Post-Concussion Syndrome After Mild Traumatic Brain Injury

The purpose of this study was to investigate the relationship between Post-Concussion Syndrome (PCS) and posttraumatic stress disorder (PTSD) in a population of motor vehicle accident survivors. The authors anticipated finding more PCS in MTBI individuals with concurrent PTSD than in TBI patients without PTSD. Their hypothesis was that the additional cognitive load of anxiety and intrusive symptoms of PTSD influenced MTBI patients’ experience of PCS.

The population was divided into two groups, one group of 46 with MTBI, and one group of 59 with no TBI. Assessment for PTSD and PCS was done for both groups six months post-trauma. A clinical psychologist conducted the assessment using the PTSD module from the Composite International Diagnostic Interview (CIDI). The authors also administered a postconcussive symptom checklist requiring patients to report the presence or absence of postconcussive symptoms consisting of: dizziness, fatigue, headaches, irritability, sensitivity to light, sensitivity to sound, concentration deficits and visual disturbances.

MTBI patients with chronic PTSD reported more concentration deficits, dizziness, fatigue, headaches, sensitivity to sound and visual disturbances than MTBI patients not suffering from PTSD. Additionally, the presence of concentration deficits, dizziness, fatigue, headaches, irritability, and visual disturbances was significantly linked with the severity of PTSD. The authors surmise that their findings add to the growing body of literature linking psychological and neurological factors to PCS:

“It is possible that the heightened anxiety and cognitive load experienced by PTSD patients resulted in greater demands on their cognitive resources, and this may have contributed to PCS. This interpretation is indicated by the finding that persistent PCS were associated with the severity of intrusive, avoidance, and arousal symptoms. Intrusive and avoidance symptoms cannot be readily attributed to neurological factors. Accordingly, this finding suggests that the degree of posttraumatic stress experienced by MTBI patients contributed to persistent PCS. The presence of this pattern in the MTBI sample but not in the non-TBI sample indicates that heightened posttraumatic stress compounded the neurological effects of the MTBI. This pattern accords with Rutherford’s (1989) view that PCS is mediated by an interaction of psychological and neurological factors. This study did not obtain neuropsychological data, and the role neurological factors could be more rigorously indexed in future studies by investigating the role of cognitive deficits in the relationship between PCS and PTSD after MTBI.”

The authors conclude:

“These findings point to the importance of PTSD in the development and maintenance of PCS. Considering the potential impairment caused by both PTSD and PCS, these findings indicate that rehabilitation of MTBI individuals needs to recognize that effective management of PCS may be facilitated by addressing the symptoms associated with PTSD.”

  1. Bryant RA, Harvey AG. Postconcussive symptoms and posttraumatic stress disorder after mild traumatic brain injury. Journal of Nervous and Mental Disease 1999;187(5):302-305.
  2. Peters L, Andrews G, Cottler LB, Chatterji S, Janca A, Smeets, RMW. The composite international diagnostic interview post-traumatic stress disorder module: Preliminary data. International Journal on Methods ofPsychiatric Research 1996;6:167-174.

Proof of Ligament Trauma After Auto Injury

Much of the research on whiplash injuries over the last few years has focused on the ligaments of the spine as the source of chronic pain and loss of function. Ligament injuries are problematic for two reasons: first, such injuries can be impossible to detect using plain x-rays or CT scans; and, second, torn ligaments can cause permanent disability if untreated.

A 2004 study1 found that the transverse ligament could be injured from rear-end collisions. A new study2 from Norway adds some exciting new insight to the nature of ligament injuries from auto collisions, and provides some new information on the role of head position at the time of the collision.

Previous researchers have found that head position can be an important risk factor in whiplash; patients who have their heads turned at the moment of the crash are much more likely to be injured. This is due to the fact that combined extension of the neck with rotation places severe strains on the ligaments of the spine.

To investigate this issue, the authors of this recent study2 performed MRIs on 92 whiplash patients and 30 healthy control subjects. All of the whiplash patients had normal x-ray results one week after the collision. The MRI was performed an average of six years after the collision.

