Headaches are a common complaint among patients with whiplash associated disorder (WAD) following a motor vehicle collision, slip and fall, or sports injury. While in some cases, the cause of WAD-associated headache can be a concussion or traumatic brain injury (TBI), in many instances the underlying cause of WAD-related headaches can be injury to the neck. How is this possible?
Past research has demonstrated that irritation of the nerves that pass through the top of the cervical spine (C1, C2, and C3) can lead to tension-type or cervicogenic headaches, especially when the C2 nerve is involved. These nerves exit the spine and travel through a thick group of muscles located at the top of the neck/base of the skull or “suboccipital” region.
In a 2019 study, a group of anatomists discovered the close relationship of the greater occipital nerve (C2) and a muscle called the obliquus capitus inferior (OCI) and sought to determine how the C2 might get “pinched” in injuries such as whiplash.
The authors studied 20 cadavers and found three patterns. The nerves either travelled loosely around the muscle (Type I), were incorporated in the dense muscle fascia (Type II), or travelled directly through a myofascial sleeve within the muscle (Type III). Among the 40 C2 nerves (there is a left and right), the research team found seven instances of Type I, thirty-one instances of Type II, and two instances of Type III. Because of the intimate relationship between the OCI and C2 nerve, it’s understandable that during the whiplash process, the stretching of C2 nerve combined with the contraction of the OCI could set the stage for injury to the nerve.
Doctors of chiropractic frequently find that WAD patients have a great deal of tenderness in the suboccipital region and respond well to upper cervical spinal manipulation and mobilization. When these muscles are more relaxed, neck pain and headaches often improve. Similarly, exercises that focus specifically on this region help the patient self-manage headaches and neck pain, which reduces the need for medications, many of which have negative side-effects.
One such exercise is called the cervical brace. This is done by kneeling on all fours and is broken down as follows: 1) “poke” your chin/head straight down toward the floor; 2) in a smooth scooping motion, tuck your chin down (chin-to-chest); 3) and then scoop your head back up to neutral keeping the chin tucked. Repeat in a smooth scooping motion (avoid doing it “steps”). Repeat until your neck feels loose. You may notice some painless popping, crunching sounds as you do the exercise. As modifiers, try it sitting or standing, with or without resistance applied to the forehead.
Studies show neck pain and headaches arising from WAD injuries respond very quickly to chiropractic care. Please consider chiropractic care FIRST in your post-WAD management process!