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Anarte-Lazo E, Abichandani D, Rodriguez-Blanco C, Bernal-Utrera C, Falla D. Headache features in people with whiplash associated disorders: A scoping review. Musculoskelet Sci Pract 2023; 66:102802. [PMID: 37357053 DOI: 10.1016/j.msksp.2023.102802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/06/2023] [Accepted: 06/10/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Whiplash-associated headache (WAH) is one of the most common symptoms after a whiplash injury, leading to high disability. Nevertheless, the clinical characteristics of WAH have not been well described. OBJECTIVE To synthesise the existing literature on the clinical characteristics of WAH. DESIGN Scoping review. METHODS The protocol for this scoping review was registered in Open Science Framework and the PRISMA extension for Scoping Reviews tool was used to ensure methodological and reporting quality. A systematic search was conducted in PubMed, EMBASE, CINAHL, Web of Science and Scopus. The search was performed by one author and the screening of articles was conducted by two authors independently. RESULTS A total of 11363 articles were initially identified and finally 26 studies were included in the review. Headache intensity was the most commonly reported feature. Headache duration, frequency and location were also reported in at least four studies. Few studies reported physical impairments that may be related to the presence of WAH. A differentiation with concussion characteristics was only performed in eight studies. CONCLUSION WAH appears to be of mild to moderate intensity, typically with episodes of short duration which is commonly experienced in the occipital region amongst other regions, and with a tendency to reduce in intensity over time.
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Affiliation(s)
- E Anarte-Lazo
- Doctoral Program in Health Sciences, University of Seville, Seville, Spain; Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - D Abichandani
- Department of Physiotherapy, Institute of Health and Social Care, London South Bank University, London, UK
| | - C Rodriguez-Blanco
- Physiotherapy Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain
| | - C Bernal-Utrera
- Physiotherapy Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain
| | - D Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.
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Anarte-Lazo E, Rodriguez-Blanco C, Bernal-Utrera C, Falla D. Headache production during physical examination in patients with and without headache attributed to a whiplash injury: A case-control study. Musculoskelet Sci Pract 2023; 66:102779. [PMID: 37271677 DOI: 10.1016/j.msksp.2023.102779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/16/2023] [Accepted: 05/20/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Provocation of headache on physical examination of the neck may reflect a role of cervical structures in the presence of acute whiplash-associated headache (WAH). OBJECTIVE To determine differences in headache provocation during physical tests in people with and without WAH after a whiplash injury. DESIGN Case-control study. METHODS Forty-seven people with acute whiplash-associated disorders participated, 28 with WAH. Passive accessory intervertebral movement over the tubercle of C1, the spinous processes of C2-C3 and facet joints of C0-C4, the flexion-rotation test (FRT), manual palpation of cranio-cervical muscles and the upper limb neurodynamic test + cranio-cervical flexion were assessed bilaterally twice by a blinded examiner; headache provocation was determined. Cohen's kappa and Chi-squared were determined to evaluate the intra-rater reliability of test results and differences between groups, respectively. A logistic regression model was also performed. RESULTS Intra-rater reliability of headache provocation was good or excellent for most tests. Significant differences between groups were found with higher positive tests in WAH for the assessment of C2 (68%), the most painful side of C0-C1 (57%), C1-C2 (75%) and C2-C3 (53%), most (79%) and least (25%) restricted sides of the FRT, and manual palpation of the most painful side for the trapezius (53%), masseter (50%) and temporalis (46%) muscles. Provocation of headache during the assessment of C2 and C1-C2 on the most painful side demonstrated the highest association with WAH. CONCLUSION Mechanical provocation of headache is more frequent in people with WAH than in those without headache soon after a whiplash injury.
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Affiliation(s)
- E Anarte-Lazo
- Doctoral Program in Health Sciences, University of Seville, Seville, Spain; Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - C Rodriguez-Blanco
- Physiotherapy Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain
| | - C Bernal-Utrera
- Physiotherapy Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain.