Ligament injury after whiplash
The transverse ligament limits the motion of the 1st Cervical Vertebrae (Atlas) and the 2nd Cervical Vertebrae (Axis). If the head is turned during a rear-end collision, this ligament can be stretched or torn, resulting in chronic pain and loss of neck function.

The authors found significant differences between the whiplash patients and control subjects:

  • “For all the neck structures considered, the chronic whiplash patients had significantly more MRI high-grade changes than the controls…”
  • The alar ligament was the most commonly injured structure, as 66% of the whiplash patients showed significant damage to the ligament.
  • “The patients who had the head rotated at the instant of collision had more often high-grade MRI changes of the alar ligaments than those with the head in a neutral position. A total of 61.7% of the patients with rotated neck position had alar ligament grade 3 lesions, as opposed to only 4.4% in the patient group with neutral neck position.”
  • “The association between head position and high-grade lesions (grade 2-3) of the alar ligaments was more pronounced in rear-end…than in front collisions.”
  • “High-grade lesions to the transverse ligament were also more common among patients with the head turned at the instant of the collision. Similar results appeared for the tectorial membrane, although with rather few high-grade changes.”
  • “Severe MRI changes in the transverse ligament and the posterior atlanto-occipital membrane were considerably more common in front-end than in rear-end collisions.”

This study provides some very important findings relevant for those who represent whiplash injury patients:

  • Front-end collision can cause ligament injury from hyper-flexion. The authors write that, “front-end collisions should be included in the definition of potential causes of a whiplash trauma, not only rear-end or side impact.”
  • Head position is an important risk factor in whiplash injuries, as a turned head at the time of impact dramatically increases the changes of ligament injury. When working with whiplash patients, it is critical to take a careful history, with particular emphasis on the position of the occupant’s head at the time of impact.
  • MRI exams of the ligaments of the upper cervical spine can be a useful tool in diagnosing chronic whiplash pain. The authors of this study looked for increased signal intensity in the affected structures.

The authors conclude their study, “the difference in MRI-verified lesions between [whiplash] patients and control persons, and in particular the association with head position and impact direction at the time of the accident, indicate that these lesions are caused by the whiplash trauma.”

  1. Krakenes J, Kaale BR, Nordli H, Moen G, Rorvik J, Gilhus NE. MR analysis of the transverse ligament in the late stage of whiplash injury. Acta Radiologica 2003;44:637-644.
  2. Kaale BR, Krakenes J, Albrektsen G, Wester K. Head position and impact direction in whiplash injuries: associations with MRI-verified lesions of ligaments and membranes in the upper cervical spine. Journal of Neurotrauma 2005;22(11):1294-1302.

Similarities Between Auto Injury and Brain Injury

The biggest challenge with treating auto injuries is getting a proper diagnosis. Countless studies show that whiplash patients have objective, organic injuries; unfortunately, many of these injuries are difficult to pinpoint with conventional diagnostic imaging techniques, such as CT or MRI.

Further complicating diagnosis is the fact that the focal point of the injury in most patients is the neck. Due to the complexity of the cervical spine, many different structures can be injured and the symptoms of different types of injuries can overlap with other kinds of injuries.

Common Symptoms of Mild Traumatic Brain Injury

  • Headache
  • Dizziness
  • Tinnitus (ringing in the ears)
  • Difficult concentrating
  • Visual Symptoms
  • Memory Loss
  • Feeling dazed
  • Nausea

A current study looks at this problem; specifically, it examines the diagnostic challenge of differentiating whiplash associated disorder (WAD) from concussion in patients with neck injuries.

For many years, researchers have realized that many patients with whiplash present with symptoms similar to patients with brain injury. The chart shows the most common symptoms of brain injury. Over the last ten years, dozens of studies have been published showing that many whiplash patients complain of the same problems. The challenge is to determine which patients have TBI and which have spinal injuries.

