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:
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Authors | 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, Michel Lacerte |
Journal | European journal of pain (London, England)
(Eur J Pain)
Vol. 23
Issue 6
Pg. 1051-1070
(07 2019)
ISSN: 1532-2149 [Electronic] England |
PMID | 30707486
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review)
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Copyright | © 2019 European Pain Federation - EFIC®. |
Topics |
- Adult
- Exercise
- Exercise Therapy
- Guidelines as Topic
- Headache
(complications, therapy)
- Humans
- Massage
- Migraine Disorders
(therapy)
- Musculoskeletal Manipulations
- Neck Pain
(therapy)
- Ontario
- Post-Traumatic Headache
(therapy)
- Tension-Type Headache
(therapy)
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