Concussion, whiplash & other migraine related injuries

Concussion and whiplash

There are few underlying migraine causes that are understood to be the sole or major contributing factor leading to migraines in an individual. Medical researchers agree that there is a genetic link to migraine.  But this doesn’t explain many cases of migraine, some of which can arise spontaneously.

Many cases of migraine begin or get significantly worse after an incident or injury. 1 in 7 daily chronic headaches are due to head or neck injury according to migraine.com. These injuries can be any kind of physical trauma to the head or neck. Two of the most common types are concussion and whiplash.

Concussion is understood by most of us as getting a knock to the head that leaves us dazed or unconscious. The American Medical Society defines concussion as a “traumatically induced transient disturbance of brain function involving complex pathophysiologic processes.” Concussion is a type of brain injury that is usually self limited and at the lower end of the brain injury severity spectrum. (1)

Concussion is more prominent in males due to contact sports. However, by participation, a higher incidence of concussion is reported amongst female athletes. (2)

Causes Of Concussion

In the US it is estimated that 3.8 million concussions occur each year during competitive sports and recreational activities. As many as 50% of concussions may go unreported. (1)

Concussions occur in all sports. The highest incidence is found in football, hockey, rugby, soccer & basketball.

Sports injuries, bicycle accidents, car accidents and falls can all lead to a concussion. In adults car accidents and falls are the most frequent cause. (3) In the army, a concussion can result from a nearby explosion.

Young athletes may have a more prolonged recovery and be more vulnerable to serious brain injury with concussion than adults.

Suffering from concussion not only requires physical rest but also cognitive rest. In children, academic accommodations such as reduced workload or extended time for tests may be required whilst the child recovers from concussion. TV may even be considered too much stimulation. It is important to follow the advice provided by your doctor. Managing your condition effectively and early minimises the risk of long-term symptoms.

Headache is the most common symptom after a sports related head injury. (4) Up to 86% of athletes experience headache. A range of headache types may be experienced after head trauma. These include tension, migraine and cluster like headaches.

Concussion symptoms

  • Headache
  • Nausea
  • Vomiting
  • Balance problems
  • Dizziness
  • Visual problems
  • Fatigue
  • Sensitivity to light
  • Sensitivity to noise
  • Numbness/tingling
  • Dazed Stunned
  • Loss of consciousness
  • Feeling mentally “foggy”
  • Feeling slowed down
  • Difficulty concentrating
  • Difficulty remembering
  • Forgetful of recent information and conversations
  • Confused about recent events
  • Answers questions slowly
  • Repeats questions
  • Irritability
  • Sadness
  • More emotional
  • Nervousness
  • Drowsiness
  • Sleeping more than usual
  • Sleeping less than usual
  • Difficulty falling asleep

Less than 10% of sports related concussions among children involved getting “knocked out” or loss of consciousness. (4)

The dangers of concussion

Many incidents of concussion go unreported. Therefore appropriate treatment is not received to allow sufficient time for required rest and recovery.

A second blow before the brain has fully recovered can result in further damage. Some evidence suggests that when cognitive or physical activity begins too early before full recovery the brain may be vulnerable to prolonged dysfunction.

Helmets have been shown to help prevent impact injuries such as fractures, internal bleeding and lacerations but they have not been shown to assist with concussions.

Neither the frequency nor severity of concussions are affected by hard or soft helmets. For example, hard helmets are used in hockey & football whilst soft helmets are used in rugby.

Neuropsychological tests have shown that cognitive issues can continue after other physical symptoms of a concussion have passed. (1)

Studies suggest that repeated concussions may increase a person’s risk in later life for dementia, Parkinson’s disease and depression. (6)

The majority of people who experience concussion will experience a full recovery. Most of the symptoms resolve within a few weeks if due care is taken. (7)

Between 10 to 20% may have symptoms which continue for longer than a month. When this occurs it is referred to as post-concussion syndrome. Post concussion syndrome can involve symptoms which do not resolve for weeks, months or years after a concussion. In some cases symptoms can be permanent. (8)

When a migraine occurs after head trauma it is often referred to as a posttraumatic migraine.  Posttraumatic migraine (PTM) is a complication of a sport related concussion that is not well understood. (5)

Due to the lack of understanding, often a specific diagnosis of PTM is not provided and an optimal course of treatment is not followed.

