Headaches in the whiplash syndrome

Abstract

Study design: A prospective clinical analysis of headaches in whiplash injury. Objectives: To provide a detailed clinical account of the nature, characteristics and natural history of headaches, and to examine their possible relation to the neck injury. Setting: One medicolegal practice in UK. Methods: This study consists of a prospective clinical analysis of headache symptoms in consecutive patients referred to the author for medicolegal assessment of whiplash injury, with no special reference to headaches. Results: All 80 patients noted neck pain. Headaches were related as a consequence of the accident by 48 patients (60% of the total). The circumstances of injury did not dier from whiplash victims who did not have prominent headache. The headache onset was maximum in the ®rst 24 h after injury. The failure to recall well documented pre-accident headaches in almost one ®fth of patients is signi®cant. The common types of headaches were non-speci®c, generalised, dull, aching pain (25 patients), a mixtures of aching and tightness, and tension type headache. Only three (6%) had migraine without aura. Conclusion: Post-whiplash headache is a genuine common but short lived aair, constant headaches disappearing within 3 weeks in 85% subjects. In the minority complaining of headache after that period there was no evidence of persisting physical injury, nor of inability to work or other disability caused by headaches. Spinal Cord (2001) 39, 228 ± 233

Surgical anatomy of greater occipital nerve and its relation to occipital artery

“…5 Migraine (with its complex cerebral and brainstem mechanisms), cluster headache, occipital neuralgia, cervicogenic headache, whiplash syndrome, and various tension type headaches have shown variable degree of improvement following (GON) blockade. 6,7 So the aim of this research was to study the anatomy of greater occipital nerve and its relation to occipital artery. These anatomical measures will be useful in local injection of the greater occipital nerve for treatment of migraine.…”

Whiplash in individuals with known pre–accident, clinical neck status

“…The other faction has it that organic, cervical changes are more likely to some extent to underlie the symptoms [4,5]. Clinical neurological examination has not uncovered consistent neck abnormalities [1]. This can, however, not be taken as hard evidence that the firstmentioned faction is right.…”

“…The study designs have, however, been entirely different in various studies concerning the prognosis of neck sprain. The basis could be: e.g., all cases reported to a Motor Accidents Board, a statuary authority that recorded all such cases [11]; consecutively referred patients for medicolegal assessment of whiplash injury [1,32]; participants in traffic accidents, gathered in aftertime from a Traffic Police Department registry [39]; individuals at the grass-roots level registered at a parochial health centre, none of the latter ones being involved in litigation processes (present study). It would be strange if these series from the outset consisted of a homogeneous type of individual.…”

“…Grossly, the medical world is divided into two factions in its view of the late whiplash syndrome. One faction ascribes the complaints largely to a particular mental attitude towards putative economic compensation [e.g., [1][2][3]. The other faction has it that organic, cervical changes are more likely to some extent to underlie the symptoms [4,5].…”

Chiropractic management of ‘intractable’ chronic whiplash syndrome

“…hyperflexion, hyperextension and, possibly, lateral flexion or torsional forces to the cervical spine. 9 Most RTAs are not fatal and result in a sprain/strain type injuries to the muscles, ligaments, soft tissues, intervertebral discs and facet joints of the cervical spine. 10 This leads to local tissue inflammation, oedema, muscle spasm, stiffness 11 and nociception as a result of altered cervical facet joint biomechanics 12 together with proprioceptive dysfunction.…”