Pierre Côté1,2,3, Hainan Yu2,4, Heather M Shearer2,5, Kristi Randhawa2,5, Jessica J Wong2,4,5, Silvano Mior2,3,5, Arthur Ameis3, Linda J Carroll6, Margareta Nordin7, Sharanya Varatharajan2,5, Deborah Sutton2,5, Danielle Southerst8, Craig Jacobs2,9, Maja Stupar2, Anne Taylor-Vaisey2, Douglas P Gross10,11, Robert J Brison12,13, Mike Paulden14, Carlo Ammendolia15,16, J David Cassidy17,18, Patrick Loisel5,19, Shawn Marshall20, Richard N Bohay21, John Stapleton22, Michel Lacerte23,24. 1. Canada Research Chair in Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), Oshawa, Ontario, Canada. 2. UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Canadian Memorial Chiropractic College (CMCC), University of Ontario Institute of Technology (UOIT), Oshawa, Ontario, Canada. 3. Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), Oshawa, Ontario, Canada. 4. Canadian Memorial Chiropractic College, Toronto, Ontario, Canada. 5. Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada. 6. School of Public Health and Injury Prevention Centre, Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alberta, Canada. 7. Departments of Orthopedic Surgery and Environmental Medicine, NYU School of Medicine, Occupational and Industrial Orthopedic Center, New York University, New York, New York. 8. Rebecca MacDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, Toronto, Ontario, Canada. 9. Division of Clinical Education, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada. 10. Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada. 11. Rehabilitation Research Centre, University of Alberta, Edmonton, Alberta, Canada. 12. Clinical Research, Kingston General Hospital, Kingston, Ontario, Canada. 13. Department of Emergency Medicine, School of Medicine, Queen's University, Kingston, Ontario, Canada. 14. Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada. 15. Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. 16. Institute for Work and Health, Toronto, Ontario, Canada. 17. University of Southern Denmark, Odense, Denmark. 18. Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. 19. Division of Occupational and Environmental Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. 20. University of Ottawa, Ottawa, Ontario, Canada. 21. Western University, London, Ontario, Canada. 22. Open Policy Ontario, Toronto, Ontario, Canada. 23. Université de Montréal, Montreal, Quebec, Canada. 24. Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Abstract
OBJECTIVES: To develop an evidence-based guideline for the non-pharmacological management of persistent headaches associated with neck pain (i.e., tension-type or cervicogenic). METHODS: This guideline is based on systematic reviews of high-quality studies. A multidisciplinary expert panel considered the evidence of clinical benefits, cost-effectiveness, societal and ethical values, and patient experiences when formulating recommendations. Target audience includes clinicians; target population is adults with persistent headaches associated with neck pain. RESULTS: When managing patients with headaches associated with neck pain, clinicians should (a) rule out major structural or other pathologies, or migraine as the cause of headaches; (b) classify headaches associated with neck pain as tension-type headache or cervicogenic headache once other sources of headache pathology has been ruled out; (c) provide care in partnership with the patient and involve the patient in care planning and decision making; (d) provide care in addition to structured patient education; (e) consider low-load endurance craniocervical and cervicoscapular exercises for tension-type headaches (episodic or chronic) or cervicogenic headaches >3 months duration; (f) consider general exercise, multimodal care (spinal mobilization, craniocervical exercise and postural correction) or clinical massage for chronic tension-type headaches; (g) do not offer manipulation of the cervical spine as the sole form of treatment for episodic or chronic tension-type headaches; (h) consider manual therapy (manipulation with or without mobilization) to the cervical and thoracic spine for cervicogenic headaches >3 months duration. However, there is no added benefit in combining spinal manipulation, spinal mobilization and exercises; and (i) reassess the patient at every visit to assess outcomes and determine whether a referral is indicated. CONCLUSIONS: Our evidence-based guideline provides recommendations for the conservative management of persistent headaches associated with neck pain. The impact of the guideline in clinical practice requires validation. SIGNIFICANCE: Neck pain and headaches are very common comorbidities in the population. Tension-type and cervicogenic headaches can be treated effectively with specific exercises. Manual therapy can be considered as an adjunct therapy to exercise to treat patients with cervicogenic headaches. The management of tension-type and cervicogenic headaches should be patient-centred.
OBJECTIVES: To develop an evidence-based guideline for the non-pharmacological management of persistent headaches associated with neck pain (i.e., tension-type or cervicogenic). METHODS: This guideline is based on systematic reviews of high-quality studies. A multidisciplinary expert panel considered the evidence of clinical benefits, cost-effectiveness, societal and ethical values, and patient experiences when formulating recommendations. Target audience includes clinicians; target population is adults with persistent headaches associated with neck pain. RESULTS: When managing patients with headaches associated with neck pain, clinicians should (a) rule out major structural or other pathologies, or migraine as the cause of headaches; (b) classify headaches associated with neck pain as tension-type headache or cervicogenic headache once other sources of headache pathology has been ruled out; (c) provide care in partnership with the patient and involve the patient in care planning and decision making; (d) provide care in addition to structured patient education; (e) consider low-load endurance craniocervical and cervicoscapular exercises for tension-type headaches (episodic or chronic) or cervicogenic headaches >3 months duration; (f) consider general exercise, multimodal care (spinal mobilization, craniocervical exercise and postural correction) or clinical massage for chronic tension-type headaches; (g) do not offer manipulation of the cervical spine as the sole form of treatment for episodic or chronic tension-type headaches; (h) consider manual therapy (manipulation with or without mobilization) to the cervical and thoracic spine for cervicogenic headaches >3 months duration. However, there is no added benefit in combining spinal manipulation, spinal mobilization and exercises; and (i) reassess the patient at every visit to assess outcomes and determine whether a referral is indicated. CONCLUSIONS: Our evidence-based guideline provides recommendations for the conservative management of persistent headaches associated with neck pain. The impact of the guideline in clinical practice requires validation. SIGNIFICANCE: Neck pain and headaches are very common comorbidities in the population. Tension-type and cervicogenic headaches can be treated effectively with specific exercises. Manual therapy can be considered as an adjunct therapy to exercise to treat patients with cervicogenic headaches. The management of tension-type and cervicogenic headaches should be patient-centred.
Authors: Eric J Roseen; Bolanle Aishat Kasali; Kelsey Corcoran; Kelsey Masselli; Lance Laird; Robert B Saper; Daniel P Alford; Ezra Cohen; Anthony Lisi; Steven J Atlas; Jonathan F Bean; Roni Evans; André Bussières Journal: BMJ Open Date: 2021-01-25 Impact factor: 2.692
Authors: Amy W McDevitt; Joshua A Cleland; Daniel I Rhon; Rebecca A K Altic; Drew J Courtney; Paul E Glynn; Paul E Mintken Journal: J Man Manip Ther Date: 2021-07-16
Authors: P M Wayne; C Bernstein; M Kowalski; J P Connor; K Osypiuk; C R Long; R Vining; E Macklin; P M Rist Journal: Contemp Clin Trials Commun Date: 2020-01-22
Authors: Cheryl Hawk; Wayne Whalen; Ronald J Farabaugh; Clinton J Daniels; Amy L Minkalis; David N Taylor; Derek Anderson; Kristian Anderson; Louis S Crivelli; Morgan Cark; Elizabeth Barlow; David Paris; Richard Sarnat; John Weeks Journal: J Altern Complement Med Date: 2020-07-30 Impact factor: 2.579