The authors decided to study the issue by looking at hockey players. They followed 20 teams (183 players) for a single season. During that time, 13 players received either a whiplash injury or a concussion. Each of the injured players was given a thorough examination. This is what the study found:

  • All of the patients with whiplash injury (6 players) reported concussion symptoms, even if the patient had the least severe type of whiplash injury.
  • “Full resolution of concussion symptoms at the 7-10 day follow-up evaluation was reported by five of the 13 subjects. Of these five subjects, two were still experiencing WAD symptoms.”
  • 12 of the 13 injured players reported headache; 10 of the 13 reported dizziness.

At the 7-10 day follow-up:

  • 6 of the 13 injured players reported a complete resolution of whiplash symptoms, but three of the six were still experiencing the symptoms of concussion.
  • “Full resolution of concussion symptoms at the 7–10 day follow-up evaluation was reported by five of the 13 subjects. Of these five subjects, two were still experiencing WAD symptoms.”
  • “Overall, only three of the 13 subjects or 23% experienced full resolution of both their WAD and concussion symptoms at the follow-up evaluation.”

The authors have this to say about their findings:

“The athletes studied in this investigation experienced symptoms of both WAD and concussion after a head and/or neck complex acceleration/deceleration injury. However, the number of concussion symptoms they experienced did not associate with an increased severity of WAD grading. Symptom resolution during the 7–10 day follow-up period differed between athletes and injury mechanisms. Based on the observed prevalence of symptoms of both WAD and concussion irrespective of the mechanism of injury, it is important for the clinician treating a patient or athlete for WAD to evaluate for symptoms of concussion and for the team therapist/clinician to be cognizant of conducting a thorough cervical evaluation when dealing with concussed players.”

The same holds true for non-athlete patients in motor vehicle collisions. Because symptoms of traumatic brain injury can overlap with those of cervical spine injury, patients with symptoms of brain injury should be carefully examined for the presence of concussion.

Of particular concern are those patients who don’t seem to be recovering from the current treatment, or for those patients who experience personality changes after the collision. Undiagnosed brain injury can result in unemployment, divorce, depression, and other serious social and medical problems.

Hynes LM, Dickey JP. Is there a relationship between whiplash-associated disorders and concussion in hockey? Brain Injury 2006;20(2):179-188.

Aggressive Behavior after Brain Injury

Traumatic brain injury (TBI) is a complex issue for a variety of reasons. First, many cases of TBI go undiagnosed for months or even years. Since patients with head injuries often times have other injuries, the brain trauma may not receive the attention it deserves.

Another problem with head injury is that it often results in psychological symptoms that can complicate the diagnosis and treatment. Traumatic brain injury can result in depression, changes in personality, anxiety, paranoia, or apathy. One of the most frustrating and challenging symptoms is aggression.

The authors of a current study on aggression after brain injury stated the problem succinctly:

“Associations between TBI and neuropsychiatric disorders have been recognized for many years. Aggressive behavior is one of the most socially and vocationally disruptive consequences of these neuropsychiatric disorders. Aggression endangers the safety of patients, families, and caregivers. It may prevent patients from receiving the care that they need and disrupt their rehabilitation process. Estimates of the frequency of aggressive behaviors during the acute period after TBI have ranged from 11% to 96%.”

In this study, the researchers assessed 89 patients with TBI and 26 patients with multiple traumas, but without TBI. All of the TBI patients in the study had post-traumatic amnesia that lasted at least 30 minutes.

Aggressive behavior was assessed with the Overt Aggression Scale (OAS). The OAS allows clinicians to quantify aggression by defining four categories of aggressive behavior: verbal aggression, physical aggression against objects, physical aggression against self, and physical aggression against others. All patients also received a thorough psychiatric assessment. The authors found the following:

Aggression After Brain Injury
The frontal lobe (shown here in blue) regulates higher “executive” functions of the brain, such as conscious thought, memory, intelligence, concentration, behavior, and personality. Injury to the frontal lobe can result in aggression in some patients.
  • Patients with TBI were much more likely to exhibit aggression. In the TBI group, 33.7% met the criteria for aggressive behavior in the first six months after injury, while only 11.5% of the non-TBI patients did.
  • Within the TBI group there were no significant differences between the aggressive and the non-aggressive groups in age, gender, race, years of education, socioeconomic status, or history of anxiety disorder.
  • There was a strong relationship between depression and aggression: of the 30 aggressive patients, 17 also met the criteria for major depression.
  • Aggressive patients also suffered from poorer social functioning.
  • Patients with aggressive behavior were more likely to have injuries to the frontal lobe. While non-aggressive patients were more likely to have diffuse brain injuries.
  • Patients with aggressive behavior had a significantly higher frequency of legal interventions for aggressive behavior prior to the brain injury, and were more likely to have a history of drug or alcohol abuse.

