Headache

The Management of Common Recurrent Headaches by Chiropractors: A Descriptive Analysis of a Nationally Representative Survey

The Chiro.Org Blog

SOURCE:   BMC Neurol. 2018 (Oct 17); 18 (1): 171

Craig Moore, Andrew Leaver, David Sibbritt, and Jon Adams

Faculty of Health,
University of Technology Sydney,
Level 8, Building 10,
235-253 Jones Street Ultimo,
Sydney, NSW, 2007, Australia.

BACKGROUND:   Headache management is common within chiropractic clinical settings; however, little is yet known about how this provider group manage headache sufferers. The aim of this study is to report on the prevalence of headache patients found within routine chiropractic practice and to assess how chiropractors approach key aspects of headache management applicable to primary care settings.

METHODS:   A 31-item cross-sectional survey was distributed to a national sample of chiropractors (n = 1050) to report on practitioner approach to headache diagnosis, interdisciplinary collaboration, treatment and outcome assessment of headache patients who present with recurrent headache disorders.

RESULTS:   The survey attracted a response rate of 36% (n = 381). One in five new patients present to chiropractors with a chief complaint of headache. The majority of chiropractors provide headache diagnosis for common primary (84.6%) and secondary (90.4%) headaches using formal headache classification criteria. Interdisciplinary referral for headache management was most often with CAM providers followed by GPs. Advice on headache triggers, stress management, spinal manipulation, soft tissue therapies and prescriptive neck exercises were the most common therapeutic approaches to headache management.

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Prevalence of Neck Pain in Migraine and Tension-type Headache: A Population Study

The Chiro.Org Blog

SOURCE:   Cephalalgia. 2015 (Mar); 35 (3): 211–219

Sait Ashina, Lars Bendtsen, Ann C Lyngberg, Richard B Lipton, Nazrin Hajiyeva and Rigmor Jensen

Department of Pain Medicine and Palliative Care,
Mount Sinai Beth Israel,
Icahn School of Medicine at Mount Sinai, NY, USA

BACKGROUND:   We assessed the prevalence of neck pain in the population in relation to headache.

METHODS:   In a cross-sectional study, a total of 797 individuals completed a headache interview and provided self-reported data on neck pain. We identified migraine, TTH or both migraine and TTH (M+TTH) groups. Pericranial tenderness was recorded in 496 individuals. A total tenderness score (TTS) was calculated as the sum of local scores with a maximum score of 48.

RESULTS:   The one-year prevalence of neck pain was 68.4% and higher in those with vs. without primary headache (85.7% vs. 56.7%; adjusted OR 3.0, 95% CI 2.0–4.4, p<0.001). Adjusting for age, gender, education and poor self-rated health, in comparison with those without headaches, the prevalence of neck pain (56.7%) was significantly higher in those with M+TTH (89.3%), pure TTH (88.4%) and pure migraine (76.2%) (p<0.05 for all three group comparisons). Individuals with neck pain had higher TTS than individuals without neck pain (15.1±10.5 vs. 8.4±8.0, p<0.001).

CONCLUSIONS:   Neck pain is highly prevalent in the general population and even more prevalent in individuals with primary headaches. Prevalence is highest in coexistent M+TTH, followed by pure TTH and migraine. Myofascial tenderness is significantly increased in individuals with neck pain.

KEYWORDS:   Neck pain, migraine, tension-type headache, prevalence, population, tenderness

From the FULL TEXT Article:

Introduction

Neck pain and primary headaches are highly prevalent in the population. [1, 2] Estimated global one-year period prevalence is about 10% for migraine and about 38% for tension-type headache (TTH). [3, 4] One-year prevalence of neck pain ranges from 4.8% to 79.5% in population-based studies. [1] Variation in epidemiological studies of neck pain is attributable, at least in part, to differences in sample selection, ascertainment of symptoms and case definitions. [1] Neck pain can arise from many local structures, including muscles, ligaments, facet joints and visceral structures of the neck, through direct compression of upper cervical roots or it can be referred. [5] Thus, the differential diagnosis for neck pain includes various conditions such as spinal disease, whiplash-associated disorder, fibromyalgia, myofascial pain, rheumatic disease, direct trauma and neoplasms.

Neck pain is common in people with primary headaches, both in population-based studies and in the clinic. [6–10] Neck pain may occur as a premonitory manifestation or during the headache phase. [11] A better understanding of neck pain in primary headache is important. First, it will help facilitate more accurate diagnosis. Second, neck pain may influence the treatment response and result in increased disability in headache suffers. [12] Finally, neck pain may play a role in the pathophysiology of both migraine and TTH. [13, 14] It may arise because of convergent input from the first division of the trigeminal nerve and the upper cervical roots to the trigeminal cervical complex. [13]

The aim of our study was to assess the prevalence of self-reported neck pain in individuals with common primary headaches including migraine, TTH and coexistent migraine and TTH in a general population sample using the clear diagnostic criteria of the International Classification of Headache Disorders (ICHD).

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