Whiplash Headaches

What Is Whiplash?

Whiplash is a condition caused by excessive force inflicted on the bones and joints of the neck. The neck is composed of cervical vertebrae, the first few spinal bones that extend from the base of the skull to the upper back. It can withstand a certain amount of abrupt backward and forward motion, due to the protective and flexible properties of the ligaments and muscles around the bones. However, accidents or situations in which an excessive amount of force is experienced can cause damage to these structures. This can lead to the often chronic type of pain known as whiplash.

Up to 50% of whiplash sufferers may fully recover, whereas the other 50% may develop mild to severe consistent, long-term symptoms including stiffness and pain in the head and neck. Whiplash is often a result of accidents such as motor vehicle collisions. The incidence of this condition is also associated with potentially high-impact recreational activities and sports such as skiing or football. Injury, including that resulting from assault or severe shaking is another possible cause. Whiplash-related injuries may cause considerable detriment to the ability to work or function normally, and is associated with high healthcare costs. Headache is a prevalent symptom of whiplash, possibly due to damage to certain important nerves in the neck.

Causes Of Whiplash

Whiplash mainly refers to the actual trauma as a result of excessive force to the neck joints. Symptoms such as headache are known as whiplash-associated disorders. These disorders may result from nerve, bone, or ligament damage. The latter may result in increased instability in the neck region, thus increasing the risk of prolonged pain and delayed recovery. Approximately 50% of whiplash patients also experience damage of the facet joints, which are the joints between cervical vertebrae. This may be associated with the development of whiplash headache, which is often described as migraine-like in nature.

Whiplash may also cause other forms of headache, such as those that are short-term and accompanied by facial pain, depending on which nerves are affected by the trauma. Pain is also associated with the release of inflammatory molecules from damaged neck tissues. Therefore, treatment for whiplash should include interventions to address inflammation.

Treatments For Whiplash Pain

The first-line treatments for whiplash may be in the form of complementary or physical therapies, such as acupuncture or chiropractic manipulation. Chiropractic manipulation applied to the neck after whiplash can correct the deformation of structures in the neck caused by whiplash, and help relieve the pain in muscles and ligaments. This may contribute to the reduction of neck pain, which may improve headache symptoms. Pain-relieving (or analgesic) drugs may also be recommended for the treatment of whiplash headaches. Non-steroidal anti-inflammatory drugs (NSAIDs) are associated with significant headache symptom reduction and also reduce inflammation.

The next step in pharmacological whiplash headache treatment is often epidural nerve injections. Epidural injections, or nerve blocks, are injections of analgesic medications directly to the nerves that may be responsible for headache pain transmission due to whiplash damage. In these cases, the analgesics are local anesthetics, possibly in combination with steroids (which act to inhibit inflammation). These are administered in close proximity to nerves such as those serving the facet joints (medial branch nerves). Occipital nerve blocks can also relieve headache, including the rarer forms presenting with facial pain. Nerve blocks are associated with effective relief from pain that may last from a number of weeks to a number of months.

If this treatment is right for you, your pain specialist will work out an appropriate schedule for nerve block treatment based on the duration of this response. Nerve blocks are safe in the vast majority of cases, but carry some risks, mainly associated with the side effects of the analgesics used. The injection of anesthetics may result in nerve damage, numbness, and temporary headache. Steroids, if used, are associated with increased risks of arthritis, immune system dysfunction, mood abnormalities, and gastrointestinal side effects.

If pain associated with whiplash does not respond to nerve blocking, a subsequent line of intervention targeting damaged nerves may be necessary. Radiofrequency ablation is the practice of temporary nervous tissue disruption, in order to ensure more effective and durable relief from chronic pain. This procedure involves the use of thin probes (inserted into the neck under a local anesthetic) to locate nerves associated with severe pain such as headache and the application of radiofrequency (or thermoelectric) impulses through the probe. This will produce a semi-permanent lesion on the nerve, thus disrupting its ability to convey consistent pain “messages” to the brain. This treatment is associated with significant pain reduction in cases of whiplash, and may be applied to occipital or medial branch nerves. Radiofrequency ablation is associated with risks of tissue damage and infection in the skin through which probes are inserted, and with rare incidences of sensory or motor dysfunction due to inaccurate probe placement.

Conclusion

Whiplash is associated with abrupt, excessive backward and forward motion of the neck, exceeding its usual ranges of motion and flexibility. This results in bone, ligament, or nerve damage. This is associated with the development of chronic pain symptoms in approximately 50% of people who experience this type of trauma. These symptoms may range from mild to severe, and may manifest in many forms, including headache. Whiplash headache may arise in a form similar to migraine, or in other, rarer forms depending on which spinal or cervical nerves are damaged. Typical first-line treatments for this condition may include analgesic medications, such as those that may be bought over the counter. If these prove ineffective, whiplash headaches may benefit from epidural injections directed at the damaged nerves associated with this pain. If nerve-blocking treatment fails to produce the expected result, a patient may also consider radiofrequency ablation of the nerves in question.