Headaches After Motor Vehicle Accidents (Part 1)

There are many causes of headaches following motor vehicle accidents, but in the following two blogs, I will summarize some of the more common ones.

1. Injury to the cranial sutures. The skull is often thought to be one solid bone, but it is actually many plates with joints between them. The most commonly injured in vehicle related accidents are the sagittal suture (which runs from the top center portion of the head towards the back of the head), coronal sutures (which run on the side of the head near the temples), and the lambdoidal sutures (which run diagonally across the back of the head). These joints are ragged and only a tiny bit apart. During a vehicle-related accident, the head may strike any part of the inside of the car, causing these joints to “jam”, which causes swelling and pain. The joints can also jam together if the head whiplashes backwards and forwards rapidly, even if there is no direct contact with any part of the inside of the vehicle. These injuries are extremely common and occur to some degree in over 80% of the patient that we see. These headaches can vary from being relatively mild to extremely severe. One of our present staff members had such severe headaches due to this injury, that she was essentially bedridden for nine months on high doses of narcotic medications. After the physical therapist gently maneuvering the joints back into their normal position, the headaches resolved. She has been headache free, and an import part of the Medig team ever since.

2. Headaches also often originate from the TMJ (jaw joint). As the head whiplashes backwards and forwards, the jaw is thrust upwards and jams against the temple bone. It also “flies downwards”, causing stretching of the ligaments around the jaw joint. There is a tiny piece of cartilage, or meniscus, shaped like a very tiny lifesaver candy that sits between the top of the jawbone and the temple. During a whiplash injury this structure can be forced out of position, causing the jaw to “lock” or “click”, which can be extremely painful, as well as make chewing extremely difficult. The surrounding muscles—the masseter, or chewing muscle, and temporalis, or temple muscle—often go into spasm to protect the joint. This leads to significant tightness of the facial muscles and headaches over the temple area. Treatment includes icing the affected area, limiting your diet to soft food and liquids only, antiinflammatories such as Aleve or Ibuprofen if you do not have any history of stomach irritation/ulcers and are not on blood thinners such as Coumadin or Plavix, muscle relaxers, and then physical therapy. Physical therapy to the jaw area is extremely complex and requires significant skill to treat the area well, but the vast majority of patients respond well to a combination of the above management. Very occasionally the use of a bite splint or even jaw surgery is required.

3. There are a significant number of structures that exist where the neck joins the base of the skull. Muscles in this area are often torn, leading to bleeding and stretching, and thus pain. Commonly injured nerves in this area include the greater and lesser occipital nerve that runs from the base of the skull up the back of the skull towards the top of the head. Facet joints (the joints on the side of each spine bone), that allow most rotation from side to side, can become locked or jammed if your head twists during the whiplash process. These “jammed joints” can cause pinching of the exiting nerves, causing significant pain.. Icing and antiinflammatories, as well as muscle relaxants, can cause symptomatic relief. All of these injuries can be reasonably easily treated by very experiences physical therapists who will very gently maneuver the facet joints into their normal position, gently stretch the injured muscles, and help the nerves to “slide and glide”, thus “un-trapping” them.

We will finish the rest of the causes in next month’s blog.

A Better Way to Get Better,
Adrian Lewis
Adrian Lewis, MD