Unfortunately there is no scientifically established treatment for concussion. The severity of the concussion and symptoms will determine the treatment protocol.

The recommended recovery technique for concussion is rest. Most concussions resolve within 7-10 days although this may be longer for children and adolescents. (9) Sufficient sleep and a gradual return to activities at a pace that does not cause symptoms is recommended.

For the minority who continue to experience symptoms beyond a few weeks, resting is no longer an effective treatment. When symptoms persist for longer than a month it is referred to as post-concussion syndrome. Most post-concussion syndrome symptoms go away on their own within a few months. (10) It is still being debated whether the syndrome is due to structural damage or other factors such as psychological or some combination of these.

With a higher number of concussions come a significantly higher risk of psychiatric disorders and long memory impairment. In retired American football players with a history of 3 or more concussions the risk of developing clinical depression was found to be significantly higher than those with no concussion history. (10) There is also a fivefold greater chance of developing Alzheimers disease earlier and a threefold increase in developing memory deficits with 3 or more concussions. (11)

Whiplash

Whiplash describes a range of injuries to the neck caused by a sudden distortion or extension. (12) It is one of the most common nonfatal car crash injuries. Whiplash can occur at just 15mph. It’s the sudden jolt to the head as a collision occurs that causes the hyperflexion and hyperextension.

Whiplash is not a medical term, cervical acceleration-deceleration describes the mechanism of injury. Most commonly, but not always, whiplash occurs when an individual is hit from behind by another vehicle. Over one million whiplash injuries are estimated to occur each year in the US.

Whiplash Symptoms

Symptoms of whiplash include:

  • Pain and aching to the neck and back
  • Referred pain to the shoulders
  • Sensory disturbances i.e. pins and needles to arms and legs
  • Headaches

Symptoms can appear directly after the injury, but like concussion, it’s also common not notice symptoms until some time after the incident. It may be several days before any symptoms are noticed. Neck pain is very common, however neck therapy itself does not often provide lasting relief. (13)

This missing link in whiplash injuries may be the trapezius muscle which can be damaged through eccentric muscle contraction during whiplash. Another study suggests that a shoulder impingement could be a factor which does not express obvious symptoms. (14) Shoulder impingements affect the nearby supraspinatus muscle.

The lack of understanding suggests that Whiplash treatments are variable and inconsistent.

Rehabilitation is dependent on the severity of the injury. The earlier rehabilitation begins the better outlook to minimise future pain. (15)

Active mobilisation rather than a soft collar delivers better recovery results according to current research. (16) Light exercises are generally given to the patient with instructions to follow to avoid damage. The more strictly these exercises are adhered to the better the long term results. (17) Returning to normal daily activities is encouraged as soon as comfortably possible to expedite a full recovery.

Whiplash Prognosis

Most people experience mild pain for a few days after a whiplash injury. (18) A minority can experience severe disability. Around half of those injured will have lingering symptoms. (17) After 12 months this falls to one in five people who still experience any symptoms.

There is evidence that suggests persistent inflammation is present in the neck of those with chronic pain after whiplash. There is also some evidence that tempromandibular joint dysfunction (TMD) can occasionally follow a whiplash injury. (20)

Many cases of whiplash are not reported. It is estimated that 6.2% of the US population are experiencing long term whiplash symptoms. (19)

Treating Migraine Caused By Injuries

If you find yourself experiencing migraines at a higher frequency as a result of your injury then you’re not alone.

Many migraineurs can remember a turning point where their migraines became much more severe or frequent after a particular incident or injury. Likewise, some can remember the accident that started the beginning of their migraines in the first place.

Whatever your situation, it is usually clear if the incident has played a role in your migraine condition or not.

If it has, then you may still find benefit in addressing your original injury.

For whiplash, comprehensive examination and rehabilitation of your entire neck, shoulders and back area is encouraged to minimise ongoing complaints. The sooner you begin your rehabilitation the better for your recovery. Ideally, consult with a doctor as soon as possible after the incident.

If you didn’t notice any symptoms at the time of the incident or were in shock, you may not have reported whiplash or sought any treatment. Many people may have had no examination or rehabilitation whatsoever even years after the event. In this case it may still be worthwhile getting some kind of physical therapy or manual therapy expert to help correct any maladaptive healing or habits your body may have developed as a result.

For concussion, the risk of another concussion rises significantly once your first concussion occurs. Given the long term damage and risks of multiple concussions this makes it extremely important to get enough rest and slowly reintroduce normal activities as advised by your doctor.

