Frequency of Primary Neck Pain in Mild Traumatic Brain Injury/Concussion Patients

Arch Phys Med Rehabil. 2020 Jan;101(1):89-94. doi: 10.1016/j.apmr.2019.08.471. Epub 2019 Sep 4.


Objectives: To determine (1) the frequency of neck pain overall and relative to other symptoms in patients presenting to a level I trauma center emergency department (ED) with mild traumatic brain injury (mTBI) and (2) the predictors of primary neck pain in this population.

Design: Cohort study.

Setting: Level I trauma center ED.

Participants: Patients presenting to the ED with symptoms of mTBI having been exposed to an event that could have caused mTBI (N=95).

Interventions: Not applicable.

Main outcome measures: Frequency of self-reported neck pain as measured by Sport Concussion Assessment Tool 3 (SCAT3) symptom questionnaire at <3, 8, 15, and 45 days post injury. Primary neck pain was defined in 2 ways: (1) neck pain rated as equal or greater in severity than all other SCAT3 symptoms and (2) neck pain worse than all other symptoms.

Results: The frequency of any reported neck pain was 68.4%, 50.6%, 49%, and 41.9% within 72 hours and at 8, 15, and 45 days, respectively. Frequency of primary neck pain (equal or worse/worse definitions) was 35.8%/17.9%, 34.9%/14.5%, 37%/14.8%, and 39.2%/10.8% across the 4 follow-up assessments. Participants who sustained their injuries in motor vehicle collisions had a higher rate of primary neck pain than those with other mechanisms of injury.

Conclusions: A sizable percentage of patients who present to level I trauma center EDs with mTBI report neck pain, which is commonly rated as similar to or worse than other mTBI-related symptoms. Primary neck pain is more common after motor vehicle collisions than with other mechanisms of injury. These findings support consensus statements identifying cervical injury as an important potential concurrent diagnosis in patients with mTBI.

Keywords: Brain concussion; Emergency service, hospital; Neck pain; Rehabilitation.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Accidents, Traffic / statistics & numerical data
  • Adult
  • Brain Concussion / complications*
  • Emergency Service, Hospital
  • Female
  • Humans
  • Male
  • Neck Pain / epidemiology*
  • Neck Pain / etiology
  • Prospective Studies
  • Severity of Illness Index
  • Trauma Centers