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Post-Whiplash Headache Risk Factors and Treatment

Post-Whiplash Headache Risk Factors and Treatment
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The International Headache Society lists “headache attributed to whiplash” as a headache that appears or existing headaches that worsen within seven days after a whiplash event (i.e., automobile collision, sports collision, slip and fall, etc.). It’s estimated that up to 60% of whiplash associated disorders (WAD) patients experience such headaches and nearly 40% will continue to do so a year after their initial injury. Thus, studies that focus on what factors are linked to post-whiplash headaches, especially those that persist in the long term, are important.

In a 2022 study, researchers monitored 47 recent WAD grade II patients (pain, stiffness, or tenderness of the neck with soft tissue injury signs, loss of range of motion, and/or point tenderness of the neck) without a previous history of headache or musculoskeletal disorders associated with headache. All participants completed self–reported questionnaires including Visual Analogue Scale for neck pain intensity, the Neck Disability Index, Pain Catastrophizing Scale, and the Tampa Scale Kinesiophobia–11. Of the 47 patients in the study, 28 developed headaches within a week of the whiplash event, which correlates to findings from previous studies.

Analysis of questionnaire data revealed that neck pain intensity, neck disability, pain catastrophizing, kinesiophobia, and anxiety were ALL higher in those with post-whiplash headaches. Previous research has also linked central sensitization (experiencing painful sensations to non-painful stimuli) to post-whiplash headaches. This suggests that worse injury to the musculoskeletal system, particularly in the vicinity of the cervical spine may contribute to post-whiplash headaches and the neck should be evaluated in WAD patients, especially those with new-onset or worsening headaches.

The 2016 update to the 2000-2010 Bone and Joint Decade Task Force on That Pain and its Associated Disorders concluded that episodic tension-type headaches, chronic tension-type headaches and cervicogenic headaches are effectively managed with low load endurance craniocervical and cervical scapular exercises, relaxation training with stress coping therapy, and/or multimodal care that includes spinal manipulation, mobilization, and postural correction.  Both cervical and thoracic spine manipulation with or without mobilization was found effective for cervicogenic headaches.  Doctors of chiropractic frequently employ these and other treatment options as part of a multimodal approach for the management of WAD patients, including those with post-whiplash headaches.


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