Whiplash-Associated Headache

Psychological symptoms are often associated with both headaches and whiplash. This study examined patients who suffered from headaches (along with the neck pain) following whiplash by using the SCL-90-R, a self-report, psychological symptom checklist that is used to assess distress. In previous studies, patients with post-traumatic headaches had scored higher on the questionnaire than patients with no chronic pain; also post-traumatic patients have indicated a higher rate of psychological distress on the SCL-90-R than migraine and tension headache sufferers did.

The study's goal was to get a psychological distress profile of patients who suffer from headache induced by whiplash injury, and to then compare those patients distress to that of previously published distress levels of traumatic and non-traumatic headache patients.

The authors found that patients with headache as a result of whiplash scored similarly to patients with other types of post-traumatic headache and to patients with whiplash but with no headache. When the whiplash patients were compared to non-traumatic headache sufferers, however, significant differences emerged. Patients with non-traumatic headache pain scored evenly on all of the test subscales, while whiplash patients scored higher in just a few different scales: somatization, obsessive-compulsive, depression, and hostility.

The authors explain their findings:

"The reactive pattern of distress exhibited by patients with post-traumatic headache and whiplash-associated headache is more suggestive of a direct secondary response to pain and disability, resulting from trauma, rather than of a more diffuse etiology. Thus, somatization can be interpreted as belief by the patient that something in the head or neck does hurt; the obsessive-compulsive subscale elevation reflects the interference of pain with cognitive functioning and subsequent insecurity; depression occurs because the pain does not go away; and hostility arises when the accident is not the patient's fault, or when doctors and solicitors cannot find and/or deny a cause or a cure."

This study is the latest of a large group of studies that show that organic pain may be at the root of whiplash-related distress. As the authors state, "These differences [in distress patterns] are prima facie grounds to resist the temptation to ascribe whiplash-associated headache to situational stress and 'tension,' and, instead, to consider the possibility of an organic pain source."

BJ Wallis, SM Lord, L Barnsley, N Bogduk.The psychological profiles of patients with whiplash-associated headache. Cephalalgia 1998;18:101-105.