Clearly, patients with a history of closed head injury and aggressive behavior are at a disadvantage when it comes to receiving proper treatment and vocational rehabilitation. The authors of this current study conclude:

“In summary, aggression following TBI is associated with multiple biological and psychosocial factors, including major depression, substance abuse, and impaired social function as well as the presence of brain injury involving the frontal lobe. These findings suggest that interventions aimed at treating major depression or substance abuse and improving social function may help reduce episodes of aggression in patients who have suffered traumatic brain injury.”

Clinical Implications

Aggression after an injury may be due to brain damage. Patients that show signs of aggression should be carefully evaluated for the existence of head injury, and proper treatment should be sought out.

Tateno A, Jorge RE, Robinson RG. Clinical correlates of aggressive behavior after traumatic brain injury. Journal of Neuropsychiatry and Clinical Neurosciences 2003;15:155-160.

Ligament Damage After an Auto Injury

Our understanding of whiplash injuries has grown impressively over the last 10 years, when the first detailed analysis of spinal mechanics was done. From countless studies, we’ve seen that the human neck experiences an abnormal motion during a rear end collision, and that the facet joints of the spine can be sprained during such collisions.

Now a new study has looked more closely at what happens to the neck, but this time by studying the anterior ligaments of the spine. Previous studies have shown that some patients experience injuries to the anterior longitudinal ligament after whiplash. This new report by leading whiplash researchers used a sophisticated mathematical analysis (based upon experimental anatomical and crash data) to see what happens to the ALL during a crash.

Anterior longitudinal ligament
The anterior longitudinal ligament runs along the front of the human neck, providing stability for the vertebrae of the spine. During a rear end collision, this ligament can become sprained, resulting in pain and even chronic degeneration of the spine.

The human spine model was subjected to three different collision speeds: 5.3, 6.7, and 8 mph. The amount of distraction, or displacement at each vertebral segment was analyzed.

The researchers found that as the speed increased, the amount of strain increased and the time of the peak distraction also occurred earlier in the motion.

The authors report a number of findings that are relevant to those who work with whiplash cases:

  • The ALL reached stretches that were near the failure rate of the ligament, at collision speeds of just 8 mph.
  • Injuries that don’t result in failure may be even more difficult to diagnose, since they will be virtually undetectable on plain film radiographs.
  • The anterior ligaments of the spine have been shown to have pain receptors. Sprains or tears of the ALL can cause referred pain that can affect adjacent areas of the spine.

The authors summarize some of the potential serious, chronic problems that can result from these types of injury:

“A possible clinical implication associated with ALL injury is cervical instability. Catastrophic injury of the ALL can result in acute disability while sub-catastrophic injury may lead to chronic pathology. Injuries to the ALL had the highest correlation to extension instability. However, that study also indicated high correlation of ALL injury to axial rotation instability and anterior column injury to lateral bending instability. Injuries produced experimentally in that study were similar to clinically observed injuries. Anterior cervical injuries sustained in whiplash are typically distractive extension stage 1 injuries resulting in an absence of neurologic abnormalities. These injuries are not visible using conventional radiographyand result in cervical instability. The ALL is intimately connected to the annular fibers of the intervertebral disc. Presuming all sub-components of the intervertebral motion segment are normal prior to injury, subcatastrophic failure of the ALL (stretch) will likely result in chronic changes within the disc as a result of decreased extension stability. The added hypermobility may lead to spinal disorders such as early degeneration of the connected intervertebral disc or vertebrae. In addition, segmental hypermobility leads to long-term instability. Catastrophic failure of the ALL in a whiplash injury will almost inevitably result in simultaneous injury to the intervertebral disc, and is likely to require surgical intervention.”

