Whiplash is defined as an acceleration-deceleration injury mechanism that transmits energy to the neck, potentially causing bone or soft tissue injuries. These injuries can lead to various clinical manifestations known as Whiplash-Associated Disorder (WAD).
Causes of Whiplash Injury 
Whiplash can occur in various types of accidents, such as diving incidents or certain high-risk sports. However, most whiplash injuries result from traffic accidents, particularly rear-end collisions, where the vehicle is hit from behind and experiences forward acceleration.
In a classic rear-end collision injury, the patient’s torso and shoulders accelerate similarly to the car seat, while the head remains static. This results in a forced hyperextension of the neck, which is the main and most severe cause of injury. After this extension, inertia moves the head forward, causing hyperflexion.
Symptoms 
- Neck pain: The most common symptom, present in almost all patients.
- Headache: The second most frequent symptom, typically occurring in the occipital region.
- Tingling (paresthesia) in the upper limbs
- Cognitive disturbances: Usually temporary, including difficulty maintaining concentration and attention.
- Difficulty swallowing: Present in 18% of cases.
- Auditory symptoms: Hearing loss and tinnitus (ringing in the ears).
- Dizziness and instability: Present in up to 50% of cases.
Despite numerous and exhaustive neuro-otological studies conducted to date, the pathophysiological mechanisms of vertigo and dizziness associated with whiplash injury remain unclear.
Several theories have been proposed to explain these symptoms:
- Brain injuries:
- Ischemic mechanisms due to vertebral artery compression.
- Hemorrhagic mechanisms, such as intraparenchymal microhemorrhages or post-contusional degeneration of white matter caused by diffuse neuronal shear injury.
- Alterations in cervical sensory afferents (cervico-vestibular pathway).
- Isolated vestibular nerve injury or as part of the cochleovestibular nerve.
- Labyrinthine contusion, possibly due to microhemorrhages and degenerative changes in the cochlear and vestibular neurons.
- Post-traumatic benign positional vertigo (BPPV), with a pathophysiology similar to benign paroxysmal positional vertigo (BPPV).
- Perilymphatic fistula, accompanied by hearing loss, tinnitus, and vertigo that worsens with Valsalva maneuvers.
- Endolymphatic hydrops, resulting from altered formation and/or absorption of endolymph, as seen in Ménière’s disease.
- Cerebrospinal fluid hypotension, which may cause cerebellar tonsillar descent.
Diagnosis of Whiplash-Associated Disorder
Managing vertiginous syndrome associated with whiplash injury is particularly challenging due to the lack of consensus and standardized protocols.
An otolaryngology evaluation is recommended when a patient with whiplash reports vertigo (rotational dizziness), instability, or imbalance lasting more than 48–72 hours. The goal is to confirm or rule out a vestibular origin for these symptoms.
During the consultation, a detailed medical history of the symptoms will be taken, followed by a comprehensive otoneurological examination. A series of complementary tests may be performed, depending on the case, including:
- Audiometry
- Impedance testing
- Caloric tests (electronystagmography)
- vHIT (video head impulse test)
- VEMP (vestibular evoked myogenic potential)
- Dynamic posturography
Treatment and Evolution of Dizziness from Whiplash Injury
- Epley maneuver for BPPV
- It is important for the patient to understand that most of these conditions resolve without long-term consequences. However, full recovery may take time, so leading a normal life as much as possible is recommended.
- Medications: Treatment is primarily symptomatic, regardless of the suspected underlying mechanism. Common medications include antivertigo drugs, muscle relaxants, antiemetics, and vasodilators.
- Repositioning maneuvers for cases of benign paroxysmal positional vertigo (BPPV), performed in consultation and, when necessary, supplemented with vestibular rehabilitation exercises at home.
- Cervical rehabilitation and physiotherapy, prescribed by a traumatologist, is often highly beneficial in these cases.