Posttraumatic headaches as a result of head and neck trauma are one of the most common secondary headache types we see in the office at Integrity Chiropractic. Dr. Leatherman and Dr. Bak understand that headache and neck pain are the cardinal symptoms of trauma following motor vehicle accidents (crashes) and an cause mild, moderate or severe limitations. Patients often present to the emergency room after a crash for fear of permanent or lethal damage due to head and neck pain.
Posttraumatic headaches can be acute or chronic, when not managed appropriately, and are the second most common symptom and complaint of those involved in a motor vehicle crash (MVC) or who have experienced a “Whiplash Type Injury”. In fact neck pain is the only complaint more common than headaches after a crash.
Patients with this condition often submit to multiple medical investigations and imaging techniques such as CT and MRI of the head to determine the specific cause of pain, even when they aren’t recommended for proper diagnosis. Unfortunately these investigations are costly and generally unsuccessful at improving quality of life. Headaches can be present in those with head trauma or without head trauma, and are often present even if there has been NO associated concussion. The main reason is that the injury is NOT to the head but in the soft tissue structures of the upper neck.
In 2001, research by Radenov et al. discussed these issues. In their paper, they reported on whiplash patients with resulting mild-to-moderate head trauma were evaluated for headache type. The 112 patients experienced headaches at least twice per week, and had experienced the injury an average of two-and-a-half years. TALK ABOUT CHRONIC PAIN … that is 130 weeks of headache symptoms after their crash involvement.
- Tension-type headache was the most common (37% of patients)
- Migraine was second most common (27%)
- Cervicogenic headache was third most common (18%).
- Another (18% of patients ) were unclassified headache types
- Note: cervicogenic means head pain that is arising specifically from the neck, not the head, and tension headaches are very similar.
- Regarding migraine, there was no significant difference between genders, suggesting no hormonal component as would be suspected from a trauma induced symptom.
- Patients who had suffered loss of consciousness were NOT more likely to experience migraine.
- 59% of cases had pain that was bilateral
- 25% of cases had pain on one side only
- 16% of cases had pain that alternated between sides.
- Neck pain occurred concurrently in 93% of whiplash mechanism of injury sufferers.
The researchers concluded the poor responsiveness to current treatment for chronic headaches in whiplash patients may indicate that treatment methods are not specific enough to the type of headache. In other words, the doctors didn’t examine well, diagnose properly or create a proper course of care for these symptoms. The authors suggest that treatment plans for chronic whiplash headache should address the particular type of headache. A detailed analysis of headache symptomatology, location, duration and offending tissues, is needed following whiplash in posttraumatic headache patients to determine optimal patient care.
At Integrity Chiropractic, Dr. Leatherman and Dr. Bak have studied these injuries extensively through hundreds of hours of post-doctoral coursework and have treated thousands of MVC patients. The doctors totally agree with Radanov’s conclusions, and this issue of headaches arising from the neck has been known and published as early as the 1950’s!
Motor vehicle crash headache sufferers often come to Integrity Chiropractic with acute headaches post trauma, which can be easier to treat than chronic headache, but they also come to us after 1-2 years of failed therapy by other doctors or physical therapists. Taking the time to examine every patient carefully, understanding the mechanism of injury, tracking where the pain syndromes are located on the head, and confirming the tissues involved with headache pain is paramount for appropriate treatment and recovery.
At Integrity Chiropractic, we often find that headaches are arising from the ligaments of the upper neck as well as the joint surfaces (facet joints), and that the neck curve has been altered and often buckled compared to the normal position. It is only when these factors are specifically addressed that we are effective in reducing the chronic headache pain that had previously been unresponsive to prior treatment. And here is the best news of all, regular Chiropractic care as well as advanced CBP (Chiropractic Biophysics) care has been proven to help reduce whiplash associated pain and headache pain in the clinical literature.
- Holle D, Obermann M. The role of neuroimaging in the diagnosis of headache disorders. Ther Adv Neurol Disord. 2013;6(6):369–374. doi:10.1177/1756285613489765 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3825114/
- Headaches and Neuroimaging: High Utilization and Costs Despite Guidelines. Brian C. Callaghan, MD, MS1; Kevin A. Kerber, MD, MS1; Robert J. Pace, MD1; et alLesli E. Skolarus, MD, MS1; James F. Burke, MD, MS1,2 JAMA Intern Med. 2014;174(5):819-821. doi:10.1001/jamainternmed.2014.173 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1835347
- Radanov BP, Stefano GD, Augustiny KF. Symptomatic approach to posttraumatic headache and its possible implications for treatment. European Spine Journal 2001:10, pp. 403-407.
- Cervical Afferents and Primary Headache: An investigation of the potential role of cervical nociceptors in sensitising the trigemino-cervical nucleus in primary headache. Dean H Watson Master Applied Science in Manipulative Therapy, Thesis submitted in fulfillment of requirement for the degree of Doctor of Philosophy, May 2016.
- Curr Opin Neurol. 2017 Jun;30(3):263-271. Extracranial origin of headache. Burstein R1, Blake P, Schain A, Perry C. Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Department of Anesthesia, Harvard Medical School, Boston, Massachusetts, Headache Center of Greater Heights, Memorial Hermann Medical Group, River Oaks Plastic Surgery Center, Houston, Texas, USA. https://www.ncbi.nlm.nih.gov/pubmed/28248698
- SELETZ E. Headache of extracranial origin. Calif Med. 1958;89(5):314–317. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1512509/
- Fortner MO, Oakley PA, Harrison DE. Alleviation of chronic spine pain and headaches by reducing forward head posture and thoracic hyperkyphosis: a CBP® case report. J Phys Ther Sci. 2018;30(8):1117–1123. doi:10.1589/jpts.30.1117 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6110208/
- Injury. 1996 Nov;27(9):643-5. Chiropractic treatment of chronic ‘whiplash’ injuries. Woodward MN1, Cook JC, Gargan MF, Bannister GC., University Department of Orthopaedic Surgery, Bristol, UK. https://www.ncbi.nlm.nih.gov/pubmed/9039361