Extra precautions should be taken when engaging in higher risk activities such as snow sports, cycling and contact sport. It’s also worth noting that over 50% of all injuries to the head or neck are alcohol related. Age groups most at risk of head injuries are between 15-29 or 65-70 years old. 

Both concussions and whiplash are similar in that:

  • Many incidents go unreported.
  • It is under treated as a result of not being reported.
  • Symptoms may not arise until a day or more after the actual incident.
  • You can get worse from the injury before you get better in the days following the incident.
  • It takes surprisingly little force or speed (15mph) to cause injury.
  • Adherence to early rehabilitation under medical guidance delivers the best long term results.

You might be thinking you wish you knew all this earlier. Whilst we can’t change the past we can change the future. There may still be benefits to be gained from seeing an expert to evaluate any unaddressed long term injuries which may be triggering migraines or making you more vulnerable to attacks.

When it comes to managing migraines after your injury there is no treatment regime unique for injury based migraines. All the usual rules still apply, but given that the injury is a large part of your problem, it may also be a large part of your solution. That means ensuring that your original injury is taken care of as well as possible, is all the more important.

Can you think of an injury, whiplash or concussion that caused or made your migraines worse?

SOURCES

1) Harmon, Kimberly G., et al. "American Medical Society for Sports Medicine position statement: concussion in sport." British journal of sports medicine 47.1 (2013): 15-26.
2) Gessel LM, Fields SK, Collins CL, et al. Concussions among United States high school and collegiate athletes. J Athl Train. 2007;42:495–503. 21. Powell JW, Barber-Foss KD. Traumatic brain injury in high school athletes. JAMA. 1999;282:958–963.
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4) From American Academy of Pediatrics, Clinical Report, "Sport-Related Concussion in Children and Adolescents", Pediatrics, Mark E. Halstead, MD, Kevin D. Walter, MD, The Council on Sports Medicine and Fitness, Vol. 126 No. 3, September 1, 2010.
5)Mihalik, Jason P., et al. "Posttraumatic migraine characteristics in athletes following sports-related concussion." Journal of neurosurgery 102.5 (2005): 850-855.
6) Kenneth Maiese (January 2008). "Concussion". The Merck Manual Home Health Handbook.
7) Iverson GL (2005). "Outcome from mild traumatic brain injury". Current Opinion in Psychiatry 18 (3): 301–17. doi:10.1097/01.yco.0000165601.29047.ae. PMID 16639155.
8) Ryan LM, Warden DL (2003). "Post concussion syndrome". International Review of Psychiatry 15 (4): 310–316. doi:10.1080/09540260310001606692. PMID 15276952.
9) McCrory, P; Meeuwisse, W; Johnston, K; Dvorak, J; Aubry, M; Molloy, M; Cantu, R (Jul–Aug 2009). "Consensus statement on concussion in sport: the 3rd International Conference on Concussion in Sport held in Zurich, November 2008.". Journal of athletic training 44 (4): 434–48. doi:10.4085/1062-6050-44.4.434. PMC 2707064. PMID 19593427.
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11) Cantu RC (2007). "Chronic traumatic encephalopathy in the National Football League". Neurosurgery 61 (2): 223–5. doi:10.1227/01.NEU.0000255514.73967.90. PMID 17762733.
12) Insurance Institute for Highway Safety. "Q&A: Neck Injury". Retrieved 2007-09-18.
13) Bismil QMK, Bismil MSK (2012). "Myofascial-entheseal dysfunction in chronic whiplash injury". J R Soc Med Sh Rep 3 (8): 57. doi:10.1258/shorts.2012.012052.
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16) Schnabel, M.; Ferrari, R.; Vassiliou, T.; Kaluza, G. (May 2004). "Randomised, controlled outcome study of active mobilisation compared with collar therapy for whiplash injury.". Emerg Med J 21 (3): 306–10. doi:10.1136/emj.2003.010165. PMC 1726332. PMID 15107368.
17) Rosenfeld, M.; Seferiadis, A.; Carlsson, J.; Gunnarsson, R. (2003). "Active intervention in patients with whiplash-associated disorders improves long-term prognosis: a randomized controlled clinical trial.". Spine 28 (22): 2491–8. doi:10.1097/01.BRS.0000090822.96814.13. PMID 14624083.
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