In a recently published paper, a group of prominent Canadian researchers have developed evidence based clinical guidelines for non-pharmalogical treatment of persistent tension-type headache or cervicogenic headache.
The researchers studied systematic reviews of neck pain, looking at the evidence of clinical benefits, cost‐effectiveness, societal and ethical values, and patient experiences when formulating the recommendations.
The recommendations are of great relevance to clinicians and patients suffering from persistent tension-type headache or cervicogenic headache because they uniformise treatment of neck pain and increase the quality of the treatment.
This has resulted in 9 recommendations from clinical guidelines for non-pharmalogical treatment of headaches associated with neck pain. The guidelines recommend involving the patient in decisions regarding planning of care and various general exercise; The guidelines are of great relevance to clinicians who treat patients suffering from persistent headaches associated with neck pain.
- rule out major structural or other pathologies, or migraine as the cause of headaches
- classify headaches associated with neck pain as tension‐type headache or cervicogenic headache once other sources of headache pathology has been ruled out
- provide care in partnership with the patient and involve the patient in care planning and decision‐making;
- provide care in addition to structured patient education
- consider low load endurance craniocervical and cervicoscapular exercises for tension‐type headaches (episodic or chronic) or cervicogenic headaches >3 months duration
- consider general exercise, multimodal care (spinal mobilization, craniocervical exercise, and postural correction), or clinical massage for chronic tension‐type headaches
- do not offer manipulation of the cervical spine as the sole form of treatment for episodic or chronic tension‐type headaches
- 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
- reassess the patient at every visit to assess outcomes and determine whether a referral is indicated
Read a more elaborate description of the 9 recommendations in the original paper – click on the link below
The study was carried out by Pierre Côté, Hainan Yu, Heather M. Shearer, Kristi Randhawa, Jessica J. Wong, Silvano Mior, Arthur Ameis, Linda J. Carroll, Margareta Nordin, Sharanya Varatharajan, Deborah Sutton, Danielle Southerst, Craig Jacobs, Maja Stupar, Anne Taylor‐Vaisey, Douglas P. Gross, Robert J. Brison, Mike Paulden, Carlo Ammendolia, J. David Cassidy, Patrick Loisel, Shawn Marshall, Richard N. Bohay, John Stapleton and Michel Lacerte (see titles and affiliations in the original paper).