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Whiplash Associated Disorders and Headaches

Whiplash Associated Disorders and Headaches
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Whiplash associated disorders (WAD) is a term used to describe the constellation of symptoms that occur following the sudden acceleration-deceleration of the head and neck, most commonly during an automobile collision. Headaches are the second most common WAD symptom that drive patients to seek chiropractic care, with neck pain being first.

The International Headache Society defines headaches attributed to whiplash as those that appear within seven days post-crash or pre-existing headaches that worsen in the same time frame. Current research suggests that 60% of WAD patients experience headache within seven days of a whiplash event, with the number dropping to 23% by three months. However, the percentage jumps back up to 30% and 38% by the six- and twelve-month time points, respectively.

To better understand which WAD patients may be most likely to experience ongoing headaches, researchers have conducted several studies comparing the initial presentation of patients who did with those who did not develop chronic WAD headaches. These studies identified the following post-injury risk factors for WAD headaches: higher neck pain and disability; fear of movement (kinesiophobia), catastrophizing (an exaggerated mental outlook toward their pain); and anxiety.

When a patient first presents for chiropractic treatment for WAD, they will complete a detailed history of the accident including the mechanism of injury (the direction of the impact, the speed of both vehicles, awareness of the impending crash); immediate vs. delayed symptom onset; changes since the crash; prior professional and personal self-care treatment(s) and the associated responses; a past history of neck pain/headache; and a review of systems (general health status). They may also complete questionnaires regarding pain, disability, and psychosocial factors (anxiety, depression, locus of control), as well as a pain diagram to help relate where they feel pain in their body. These assessments may be repeated at various points during the course of care to track progress.

Treatment will typically involve a multimodal approach aimed at restoring normal movement to the cervical spine, which can help to reduce pain and disability, as well as address stiffness and improve range of motion. Such an approach will likely involve manual therapies like spinal manipulation and mobilization, soft tissue work, physiotherapy modalities, mechanical traction, stabilization exercises, and more. The patient will also be given advice to maintain their normal activities within pain tolerance as well as education regarding their injury and recovery prospects—all in the effort to reduce kinesiophobia and catastrophizing. If necessary, the patient’s chiropractor may co-manage the case with an allied healthcare provider who can provide services beyond the chiropractic scope of care, which may include mental health services.

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