# Whiplash injury of the neck - Category: acute - Review status: reviewed (every claim checked against a document named on this page) - Sources: Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) · MSF Essential Drugs 2024 - paracetamol (oral) · Cervical Sprain - StatPearls - NCBI Bookshelf - disease-level clinical article (whiplash-injury-of-neck-full.txt) · Lehman A, Margetis K. Cervical Sprain. [Updated 2026 Apr 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Bookshelf ID: NBK541016. PMID: 31082060. - Verified date: 2026-08 ## Verified against - MSF Essential Drugs 2024 - paracetamol (oral) - SmPC section 4.2, https://www.medicines.org.uk/emc/product/4560/smpc - No dose - referral pathway, no medicine given in primary care - Cervical Sprain - StatPearls - NCBI Bookshelf - disease-level clinical article (whiplash-injury-of-neck-full.txt) ## Treatment metadata - Paracetamol — 500 mg — oral.solid - Referral & safety-netting (no drug therapy) - Ibuprofen — 400 mg — oral.solid ## Complete treatment card ```text WHIPLASH INJURY OF THE NECK Sources: Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) · MSF Essential Drugs 2024 - paracetamol (oral) · Cervical Sprain - StatPearls - NCBI Bookshelf - disease-level clinical article (whiplash-injury-of-neck-full.txt) · Lehman A, Margetis K. Cervical Sprain. [Updated 2026 Apr 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Bookshelf ID: NBK541016. PMID: 31082060. Review status: REVIEWED against MSF Essential Drugs 2024 - paracetamol (oral), SmPC section 4.2, https://www.medicines.org.uk/emc/product/4560/smpc, No dose - referral pathway, no medicine given in primary care, Cervical Sprain - StatPearls - NCBI Bookshelf - disease-level clinical article (whiplash-injury-of-neck-full.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (5) - The history is a sudden speeding-up and slowing-down force on the neck, typically a road crash or a collision at sport - Pain in the neck leads the picture, with headache the next commonest [headache · neck pain] - Also described are stiffness, pain between the shoulder blades, arm pain or pins and needles, jaw trouble, occipital headache, visual upset and dizziness [dizziness · headache · neck stiffness · tingling] - Thinking may feel muddled, and anxiety or low mood are part of the syndrome [anxiety · confusion · low mood] - Some arrive already in a hard collar under routine trauma precautions SIGNS - what you find (6) - Reduced neck movement is the finding you meet most often, then tenderness or spasm of the paraspinal, trapezius, masseter, temporalis and suboccipital muscles [spasm] - Palpate the spinous processes and the paraspinal muscles with the neck held neutral - A step or tenderness in the midline means imaging, and the collar stays on meanwhile - You cannot clear the neck on clinical grounds if the patient is intoxicated or has another injury pulling their attention - In an awake, alert patient with no tenderness in the midline, no deficit and no pain on moving, precautions can be lifted without any scan - The neurological check should cover power and sensation in the arms plus the balance and thinking systems TESTS (10) - The diagnosis rests mainly on clinical grounds - NEXUS calls for imaging where there is posterior midline tenderness, a focal deficit, an altered mental state, intoxication or a distracting injury - The Canadian rule images anyone over 65, a dangerous mechanism, paraesthesiae, midline tenderness, immediate neck pain, or restricted movement - For acute blunt trauma the American radiology college puts CT ahead of plain films for the first