Whiplash, Cervical - Medical Research Abstracts

1. AUTHOR	Gilkey-S-J, Ramadan-N-M, Aurora-T-K, Welch-K-M.
INSTITUTION	Department of Neurology, Henry Ford Hospital and Health Sciences Center, Detroit, Mich., USA.
TITLE	Cerebral blood flow in chronic posttraumatic headache.
SOURCE	Headache 1997 Oct, VOL: 37 (9), P: 583-7, ISSN: 0017-8748.
ABSTRACT	BACKGROUND AND PURPOSE: Headache is the most common neurologic symptom following minor closed head injury. There is often a lack of objective evidence supporting an organic basis of cerebral pathology in these cases. This pilot study considers the possibility of alterations in cerebral blood flow, indicating evidence of an organic disorder in posttraumatic headache. METHODS: Regional cerebral blood flow studies of 35 patients with chronic posttraumatic headache (PTH) (International Headache Society criteria), identified retrospectively from our cerebral blood flow data base, were compared with those of 49 nonheadache controls and 92 migraineurs (Ad Hoc Committee criteria). Regional cerebral blood flow (initial slope index method) was measured using the xenon Xe 133 inhalation technique. RESULTS: Compared to migraineurs and controls, and after adjusting for differences (analysis of covariance) in baseline variables such as blood pressure, hematocrit, and PCO2, patients with PTH had: (1) significantly lower mean initial slope indices (P < 0.001, P = 0.002, respectively); (2) regional interhemispheric flow differences (rIFD), with higher distribution of regional asymmetrical probe pairs (rIFD > or = 7%: P(PTH versus control) = 0.006, P(PTH versus migraine) = 0.016: rIFD > or = 10%; P(PTH versus control) = 0.011, P(PTH versus migraine) = 0.003); and (3) more hemispheric asymmetries (P(PTH versus control) = 0.023, P(PTH versus migraine) = 0.57). Lower mean initial slope indices and hemispheric asymmetry (mean interhemispheric flow difference > or = 3.2%) predicted PTH over control (P = 0.023 and 0.002, respectively). Lower mean initial slope indices predicted PTH over migraine (P = 0.002). CONCLUSIONS: Patients with PTH have reduced regional cerebral blood flow, and regional and hemispheric asymmetries. These cerebral hemodynamic alterations support an organic basis to chronic posttraumatic headache. Author..

2. AUTHOR	Packard-R-C, Ham-L-P.
INSTITUTION	Headache Management and Neurology, Pensacola, FL 32503, USA.
TITLE	Pathogenesis of posttraumatic headache and migraine: a common headache pathway?
SOURCE	Headache 1997 Mar, VOL: 37 (3), P: 142-52, ISSN: 0017-8748 114 Refs.
ABSTRACT	In recent years, research implicating biochemical abnormalities in various pathological conditions has spiralled. Headache is an area in which numerous research studies have been conducted examining biochemical alterations. We have noticed several similarities in biochemical changes reported to occur in migraine and in experimental traumatic brain injury. The most common symptom in mild head injury or mild traumatic brain injury is headache which, in many instances, resembles migraine but has a poorly understood pathophysiology. Biochemical mechanisms believed to be similar in both conditions include: increased extracellular potassium and intracellular sodium, calcium, and chloride; excessive release of excitatory amino acids; alterations in serotonin; abnormalities in catecholamines and endogenous opioids; decline in magnesium levels and increase in intracellular calcium; impaired glucose utilization; abnormalities in nitric oxide formation and function; and alterations in neuropeptides. In this paper, these proposed biochemical alterations will be reviewed and compared. Very similar alterations suggest posttraumatic headache associated with mild head injury and migraine may share a common headache pathway. Author.

3. AUTHOR	Haas-D-C.
INSTITUTION	Department of Neurology, State University of New York Health Science Center at Syracuse, USA.
TITLE	Chronic post-traumatic headaches classified and compared with natural headaches (see comments).
SOURCE	Cephalalgia 1996 Nov, VOL: 16 (7), P: 486-93, ISSN: 0333-1024.
CM	Comment in: Cephalalgia 1996 Nov; 16(7 ):461.
ABSTRACT	This study sought to determine whether chronic post-traumatic headaches are different from or identical to the naturally occurring headaches. The chronic post-traumatic headaches of 48 patients were classified, as if they were natural headaches, by the diagnostic criteria of the International Headache Society. Thirty-six patients' headaches (75%) were chronic tension-type headache, 10 (21%) were migraine without aura, and 2 (4%) were unclassifiable. The characteristics and accompaniments of the headaches within each diagnostic group were then compared to those in a control group with natural headaches of the same type. No notable differences between the post-traumatic and control groups were found. Hence, chronic post-traumatic headaches have no special features, but are symptomatically identical to either chronic tension-type headache or migraine without aura (in this series of patients). This identity suggests that post-traumatic headaches are generated by the same processes causing the natural headaches, not by intracranial derangement from head blows or jolts. Author.