This study shows that the anterior ligaments of the spine undergo potentially injurious motion and that this motion may lead to long-term disability. For patients who have experienced a rear-end collision, it is advisable to get a thorough diagnosis to determine cervical instability and the potential for spinal degeneration years later.

Stemper BD, Yoganandan N, Pintar FA, Rao RD. Anterior longitudinal ligament injuries in whiplash may lead to cervical instability. Medical Engineering & Physics 2006;28:515-524.

Yoga Alleviates Knee Pain

Yoga helps relieve knee painA recent study set out to determine whether yoga therapy can help alleviate pain in patients undergoing total knee-replacement surgery.

The study involved 51 patients undergoing total knee replacement (TKR) because of osteoarthritis. On the third day after surgery, baseline scores for pain and stiffness were taken. Half of the patients received conventional physiotherapy. The other half also received once-daily yoga asana treatment. Upon being discharged from the hospital, these patients were provided with photographs of the asanas and written instructions, and instructed to perform the movements 3 days per week.1

Yoga asanas are functional postures involving slow stretching and movements of muscles and joints, and encourage different muscle groups to achieve stability and equilibrium. The purpose of the study was to determine whether yoga asanas have an added advantage for treating patients who have undergone total knee replacement.

Patients were evaluated at 6 weeks and 3 months after surgery to measure their perception of pain, stiffness, and function. The researchers found lower pain and stiffness reported by the group receiving yoga therapy than for patients receiving conventional therapy alone. They concluded that patients practicing yoga had better pain relief, reduced stiffness, and better function, suggesting that yoga asanas may be a valuable addition to conventional post-surgery treatments.

Previous studies have recommended additional non-surgical approaches to reducing knee pain, particularly that resulting from osteoarthritis. Chiropractic adjustments have been shown to benefit patients with knee pain, who reported substantial drops in pain intensity and improvements in mobility, along with fewer clicking or grinding sensations within the knee.2 Weight loss has also been shown to alleviate chronic knee pain in obese patients.3 Consult with your doctor about relieving knee pain naturally.


  1. Bedekar N, Prabhu A, et al. Comparative study of conventional therapy and additional yogasanas for knee rehabilitation after total knee arthroplasty. International Journal of Yoga 2012; 5(2): 118-122.
  2. Pollard H, Ward G, Hoskins W, and Hardy K. The effect of a manual therapy knee protocol on osteoarthritic knee pain: a randomised controlled trial. The Journal of the Canadian Chiropractic Association 2008; 52(4):229-42.
  3. Richette P, Poitou C, Garnero P, Vicaut E, Bouillot JL, Lacorte JM, Basdevant A, Clement K, Bardin T, Chevalier X. Benefits of massive weight loss on symptoms, systemic inflammation and cartilage turnover in obese patients with knee osteoarthritis. Annals of the Rheumatic Disease 2011;70(1):139-44.

Helicopter Ambulances Save Lives

Helicopter Ambulances Save Lives
Photo courtesy of Dreamstime.

For over 40 years, helicopters have been used in medical emergencies to transport severely injured patients to the hospital. Compared to ambulances that take trauma patients to the hospital via roads, the service is both faster but also far more expensive. Due to the cost, there is ongoing debate about whether or not emergency helicopters are “worth it” when balanced with how effective they are at saving lives.

New research has suggested that the cost may be justified. Researchers analyzed data about patient transportation to hospitals, and they found that patients who were taken in a helicopter had a higher survival rate than those taken on the road, despite having more serious injuries.

Anonymous data was collected from more than 300 European hospitals, with transport and medical records of 13,000 patients. Approximately one-third of these patients traveled to the hospital in a helicopter. Research analysts found that these patients tended to be more severely injured, often with abdominal and chest injuries that required extensive treatment at the scene. While in the hospital,  these patients were also more likely to suffer complications and typically required more time in the hospital than those transported in an ambulance. However, the air-traveling patients benefited from a higher survival rate than the road-traveling patients.

