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Incidence and predictors of chronic headache attributed to whiplash injury
Cephalalgia, 08/13/09

Obermann M et al. – Findings show that the identified predictors parallel those found in chronic primary headache disorders; however, the lack of a control group limits the conclusions that can be drawn from this study.

Methods

Study of clinical, demographic, and psychological predictive factors for development of chronic headache associated with mild-to-moderate whiplash injury
Determination of the incidence of this chronic pain state
Prospective study of pts from 6 emergency departments
Mild-to-moderate whiplash injury defined by Quebec Task Force (QTF) score ≤II
Chronic headache defined by International Classification of Headache Disorders-2 criteria

Results

Chronic headache attributed to whiplash injury for 4.6% of pts
Headache > 42 days (QTF criteria) for 15.2% of pts
Predictive factors: pre-existing facial pain, lack of confidence to recover completely, sore throat, medication overuse, high Neck Disability Index, hopelessness/anxiety, and depression

Exclusive Author Commentary
Mark Obermann, 08/13/09

Despite the obvious limitations of this study, it provides very reasuring findings that chronic headache following whiplash injury after motor vehicle accident is a rare disease with an excellent prognosis in most patients. It is important to communicate this with patients that suffer from whiplash injury thus helping them to adequately classify their complaints and confidently cope with them. The notion that this chronic headache reslembles in many characteristics that of chronic primary headache disorders, such as chronic migraine or chronic tension-type headache is very interesting and possibly points towards a common pathophysiological pathway in the development of chronic headache in particular and chronic pain conditions in general. This will have to be explored in future studies and seems to be a promissing approach in unraveling these complex disorders. Chronic post-traumatic headache presents as huge challenge for patients, families, employers, health care providers and the health care system. The complex combination of pain and neuropsychological symptoms needs further research in understanding the underlying pathophysiological mechanisms associated with the acute headache following trauma but more so the mechanisms associated with the development of chronic pain in some patients. Investigators should refrain from oversimplifying these complex mechanisms as hysteric exaggeration of every day complains and from implying greed as motivation for this potentially very disabling disease.

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