4. AUTHOR	Evans-R-W.
INSTITUTION	Neurology Section, AMI Park Plaza Hospital, Houston, Texas.
TITLE	Some observations on whiplash injuries.
SOURCE	Neurol-Clin 1992 Nov, VOL: 10 (4), P: 975-97, ISSN: 0733-8619 134 Refs.
ABSTRACT	Motor vehicle accidents with a whiplash mechanism of injury are one of the most common causes of neck injuries, with an incidence of perhaps 1 million per year in the United States. Proper adjustment of head restraints can reduce the incidence of neck pain in rear-end collisions by 24%. Persistent neck pain is more common in women by a ratio of 70:30. Whiplash injuries usually result in neck pain owing to myofascial trauma, which has been documented in both animal and human studies. Headaches, reported in 82% of patients acutely, are usually of the muscle contraction type, often associated with greater occipital neuralgia and less often temporomandibular joint syndrome. Occasionally migraine headaches can be precipitated. Dizziness often occurs and can result from vestibular, central, and cervical injury. More than one third of patients acutely complain of paresthesias, which frequently are caused by trigger points and thoracic outlet syndrome and less commonly by cervical radiculopathy. Some studies have indicated that a postconcussion syndrome can develop from a whiplash injury. Interscapular and low back pain are other frequent complaints. Although most patients recover within 3 months after the accident, persistent neck pain and headaches after 2 years are reported by more than 30% and 10% of patients. Risk factors for a less favorable recovery include older age, the presence of interscapular or upper back pain, occipital headache, multiple symptoms or paresthesias at presentation, reduced range of movement of the cervical spine, the presence of an objective neurologic deficit, preexisting degenerative osteoarthritic changes; and the upper middle occupational category. There is only a minimal association of a poor prognosis with the speed or severity of the collision and the extent of vehicle damage. Whiplash injuries result in long-term disability with upward of 6% of patients not returning to work after 1 year. Although litigation is very common and always raises questions of secondary gain in patients with persistent symptoms, most patients are not cured by a verdict. Acute treatment of neck pain consists of ice for 24 hours followed by heat applications, pain pills, NSAIDs, and muscle relaxants. Trigger point injections can be beneficial in both the acute and the persistent phases. Use of cervical collars should probably be kept to a minimum during the first 2 to 3 weeks after the injury and then avoided. Early passive mobilization and range of motion exercises may accelerate recovery. Physical therapy and transcutaneous nerve stimulators may be helpful in reducing pain and improving movement .(ABSTRACT TRUNCATED AT 400 WORDS) Author.

5. AUTHOR	Weiss-H-D, Stern-B-J, Goldberg-J.
INSTITUTION	Department of Medicine, Sinai Hospital, Baltimore, Maryland 21215.
TITLE	Post-traumatic migraine: chronic migraine precipitated by minor head or neck trauma (see comments).
SOURCE	Headache 1991 Jul, VOL: 31 (7), P: 451-6, ISSN: 0017-8748.
CM	Comment in: Headache 1992 Mar; 32(3):157-8.
ABSTRACT	Minor trauma to the head or neck is occasionally followed by severe chronic headaches. We have evaluated 35 adults (27 women, 8 men) with no prior history of headaches, who developed recurrent episodic attacks typical of common or classic migraine following minor head or neck injuries ("post-traumatic migraine"-PTM). The median age of these patients was 38 years (range 17 to 63 years), which is older than the usual age at onset of idiopathic migraine. The trauma was relatively minor: 14 patients experienced head trauma with brief loss of consciousness, 14 patients sustained head trauma without loss of consciousness, and 7 patients had a "whiplash" neck injury with no documented head trauma. Headaches began immediately or within the first few days after the injury. PTM typically recurred several times per week and was often incapacitating. The patients had been unsuccessfully treated by other physicians, and there was a median delay of 4 months (range 1 to 30 months) before the diagnosis of PTM was suspected. The response to prophylactic anti-migraine medication (propranolol or amitriptyline used alone or in combination) was gratifying, with 21 of 30 adequately treated patients (70%) reporting dramatic reduction in the frequency and severity of their headaches. Improvement was noted in 18 of the 23 patients (78%) who were still involved in litigation at the time of treatment. The neurologic literature has placed excessive emphasis on compensation neurosis and psychological factors in the etiology of chronic headaches after minor trauma. Physicians must be aware of PTM, as it is both common and treatable. Author.

6. AUTHOR	Edmeads-J.
INSTITUTION	Sunnybrook Medical Centre, Toronto, Ontario, Canada.
TITLE	(Headache of cervical origin). TT Cephalees d'origine cervicale.
SOURCE	Rev-Prat 1990 Feb 11, VOL: 40 (5), P: 399-402, ISSN: 0035-2640.
ABSTRACT	Neck disorders implicated as causes of headache fall into two groups: a) those in which the cervical lesions are unequivocally demonstrable, and in which treatment of those lesions helps the headache; these are widely accepted as causes of headache, and include: congenital and acquired craniovertebral junction disorders, rheumatoid arthritis and ankylosing spondylitis of the upper cervical spine, and dissection or trauma to the carotid or vertebral arteries; b) those in which the neck disorder is either banal or not objectively demonstrable, and which seldom improve following treatment of the neck; these are not widely accepted as causes of headache; they include whiplash syndrome, segmental hypomobility- hypermobility syndrome, the posterior cervical sympathetic syndrome, cervical migraine, third occipital nerve headache, and cervicogenic headache. Features of a headache suggesting its cervical origin are: 1) abrupt onset following sudden excessive movement of the head; 2) persistent unilateral suboccipital or occipital pain; 3) consistent reproduction by neck movements and by nothing else; 4) abnormal postures of head and neck; 5) significant painful limitation of movement of upper cervical spine; 6) abnormal mobility at craniovertebral junction; 7) C2 sensory abnormalities or lower medulla or upper cervical cord signs. Author.

7. AUTHOR	Winston-K-R.
TITLE	Whiplash and its relationship to migraine.
SOURCE	Headache 1987 Sep, VOL: 27 (8), P: 452-7, ISSN: 0017-8748.

8. AUTHOR	Jacome-D-E.
TITLE	Basilar artery migraine after uncomplicated whiplash injuries.
SOURCE	Headache 1986 Nov, VOL: 26 (10), P: 515-6, ISSN: 0017-8748.

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