The data analysis also found that patient diagnosis and quality of care in the hospital seemed to be the same among both groups of patients. This means that the reason for the better survival rate is likely tied to the transportation method, with helicopters offering increased speed to arrive at the hospital and medical staff providing more thorough treatment at the scene and during transport.

These findings support the use of air ambulance services in saving patient lives.


Andruszkow H, et al. Survival benefit of helicopter emergency medical services compared to ground emergency medical services in traumatized patients. Critical Care 2013; 17: R124. doi:10.1186/cc12796.

Motorcyclists Medical Insurance Claims Spike 36%

Motorcyclists Medical Insurance Claims Spike 36%
Photo by Elvert Barnes via Creative Commons

Severe injury claims by motorcyclists have risen by 36% in Michigan, after the state passed laws that exempt most riders from wearing helmets, according to a new study. The findings are consistent with earlier research showing that looser helmet laws lead to more hospitalizations and fatalities.

Michigan had previously required all riders to wear helmets, but in April 2012, Michigan Governor Rick Synder signed a bill exempting riders over the age of 21 from the requirement if they carried at least $20,000 in medical insurance coverage. Safety groups said the change would result in more fatalities since helmets reduce the risk of motorcycle fatalities by 37%, according to estimates from the National Highway and Traffic Safety Administration.

Now a new analysis from HLDI found that motorcycle injuries have indeed become more severe and costly in the state. Researchers from HLDI compared medical payment losses from the 2010-11 riding season with the 2012 riding season. To see what the expected losses would have been without the change, they also compared Michigan losses to Ohio, Illinois, Indiana, and Wisconsin losses, where helmet requirements did not change.

Overall, medical payment costs were 50% higher than expected. This hike may have partially resulted from an increased crash risk since the frequency of auto-collision claims rose by about 12%. However researchers believe that higher medical payments were mostly the result of increased claim severity, which rose by 36%.

The researchers were also aware that some motorcyclists with lower insurance coverage would increase their insurance policy limits with the new law since it allows riders to go without a helmet only if they have at least $20,000 in coverage. That could affect claim severity since policies with higher limits pay more for severe injuries. After taking policy limit changes into account, they estimated that there was still a 22% increase in claim severity.

“Weakening the helmet law seems to have made it somewhat more likely that riders will sustain injuries, but the big impact has been on the seriousness of the injuries,” said David Zuby,  chief researcher at HLDI and the Insurance Institute for Highway Safety. “Helmets can’t protect against all injuries, but they do help prevent debilitating and often fatal head trauma.”

Even with the looser helmet restrictions in Michigan, the increase in severe motorcycle injuries in the state reflects a national trend. A recent study found that motorcycle injuries have risen across all age groups, and that fatal crashes among older rider rose by 145% between 2000-2006.


Michigan‘s weakened  helmet use law leads to costlier injury claims. Highway Loss Data Institute. Press Release. May 30, 2013. Accessed June 26, 2013.

The effects of Michigan’s weakened motorcycle helmet use law on insurance losses. Highway Loss Data Institute Bulletin 2013; 30 (9).

Txt Hands-free? U Are Still In Danger

The Chevrolet Mylink is one of the many new interfaces allowing drivers to have hands-free mobile communications. Photo via Creative Commons.
The Chevrolet Mylink is one of the many new interfaces allowing drivers to have hands-free mobile communications in effort to improve auto safety. But new research shows that such interfaces aren’t as safe as previously thought. Photo via Creative Commons.

More and more new cars are coming equipped with elaborate voice-activated systems that allow drivers to text, call, and even check their email with ease. But does hands-free mean risk-free? No, according to a new study that found that hands-free tasks can lead to dangerous distracted driving.

The study from the AAA Foundation and the University of Utah shows that any task that increases mental workload while driving can put drivers at-risk of an accident.

Earlier research from the US Department of Transportation found that 78% of all crashes and near crashes are caused by inattentive driving. The DOT study characterized inattention as any task that created visual, physical, and cogntive distractions.