| | - D Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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Anarte-Lazo E, Bernal-Utrera C, Montaño-Ocaña J, Falla D, Rodriguez-Blanco C. Higher Neck Pain Intensity and the Presence of Psychosocial Factors are More Likely when Headache is Present After Whiplash Associated Disorders: A Case-Control Study. PAIN MEDICINE 2022; 23:1529-1535. [PMID: 35212760 DOI: 10.1093/pm/pnac038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/20/2022] [Accepted: 02/22/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Several factors such as neck pain intensity, disability, anxiety, depression, female sex or a previous history of headache, are associated with post-whiplash headache. However, the possible role of psychosocial factors contributing to the presence of headache or worsening of headache after a whiplash trauma remains unclear. To address this gap in knowledge, there is the need to assess psychosocial factors concerning headache shortly after a whiplash injury. OBJECTIVE To evaluate psychological features, pain and disability in people with acute Whiplash Associated Disorders (WAD) and compare these features between those with and without headache. DESIGN case-control study. SETTING A secondary care traumatology center. METHODS Forty-seven people with acute WAD were recruited; 28 with headache, and 19 without. All participants completed self-reported questionnaires including Visual Analogue Scale (VAS) for neck pain intensity, the Neck Disability Index (NDI), Pain Catastrophizing Scale (PCS), Tampa Scale Kinesiophobia-11 (TSK-11) and State-Trait Anxiety Inventory. RESULTS Neck pain intensity (p < 0.001), neck disability (p < 0.001), pain catastrophising (p < 0.001), kinesiophobia (p < 0.001) and anxiety state (p = 0.007) and trait (p = 0.05) were higher in those with headache when compared to those without. In addition, high levels of neck pain (p = 0.025), moderate levels of neck disability (p < 0.001), moderate levels of pain catastrophising (p = 0.015), and moderate (p = 0.002) and severe (p = 0.016) levels of kinesiophobia were related to the presence of headache. CONCLUSION The level of neck pain intensity and disability, kinesiophobia, catastrophising and anxiety were all greater in people with acute WAD who presented with a headache compared to those without headache.
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Affiliation(s)
- Ernesto Anarte-Lazo
- Doctoral Program in Health Sciences, University of Seville, Seville, Spain.,Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Carlos Bernal-Utrera
- Physiotherapy Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain
| | - Juan Montaño-Ocaña
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Madrid, Villaviciosa de Odon, Madrid, Spain.,Department of Physiotherapy, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Tajo s/n, Villaviciosa de Odon, Madrid, Spain
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Cleofas Rodriguez-Blanco
- Physiotherapy Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain
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Abstract
Neck pain and headache are 2 of the most common complications of whiplash injury. Therefore, we performed a systematic literature search on PubMed and Embase for publications reporting on the prevalence of neck pain and headache after whiplash injury. The literature search identified 2709 citations of which 44 contained relevant original data. Of these, 27 studies provided data for the quantitative analysis. For non-population-based studies, the present meta-analysis showed that a pooled relative frequency of neck pain was 84% confidence interval (68%-95%) and a pooled relative frequency of headache was 60% (46%-73%), within 7 days after whiplash injury. At 12 months after injury, 38% (32%-45%) of patients with whiplash still experienced neck pain, while 38% (18%-60%) of whiplash patients reported headache at the same time interval after injury. However, we also found considerable heterogeneity among studies with I-values ranging from 89% to 98% for the aforementioned meta-analyses. We believe that the considerable heterogeneity among studies underscores the need for clear-cut definitions of whiplash injury and standardized reporting guidelines for postwhiplash sequelae such as neck pain and headache. Future studies should seek to optimize these aspects paving the way for a better understanding of the clinical characteristics and natural course of whiplash-associated sequelae.
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Watson DH, Drummond PD. The Role of the Trigemino Cervical Complex in Chronic Whiplash Associated Headache: A Cross Sectional Study. Headache 2016; 56:961-75. [PMID: 27091393 DOI: 10.1111/head.12805] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 01/05/2016] [Accepted: 02/15/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To investigate signs of central sensitization in a cohort of patients with chronic whiplash associated headache (CWAH). BACKGROUND Central sensitization is one of the mechanisms leading to chronicity of primary headache, and thus might contribute to CWAH. However, the pathophysiological mechanism of CWAH is poorly understood and whether it is simply an expression of the primary headache or has a distinct pathogenesis remains unclear. Thus, the factors involved in the genesis of CWAH require further investigation. METHODS Twenty-two patients with CWAH (20 females, 2 males; age 25-50 years, mean age 36.3 years) and 25 asymptomatic participants (13 females, 12 males; age 18-50 years, mean age 35.6 years) rated glare and light-induced discomfort in response to light from an ophthalmoscope. Hyperalgesia evoked by a pressure algometer was assessed bilaterally on the forehead, temples, occipital base, and the middle phalanx of the third finger. The number, latency, area under the curve, and recovery cycle of nociceptive blink reflexes elicited by a supraorbital electrical stimulus were also recorded. RESULTS Eight and 6 CWAH patients had migrainous and tension-type headache (TTH) profiles, respectively; the remainder had features attributable to both migraine and TTH. Patients in the whiplash group reported significantly greater light-induced pain than controls (8.48 ± .35 vs 6.66 ± .43 on a 0-10 scale; P = .001). The CWAH patients reported significantly lower pressure pain thresholds at all sites. For stimuli delivered at 20 second intervals, whiplash patients were more responsive than controls (4.8 ± .6 blinks vs 3.0 ± .6 blinks in a block of 10 stimuli; P = .036). While R2 latencies and the area under the curve for the 20 second interval trials were comparable in both groups, there was a significant reduction of the area under the curve from the first to the second of the 2-second interval trials only in controls (99 ± 8% of baseline in whiplash patients vs 68 ± 7% in controls; P = .009). The recovery cycle was comparable for both groups. CONCLUSIONS Our results corroborate previous findings of mechanical hypersensitivity and photophobia in CWAH patients. The neurophysiological data provide further evidence for hyperexcitability in central nociceptive pathways, and endorse the hypothesis that CWAH may be driven by central sensitization.
