Cervical spondylosis and headaches.

The incidence of headaches in well documented cases of cervical spondylosis with neurological disability was reviewed. This was compared to that in a series of cases with a clinical diagnosis of tension headache in order to determine if there were any identifiable differences between the two types of headache. Fifty-nine cases of cervical spondylosis were reviewed. Five of these patients had headaches. Fifty patients with tension headaches were also reviewed. No differences were seen when location or other qualitative features of the headaches were compared between the two groups of patients. We conclude that the incidence of headache is low in cervical spondylosis and that the pattern of headache has no features that distinguish it from that of tension headache, suggesting that the pathogenesis is similar. We therefore suggest that the basis of headache in patients with cervical spondylosis is secondary muscle contraction.

Whiplash headache.

This study considers the natural history and characteristics of headache occurring after whiplash injuries. Previous descriptions generally failed to distinguish between the headaches seen at various stages after the injury. In a prospective study of 180 cases of acute whiplash injury, it was demonstrated that 82% suffered from headache. One hundred and twenty-two cases were analysed to describe the type of headache seen and it was shown that in the majority rapid improvement occurred over a matter of some weeks. In a retrospective analysis of over 5000 cases of whiplash injury, about 25% developed chronic disability. Practically all of these had headaches. A retrospective analysis of 100 cases describes a spectrum of headaches different from those seen after the acute illness. The pathogenesis of the two types of headache is likely to be different and this needs to be investigated before rational treatment can be instituted.