Persistent headache is a common symptom following a minor head injury or concussion, possibly related to simultaneous injury of structures of the cervical spine. This study measured aspects of cervical musculoskeletal function in a group of patients (12) with post-concussional headache (PCH) and in a normal control group. The PCH group was distinguished from the control group by the presence of painful upper cervical segmental joint dysfunction, less endurance in the neck flexor muscles and a higher incidence of moderately tight neck musculature. Active range of cervical motion and postural attitude were not significantly different between groups. As upper cervical joint dysfunction is a feature of cervicogenic causes of headache, the results of this study support the inclusion of a precise physical examination of the cervical region in differential diagnosis of patients suffering persistent headache following concussion.

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The management requires the skills of a multi-disciplinary team of clinicians who have seldom faced the challenge. The team leader must draw together principles of a medical, social, cultural, religious and legal nature in reaching the best outcome. Often the basic question is whether one child should die or both? At times the question is raised whether it is justifiable to sacrifice one life to save the other. In these days of high technology, surgeons can be tempted to go a bridge too far. In reaching this decision there can be numerous hidden conflicts of interest. Increasingly the final decision needs to be made and approved by the courts so as to protect the rights of the twins and to ensure surgical intervention is not an unlawful act.