look, restated in its 2024 update - MRI is not routine; it is the step up once the picture stops looking like a simple soft-tissue strain - Move to MRI for demonstrable radiculopathy or myelopathy, cord signs, worsening neurology, heavy ongoing midline pain despite a clear CT, or pain out of keeping with the CT - In this injury the scan appearance often fails to match how the patient feels - Bending and straightening films have no routine place in the acute sprain - Nerve conduction studies turn up abnormalities in roughly 32% of cases - Angiography of the neck vessels is reserved for suspected blunt cerebrovascular injury, such as focal posterior circulation signs, cranial nerve problems or a high-risk fracture pattern IF NOT THIS - what else fits (6) - Fracture of the cervical spine - Dissection of the carotid or vertebral artery - Injury to the spinal cord, or compression of it - Subluxation, or a disc that has herniated - Strain of muscle, facet injury or a sprained ligament - Where there was no trauma, or the presentation is late, think of cancer, infection, inflammation or vascular disease Score Canadian C-Spine Rule - Does this neck need imaging after blunt trauma? Source StatPearls "Cervical Sprain" - disease-level clinical article Status traced to the source above 1. PARACETAMOL [1st line] Adult 1 g three or four times daily, maximum 4 g in 24 hours - As needed for pain or fever Peds 15 mg/kg/dose [child max 500 mg] (Child 1 month and over: 15 mg/kg per dose, 3 or 4 times daily, maximum 60 mg/kg daily. Child under 1 month: 10 mg/kg per dose, 3 or 4 times daily, maximum 40 mg/kg daily. MSF's own weight table gives one 500 mg tablet three times daily from 30 kg to under 50 kg, so 500 mg is the per-dose ceiling; the 60 mg/kg daily total still applies.) 3kg -> 45 mg/dose 4kg -> 60 mg/dose 5kg -> 75 mg/dose 6kg -> 90 mg/dose 7kg -> 105 mg/dose 8kg -> 120 mg/dose 9kg -> 135 mg/dose 10kg -> 150 mg/dose 11kg -> 165 mg/dose 12kg -> 180 mg/dose 13kg -> 195 mg/dose 14kg -> 210 mg/dose 15kg -> 225 mg/dose 16kg -> 240 mg/dose 17kg -> 255 mg/dose 18kg -> 270 mg/dose 19kg -> 285 mg/dose 20kg -> 300 mg/dose 21kg -> 315 mg/dose 22kg -> 330 mg/dose 23kg -> 345 mg/dose 24kg -> 360 mg/dose 25kg -> 375 mg/dose 26kg -> 390 mg/dose 27kg -> 405 mg/dose 28kg -> 420 mg/dose 29kg -> 435 mg/dose 30kg -> 450 mg/dose 31kg -> 465 mg/dose 32kg -> 480 mg/dose 33kg -> 495 mg/dose 34kg -> 500 mg/dose (capped) 35kg -> 500 mg/dose (capped) 36kg -> 500 mg/dose (capped) 37kg -> 500 mg/dose (capped) 38kg -> 500 mg/dose (capped) 39kg -> 500 mg/dose (capped) 40kg -> 500 mg/dose (capped) 41kg -> 500 mg/dose (capped) 42kg -> 500 mg/dose (capped) 43kg -> 500 mg/dose (capped) 44kg -> 500 mg/dose (capped) 45kg -> 500 mg/dose (capped) 46kg -> 500 mg/dose (capped) 47kg -> 500 mg/dose (capped) 48kg -> 500 mg/dose (capped) 49kg -> 500 mg/dose (capped) 50kg -> 500 mg/dose (capped) Source MSF Essential Drugs 2024 - paracetamol (oral) Why Standard first-line analgesic dose for the musculoskeletal pain of whiplash; unrelated to any specific tissue diagnosis. Caution Neurological deficit, midline cervical spine tenderness, suspicion of fracture or dislocation, features suggesting cervical spine instability. First-line analgesic for whiplash neck pain; encourage early gentle movement rather than a rigid collar. Do not exceed 4 g in 24 hours; caution in liver impairment. Refer urgently if there is neurological deficit, midline cervical tenderness, or any suspicion of fracture/instability. Egypt FEBRIMOL 500 MG 20 TAB. PHARCO 3.50 EGP (0.17/unit) CETAMOL 500 MG 20 TABS. MEMPHIS 8.00 EGP (0.40/unit) PARACETAMOL-MUP 