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Affiliation(s)
- Dean H Watson
- School of Psychology and Exercise Science, Murdoch University, Murdoch, Western Australia, Australia
| | - Peter D Drummond
- School of Psychology and Exercise Science, Murdoch University, Murdoch, Western Australia, Australia
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Section Editor's Comment on the 2014 Topical Collection on Traumatic Brain Injury (TBI). Curr Treat Options Neurol 2014; 16:322. [PMID: 25348823 DOI: 10.1007/s11940-014-0322-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Stovner LJ. Re: Ensidig om nakkesleng fra Høyesterett. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2014; 134:1638. [DOI: 10.4045/tidsskr.14.1030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Sjaastad O, Hesselberg JP. Ensidig om nakkesleng fra Høyesterett. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2014; 134:721-4. [DOI: 10.4045/tidsskr.14.0265] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Abstract
Headache is a common symptom after traumatic head injury and is a frequent feature of the postconcussive syndrome. A variety of headache subtypes can be precipitated by head trauma, although posttraumatic headaches most often resemble migraine or tension-type headache. A lack of clinical trials limits evidence-based treatment recommendations for both acute and chronic posttraumatic headaches. However, numerous pharmacologic and nonpharmacologic interventions can be used to successfully manage posttraumatic headaches. This article reviews the classification, epidemiology, prognosis, and pathophysiology of headaches after head trauma and provides a practical clinical approach for evaluating and treating patients with posttraumatic headaches.
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Stovner L. Høyesterett og sakkyndighet. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2012; 132:927-8. [DOI: 10.4045/tidsskr.12.0256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Fragliche nosologische Validität des chronischen Halswirbelschleudertraumasyndroms. DER ORTHOPADE 2011; 41:147-52. [DOI: 10.1007/s00132-011-1868-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Evans RW. Persistent Post-Traumatic Headache, Postconcussion Syndrome, and Whiplash Injuries: The Evidence for a Non-Traumatic Basis With an Historical Review. Headache 2010; 50:716-24. [DOI: 10.1111/j.1526-4610.2010.01645.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Epidemiological studies conducted in the general population point to average headache prevalence rates of 46% for 1-year prevalence and of 64% for lifetime prevalence. For migraine, most studies conducted in the adult general population of western Europe and North America indicate rates between 5% and 9% in men, and between 12% and 25% in women. Non-western countries report lower figures. Migraine shows no gender differences in children, while in the elderly its frequency appears much reduced in both genders. About one-third of migraineurs suffer from migraine with aura. For tension-type headache, prevalence data reports in the literature are few and conflicting: rates range from 11% in Singapore to 20-40% in the USA and over 80% in Denmark. It is worth noting that the highest figures are found in studies where a personal interview has been employed. This probably indicates that the prevalence of this headache subtype is particularly sensitive to the method of data collection. Cluster headache occurs in 1-3 per thousand of the general population, with a gender (M:F) ratio of about 3:1. About 4% of the adult general population suffers from chronic daily headache.
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Obermann M, Nebel K, Riegel A, Thiemann D, Yoon MS, Keidel M, Stude P, Diener HC, Katsarava Z. Incidence and predictors of chronic headache attributed to whiplash injury. Cephalalgia 2009; 30:528-34. [DOI: 10.1111/j.1468-2982.2009.01972.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We identified clinical, demographic and psychological predictive factors that may contribute to the development of chronic headache associated with mild to moderate whiplash injury [Quebec Task Force (QTF) ≤ II] and determined the incidence of this chronic pain state. Patients were recruited prospectively from six participating accident and emergency departments. While 4.6% of patients developed chronic headache attributed to whiplash injury according to the International Classification of Headache Disorders, 2nd edn criteria, 15.2% of patients complained about headache lasting > 42 days (QTF criteria). Predictive factors were pre-existing facial pain [odds ratio (OR) 9.7, 95% confidence interval (CI) 2.1, 10.4; P = 0.017], lack of confidence to recover completely (OR 5.5, 95% CI 2.0, 13.2; P = 0.005), sore throat (OR 5.0, 95% CI 1.5, 8.9; P = 0.013), medication overuse (OR 4.2, 95% CI 1.4, 12.3; P = 0.009), high Neck Disability Index (OR 4.0, 95% CI 1.3, 12.6; P = 0.019), hopelessness/anxiety (OR 3.8, 95% CI 1.3, 8.7; P = 0.024), and depression (OR 3.3, 95% CI 1.2, 9.4; P = 0.024). The lack of a control group limits the conclusions that can be drawn from this study. Identified predictors closely resemble those found in chronic primary headache disorders.
