches overtime, they may want to seek evaluation as this may be related to brain damage causing the neurons in the brain to misfire. Cognitively, clients who experience headaches who have experienced a concussion will need to work on a variety of cognitive skills which include working memory, reasoning, reaction time, attention, executive functioning, and cognitive endurance.

Source: Register-Mihalik, J., Guskiewicz, K. M., Mann, J. D., & Shields, E. W. (2007). The effects of headache on clinical measures of neurocognitive function. Clinical Journal of Sport Medicine, 17(4), 282-288.
Dustin Luchmee

Dustin was HappyNeuron's Product Specialist. With research experience in stroke, Dustin learned how a stroke can change someone's life. He also learned how different kinds of therapists can work together to help a person get better. He is passionate about neuro-rehabilitation and finding the active ingredients for effective therapy.

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