Higher Neck Pain Intensity and the Presence of Psychosocial Factors are More Likely when Headache is Present After Whiplash Associated Disorders: A Case-Control Study

BACKGROUND: Several factors such as neck pain intensity, disability, anxiety, depression, female sex or a previous history of headache, are associated with post-whiplash headache. However, the possible role of psychosocial factors contributing to the presence of headache or worsening of headache after a whiplash trauma remains unclear. To address this gap in knowledge, there is the need to assess psychosocial factors concerning headache shortly after a whiplash injury.

OBJECTIVE: To evaluate psychological features, pain and disability in people with acute Whiplash Associated Disorders (WAD) and compare these features between those with and without headache.

DESIGN: case-control study.

SETTING: A secondary care traumatology center.

METHODS: Forty-seven people with acute WAD were recruited; 28 with headache, and 19 without. All participants completed self-reported questionnaires including Visual Analogue Scale (VAS) for neck pain intensity, the Neck Disability Index (NDI), Pain Catastrophizing Scale (PCS), Tampa Scale Kinesiophobia-11 (TSK-11) and State-Trait Anxiety Inventory.

RESULTS: Neck pain intensity (p < 0.001), neck disability (p < 0.001), pain catastrophising (p < 0.001), kinesiophobia (p < 0.001) and anxiety state (p = 0.007) and trait (p = 0.05) were higher in those with headache when compared to those without. In addition, high levels of neck pain (p = 0.025), moderate levels of neck disability (p < 0.001), moderate levels of pain catastrophising (p = 0.015), and moderate (p = 0.002) and severe (p = 0.016) levels of kinesiophobia were related to the presence of headache.

CONCLUSION: The level of neck pain intensity and disability, kinesiophobia, catastrophising and anxiety were all greater in people with acute WAD who presented with a headache compared to those without headache.