Symptoms and Red Flag Signs of Whiplash
Whiplash injuries present with a characteristic pattern of symptoms that can range from mild to severe, with certain red flag signs indicating potential serious underlying pathology requiring urgent medical attention.
Common Symptoms of Whiplash
Whiplash symptoms typically develop within 24 hours of injury but may be delayed by 2-3 weeks in some cases 1. The primary symptoms include:
- Neck pain and stiffness - Most common symptom, often worse with movement
- Headaches - Typically starting at the base of the skull (occipital region) and radiating forward
- Reduced range of motion in the neck
- Pain or tenderness in shoulders, upper back, or between shoulder blades (interscapular pain)
- Paresthesias - Numbness or tingling in arms and hands (reported by more than one-third of patients acutely) 2
- Dizziness or vertigo
- Fatigue
- Difficulty concentrating or memory problems
- Sleep disturbances
- Blurred vision
Red Flag Signs Requiring Immediate Medical Attention
The following signs and symptoms suggest potentially serious complications and warrant urgent evaluation 3:
- Severe neck pain that is constant (not relieved by position change or rest)
- Neurological deficits - Weakness, numbness, or tingling in extremities that is progressive or severe
- Bilateral neurological symptoms affecting both arms or legs
- Difficulty with coordination or walking
- Bowel or bladder dysfunction (incontinence or retention)
- Severe headache that is worsening or different from usual post-injury headache
- Loss of consciousness associated with the injury
- Confusion or altered mental status
- Persistent vomiting
- Visual disturbances that persist or worsen
- Difficulty swallowing or speaking
- Neck instability - Feeling that the head is not properly supported by the neck
Risk Factors for Poor Prognosis
Certain factors identified at initial presentation are associated with prolonged recovery 2, 4:
- Female gender
- Older age
- Presence of interscapular or upper back pain
- Occipital headache
- Multiple symptoms or paresthesias at initial presentation
- Reduced range of movement of the cervical spine
- Objective neurologic deficit
- Pre-existing degenerative changes in the cervical spine
Evaluation Considerations
While most whiplash injuries resolve within 3 months, approximately 12% of patients have symptoms persisting beyond 6 months 4. For patients with persistent symptoms or red flags, imaging may be warranted:
- Plain radiographs are appropriate initial studies to rule out fracture or dislocation
- MRI is indicated when red flags are present, particularly with neurological deficits or symptoms persisting beyond 4-6 weeks 3
- CT scan provides superior evaluation of bony structures when fracture is suspected 3
Important Clinical Considerations
- The severity of the collision or vehicle damage correlates poorly with symptom severity or prognosis 2
- Psychological factors may influence recovery but should not be assumed to be the primary cause of persistent symptoms
- Temporomandibular disorders (TMDs) may co-occur with whiplash injuries, though the causal relationship remains unclear 5
Early active mobilization within pain tolerance is generally preferred over prolonged immobilization with cervical collars, which should be limited to the first 2-3 weeks after injury if used at all 2.