Whiplash in individuals with known pre–accident, clinical neck status

J Headache Pain (2006) 7:9–20 DOI 10.1007/s10194-006-0270-x ORIGINAL Ottar Sjaastad Torbjörn A. Fredriksen Jan Båtnes Hans C. Petersen Leiv S. Bakketeig Whiplash in individuals with known pre-accident, clinical neck status Received: 25 November 2005 Accepted in revised form: 31 January 2006 Published online: 20 February 2006 Abstract In whiplash studies, there may be interpretation difficulties: are post-whiplash findings, when present, a consequence of the whiplash trauma, or did they exist prior to trauma? In the Vågå headache epidemiology study (1995–1997), there was a headache history and detailed physical/neurological findings from the face/head/neck in1838 18–65-yearold parishioners. In September 2001, four years after the Vågå study, a search through the Health Centre files divulged six cases with whiplash trauma in the intervening period. These parishioners could thus be their own controls. Two females did not develop new complaints. In the four parishioners with apparently new, subjective complaints, i.e., headache, neck pain, and a feeling of stiffness in the neck, there were corresponding findings as regards various parameters: shoulder area skin-roll test, changes in two, possible changes in two; range of motion, neck, changes in two, borderline changes in one; “features indicative of cervical abnormality” (“CF”), changes in all four; the mean, post-whiplash stage value was: 3.6+, against 1.6+ prior to accident (Vågå: only 0.93%, “CF” exceeding 3+). In the two O. Sjaastad Department of Neurology, St Olavs Hospital, Trondheim University Hospitals (NTNU), Trondheim, Norway O. Sjaastad • J. Båtnes Vågå Communal Health Centre, Vågåmo, Norway T.A. Fredriksen Department of Neurosurgery, St Olavs Hospital Trondheim, Trondheim University Hospitals (NTNU), Trondheim, Norway H.C. Petersen Department of Statistics, University of Southern Denmark, Odense, Denmark L.S. Bakketeig IST Institute of Public Health, Epidemiology, Søndre Boulevard 23a, DK-5000 Odense C, Denmark O. Sjaastad () Gautes gate 12, N-7030 Trondheim, Norway e-mail: Tel: +47-73-525276 Fax: +47-73-551539 without new complaints, the mean “CF” value was 1.0+. The number of cases is small, but the similarity of the symptoms – and signs – following whiplash injury may suggest an element of organic origin in the whiplash syndrome. Keywords Headache • Whiplash • Neck sprain • Skin-roll test • Mechanical precipitation of headache 10 Introduction The so-called late whiplash syndrome is characterised by a certain constellation of symptoms: mainly neck ache, subjective feeling of neck stiffness and headache, persisting in excess of 6 months after, mostly rear-end, car collisions. Grossly, the medical world is divided into two factions in its view of the late whiplash syndrome. One faction ascribes the complaints largely to a particular mental attitude towards putative economic compensation [e.g., 1–3]. The other faction has it that organic, cervical changes are more likely to some extent to underlie the symptoms [4, 5]. Clinical neurological examination has not uncovered consistent neck abnormalities [1]. This can, however, not be taken as hard evidence that the firstmentioned faction is right. A well known, inherent shortcoming of whiplash studies in general is the interpretation difficulty: are headache/neck problems and/or neurological findings due to the trauma, or were they preexisting? During the Vågå study of headache (October 1995–September 1997) [6], a face-to-face interview and a neurological/physical examination of the head and neck [7] were incorporated. In September 2001, 4–6 years after the Vågå study, the files of the Vågå Health Centre were scanned for whiplash cases. Probably, some parishioners would have sustained an indirect neck trauma in the intervening period. This proved to be the case. The principal aim of this study was, accordingly, on the basis of pre- and post-injury examinations, to search for physical/neurological findings and symptoms, mainly headache and its attributes, possibly originating in the post-whiplash period. Table 1 Whiplash syndrome criteria. Features 5–7 are probably the main constituents of the whiplash injury symptomatology 1. Evidence for indirect neck trauma of the hyperextension/hyperflexion typea,b,c 2. Trauma of a severity leading to consultation (in our context)a,b 3. No symptoms and signs caused by additional head injuryb 4. No loss of consciousness in connection with traumab 5. Neck paina,b 6. Headachea,b,c 7. Subjective feeling of neck stiffness 8. Symptoms (headache in our context), developing within 3 daysb aBalla and Iansek [11]; bRadanov et al. [10]; cICHD-II [12] In September 2001, 4–6 years later, the files of the Vågå Communal Health Centre were scrutinised for neck sprain cases occurring after examination I. This resulted in the retrieval of six records from parishioners with probable whiplash trauma, sufficiently severe to have led to consultation, each parishioner thereby implicitly acknowledging being a patient. There was thus already at the outset a selection: these whiplash victims seemed to have exacerbations/de novo symptoms. These parishioners were then examined (examination II). The whiplash criteria of the IHS were not available at the time. Criteria were, therefore, constructed (Table 1); they were mainly based on Radanov and co-workers’ criteria [10], but also contain elements from Balla & Iansek’s work [11] and – later – proved to contain elements also from the ICHD-II [12]. To diagnose cervicogenic headache (CEH), the CHISG criteria at the time were adhered to [13]. Migraine and tension-type headaches were diagnosed according to the IHS criteria [14]. Assessment of the methods used: “features indicative of cervical abnormality” [8] Material and methods There were 3907 parishioners in Vågå in 1995, just prior to the start of the Vågå study. All 18–65-year-old parishioners were invited to participate, and 1838 of those available (88.6%) were examined by the principal investigator (O. Sjaastad) [7]. The examination included a detailed survey of headache problems in a face-to-face interview, based on an elaborate questionnaire. A routine, detailed physical/neurological examination of the face, head, and neck was carried out, and, in addition, a short-version general, neurological examination (examination I). A special, clinical examination programme [8, 9], elaborated upon in the forthcoming, “features indicative of cervical abnormality”, was included. If deemed necessary from a clinical point of view, a full-scale neurological examination was carried out. In such cases, X-ray examination and CT/MR examinations of the head/neck might also be carried out. Minor, possible abnormalities on neurological examination (changes at the “academic level”) were not taken into account. A crucial component of this study is the pre-whiplash physical examination, which comprised the following five factors: (I) skin-roll test; (II) provoc (...truncated)