What are the symptoms of whiplash headache?
Patients with headache after a whiplash injury will typically experience pain in the back of the head where the head meets the neck. This pain may radiate to the temples, the top of the head, the front of the head or down the neck. The pain may be intermittent or constant. Pain may be worse with moving the neck, reading, using a computer monitor or texting. These headaches may be associated with dizziness or a sensation that the room is spinning. The medical term for these headaches is cervicogenic headaches.
What causes whiplash headache?
Early after a whiplash injury headaches may be caused by overstretching of the ligaments and tendons of the upper neck. This is called a sprain or a strain. Typically, symptoms from sprain or strain will resolve within 6–8 weeks. When symptoms continue it is a sign of a more severe injury. Approximately 80% of the time chronic headaches following a whiplash are due to an upper joint injury in the neck. These joints are called the facet joints. Approximately 20% of the time a chronic headache may be due to a disc injury in the upper neck.
How is whiplash headache evaluated?
In the initial evaluation of a whiplash headache the most important thing is time. If the headache is predominantly caused by a sprain or a strain the headache will resolve by 6–8 weeks. When pain persists additional investigation is warranted. A physical examination will show a typical pain pattern. An MRI is obtained to determine if a disc herniation is present. If there is no disc herniation, additional diagnostic testing is required to evaluate for a facet injury. This is because a facet injury is typically not seen on MRI. This additional testing usually consists of performing a diagnostic injection at the facet joint. This injection is called a medial branch block. A medial branch block will anesthetize the joint for approximately 5 hours. If pain is relieved during that period one can confidently determine that the headaches are caused by a whiplash facet injury.
How is whiplash headache treated?
The first step in treatment of whiplash headache is therapy and neck exercises. While a sprain or strain will resolve on its own, therapy and exercises will hasten improvement. Nonsteroidal anti-inflammatory medications, ibuprofen, and muscle relaxants can also help. When pain is persistent additional testing will often reveal either a facet joint injury or a disc injury. When facet joint injuries or disc injuries persistently cause pain and disability additional treatment will be required. This may take the form of injections or minimally invasive procedures.
Whiplash headache treatments
The following spinal injections may be used to treat whiplash headache:
The following minimally invasive surgical procedures may be used to treat whiplash headache:
- Cervical rhizotomy
- Endoscopic facet debridement
- Endoscopic anterior cervical discectomy