500MG B.P. 20 TABS. MUP 13.00 EGP (0.65/unit) CETAL 500 MG 20 TABS. EIPICO 24.00 EGP (1.20/unit) ARKADOLOW 500 MG 30 F.C. TABS. UTOPIA 42.00 EGP (1.40/unit) PARAMOL 500MG 20 TAB. MISR 38.00 EGP (1.90/unit) ADOL 500MG 24 CAPLETS JULPHAR 32.00 EGP AUGICETAMIDE 500 MG 20 SACHETS AUG PHARMA 50.00 EGP FEBRIMOL ORAL DROPS 20 ML PHARCO 4.00 EGP -> ? strength differs, ? different route - not oral solid THERA-LO 3.2G/100ML ORAL SUSP. 100 ML PHAROPHARMA 5.00 EGP -> ? strength differs, ? different route - not oral solid 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source No dose - referral pathway, no medicine given in primary care Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - The NEXUS and CCR criteria for urgent imaging or referral are focal neurologic deficits, age >65, dangerous mechanism, midline tenderness, paresthesias, and altered mental status. A distracting injury or intoxication makes clinical clearance of the cervical spine unsafe - the neck cannot be cleared on examination alone until the patient is alert and cooperative. Focal posterior-circulation symptoms, cranial nerve signs or a high-risk fracture pattern raise the possibility of blunt cerebrovascular injury (carotid or vertebral artery dissection) and require vascular imaging, not reassurance. Neck pain that appears without a clear injury, or long after one, should be worked up for malignancy, infection, inflammation or vascular disease rather than treated as a sprain. Refer for surgical opinion if there is fracture-dislocation, unstable ligament disruption, a traumatic disc herniation with persistent or progressive radiculopathy, cord compression with myelopathy, craniocervical instability, or neurological deterioration despite conservative care. Muscle relaxants are widely prescribed for this injury but the evidence supporting them is limited. A patient still substantially disabled at 6 to 12 weeks is not merely healing slowly - this marks high risk of prolonged symptoms and calls for a change of approach rather than more waiting. Cervical precautions can be stopped without imaging only in an awake, alert patient with no midline tenderness, no neurological deficit and no pain on active movement of the neck. 3. IBUPROFEN [2nd line] Adult 200-400 mg PO Q6-8H PRN, max 1200 mg/day. Peds For pain and fever 20 mg/kg/day in divided doses (including OTC use). Source SmPC section 4.2, https://www.medicines.org.uk/emc/product/4560/smpc Why Standard analgesic-strength NSAID dose for whiplash pain; the much higher anti- inflammatory regimen used for genuine inflammatory disease is unnecessary for a soft- tissue sprain. Caution Add to or use instead of paracetamol for inadequate pain relief; take with or after food. Avoid in NSAID-exacerbated asthma, active peptic ulcer disease, dehydration/renal impairment, or pregnancy. Reassess if pain is not settling over 1-2 weeks, or sooner if red flags develop. Egypt DAJUANOFEN 400 MG 20 F.C. TABS. COPAD PHARMA 5.00 EGP (0.25/unit) FLABU 400MG 10 F.C.TAB. DELTA PHARMA 3.75 EGP (0.38/unit) NOVA-PROFEN 400MG 30 F.C. TABLETS SANOFI 12.75 EGP (0.42/unit) IBUPROFEN 400 MG 10 TAB. SEDICO 6.00 EGP (0.60/unit) MAFO 400 MG 30 F.C.TABS EIPICO 42.00 EGP (1.40/unit) BRUFEN 400 MG 30 TABS. KAHIRA > ABBO... 78.00 EGP (2.60/unit) PROFUSOL 400MG 20 S.G CAPS. EUROPEAN EGYP... 31.00 EGP ANALGIPROF 400 MG 25 SACHETS EVA PHARMA 37.50 EGP NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML SANOFI 2.25 EGP -> ? strength differs, ? different route - not oral solid BRUFEMOL-N SUSP. 60 ML ARAB DRUG COM... 4.50 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)