In this latest AAA study, researchers tracked drivers’ eye and head movement; reaction time to triggers of red and green lights; and mental workload with EEG skull caps that measured brain activity. Drivers performed various hands-free tasks while keeping their hands on the wheel and their eyes on the road. In one task, participants interacted with a voice-command system to answer message and dictate texts. Based on these measures, researchers rated drivers’ attention on a scale of 1-5. A score of 1 meant no distraction, and a score of 5 indicated the mental attention it would take to solve a challenging math or memory problem.

Photo via Creative Commons
Photo via Creative Commons

Drivers were the least distracted while listening to the radio (with a score of 1.21) or when listening to an audio book (1.75). Having a conversation with another person in the car scored a 2.33. Phone calls with a hands-free device were scored at 2.27 and without a hand-held phone at 2.45. By the far the most distracting task was hands-free texting, which received a score of 3.06. The results suggest that hands-free texting and voice-command systems require enough mental workload to make drivers dangerously distracted.

“These findings reinforce previous research that hands-free is not risk-free,” remarked AAA Foundation President and CEO Peter Kissinger in a press release. “Increased mental workload and cognitive distractions can lead to a type of tunnel vision or inattention blindness where motorists don’t see potential hazards right in front of them.” Kissinger said there was a “looming public safety crisis ahead” with the growth in hands-free technologies in new vehicles.

Texting while driving is now the leading cause of death in teen auto collision, according to a recent study. Other research suggest texting behind the wheel may be as dangerous as drunk driving. But this latest AAA study shows that hands-free technologies aren’t the answer this growing safety concern.

The AAA foundation encouraged automakers to limit voice-commands to driving-related activities and to disable social media and texting functions while the car is in motion.


Why is hands-free texting dangerous? The Economist. June 24, 2013. Accessed June 25, 2013.

Strayer DL, et al. Measuring cognitive distraction in the automobile. June 2013. AAA Foundation. 

TMJ Disorders Cause Teeth Grinding and Headache, Study Finds

TMJ Disorders Cause Teeth Grinding and Headache, Study FindsDamage to the temporomandibular joint is known to cause a long list of problems and medical complications in patients with temporomandibular disorders, or TMD. Former research has linked TMD with fibromyalgia, and studies have also demonstrated that TMD patients are at risk of chronic headache, just to name a few associations.

To further our understanding of pain and complications related to TMD, researchers recently analyzed the association between TMD, sleep bruxism, and primary headaches in patients with injuries in the jaw and pain in this crucial joint. Sleep bruxism, which is excessive grinding of the teeth and clenching the jaw while sleeping, as well as certain types of primary headache, were found to be mutually associated with TMD.

The study included 301 TMD patients aged 18 to 76. Researchers examined each patient, classifying their TMD using the Research Diagnostic Criteria for Temporomandibular Disorders, diagnosing possible bruxism using clinical criteria from the American Academy of Sleep Medicine, and diagnosing headaches according to the International Classification of Headache Disorders-II.

Patients with painful TMD were found to be at risk of migraine and tension-type headaches. The highest association was between TMD and chronic migraine. Participants also were diagnosed with episodic migraine and episodic tension-type headache, associated with pain in the temporomandibular joint.

Researchers also discovered that sleep bruxism was prevalent in patients with both painful TMD and chronic migraine. They found that patients with both painful TMD and sleep bruxism were significantly more likely to suffer chronic migraine, episodic migraine, or episodic tension-type headaches.

Jaw symptoms are common among patients with whiplash injuries. However, jaw pain often does not appear immediately after a crash. The long-term effects may not be immediately realized for victims of auto injuries who are affected not only by jaw pain, but also debilitating headache and tooth-damaging grinding. This is why research that demonstrates the connection between TMD and damage to the cervical spine is so important. Patients who sustain whiplash injuries have the potential for a whole host of health problems down the road, and this should be considered when assessing the damage caused by a collision.


Fernandes G, Franco AL, et al. Temporomandibular disorders, sleep bruxism, and primary headaches are mutually associated. Journal of Orofacial Pain 2013; 27(1): 14-20. doi: 10.11607/jop.921.