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Affiliation(s)
- M Obermann
- Department of Neurology, University of Duisburg-Essen, Essen, Germany
| | - K Nebel
- Department of Neurology, University of Duisburg-Essen, Essen, Germany
| | - A Riegel
- Department of Neurology, University of Duisburg-Essen, Essen, Germany
| | - D Thiemann
- Department of Neurology, University of Duisburg-Essen, Essen, Germany
| | - M-S Yoon
- Department of Neurology, University of Duisburg-Essen, Essen, Germany
| | - M Keidel
- Department of Neurology and Neurological Rehabilitation, Bezirkskrankenhaus Bayreuth, Germany
| | - P Stude
- Department of Neurology, University of Duisburg-Essen, Essen, Germany
| | - HC Diener
- Department of Neurology, University of Duisburg-Essen, Essen, Germany
| | - Z Katsarava
- Department of Neurology, University of Duisburg-Essen, Essen, Germany
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Affiliation(s)
| | - Holger Schmidt
- Insurance Medicine—Neurology, SUVA (Swiss National Accident Foundation), CH 6002 Lucerne
| | - Peter Sandor
- Headache and Pain Unit, Neurology Department, University Hospital Zurich, Switzerland
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Stovner LJ, Obelieniene D. Whiplash Headache is Transitory Worsening of a Pre-Existing Primary Headache. Cephalalgia 2008; 28 Suppl 1:28-31. [DOI: 10.1111/j.1468-2982.2008.01615.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Acute and chronic whiplash headache are new diagnostic entities in the ICHD-2 (5.3, 5.4). In a prospective cohort study, 210 rear-end collision victims were identified consecutively from police records and asked about head and neck pain in questionnaires after 2 weeks, 3 months and 1 year. The results were compared with those of matched controls who were also followed for 1 year. Of 210 accident victims, 75 developed headache within 7 days. Of these, 37 had also neck pain and complied with the criteria for acute whiplash headache. These 37 had the same headache diagnoses, headache features, accompanying symptoms and long-term prognosis as the 38 without initial neck pain who therefore did not comply with the acute whiplash headache diagnosis. Previous headache was a major risk factor for headache both in the acute and chronic stage. Compared with the non-traumatized controls, headache in the whiplash group had the same prevalence, the same diagnoses and characteristic features, and the same prognosis. Both acute and chronic whiplash headache lack specificity compared with the headache in a control group, and have the same long-term prognosis, indicating that such headaches are primary headaches, probably elicited by the stress of the situation.
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Affiliation(s)
- LJ Stovner
- Norwegian National Headache Centre, Department of Neuroscience, Norwegian University of Science and Technology, and St Olavs Hospital, Trondheim, Norway
| | - D Obelieniene
- Department of Neurology, Kaunas Medical Academy, Kaunas, Lithuania
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Aaseth K, Grande RB, Kvaerner KJ, Gulbrandsen P, Lundqvist C, Russell MB. Prevalence of secondary chronic headaches in a population-based sample of 30-44-year-old persons. The Akershus study of chronic headache. Cephalalgia 2008; 28:705-13. [PMID: 18498398 DOI: 10.1111/j.1468-2982.2008.01577.x] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We studied secondary chronic headaches (> or = 15 days/month for at least 3 months) in a random sample of 30 000 persons aged 30-44 years. They received a mailed questionnaire. Those with self-reported chronic headache within the last month and/or year were invited to an interview and examination by a neurological resident. The criteria of the International Classification of Headache Disorders (ICHD-II) were applied. The questionnaire response rate was 71%, and the participation rate of the interview was 74%. Of the 633 participants, 298 had a secondary chronic headache. The 1-year prevalence of secondary chronic headache was 2.14%, i.e. chronic posttraumatic headache 0.21%, chronic headache attributed to whiplash injury 0.17%, post-craniotomy headache 0.02%, medication-overuse headache (MOH) 1.72%, cervicogenic headache 0.17%, headache attributed to chronic rhinosinusitis 0.33% and miscellaneous headaches 0.04%. The majority of those with ICHD-II-defined secondary chronic headache had MOH, while about one-third had other secondary headaches often in combination with MOH.
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Affiliation(s)
- K Aaseth
- Head and Neck Research Group, Akershus University Hospital, 1474 Nordbyhagen, Norway.
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[Studies of whiplash trauma critically analyzed]. DER ORTHOPADE 2007; 36:379-80. [PMID: 17387447 DOI: 10.1007/s00132-007-1073-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
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