Chiro.org - Chiropractic Resource Organization.     Support Chiropractic Research!

Headache

Home/Headache

Manual Therapies for Primary Chronic Headaches

By |May 24, 2017|Headache|

Manual Therapies for Primary Chronic Headaches: A Systematic Review of Randomized Controlled Trials

The Chiro.Org Blog


SOURCE:   J Headache Pain. 2014 (Oct 2); 15: 67 ~ FULL TEXT

Aleksander Chaibi and Michael Bjørn Russell

Head and Neck Research Group,
Research Centre, Akershus University Hospital,
1478 Lørenskog, Oslo, Norway.


This is to our knowledge the first systematic review regarding the efficacy of manual therapy randomized clinical trials (RCT) for primary chronic headaches. A comprehensive English literature search on CINHAL, Cochrane, Medline, Ovid and PubMed identified 6 RCTs all investigating chronic tension-type headache (CTTH). One study applied massage therapy and five studies applied physiotherapy. Four studies were considered to be of good methodological quality by the PEDro scale. All studies were pragmatic or used no treatment as a control group, and only two studies avoided co-intervention, which may lead to possible bias and makes interpretation of the results more difficult. The RCTs suggest that massage and physiotherapy are effective treatment options in the management of chronic tension-type headache (CTTH).

One of the RCTs showed that physiotherapy reduced headache frequency and intensity statistical significant better than usual care by the general practitioner. The efficacy of physiotherapy at post-treatment and at 6 months follow-up equals the efficacy of tricyclic antidepressants. Effect size of physiotherapy was up to 0.62. Future manual therapy RCTs are requested addressing the efficacy in chronic migraine with and without medication overuse. Future RCTs on headache should adhere to the International Headache Society’s guidelines for clinical trials, i.e., frequency as primary end-point, while duration and intensity should be secondary end-point, avoid co-intervention, includes sufficient sample size and follow-up period for at least 6 months.

KEYWORDS:   Randomized clinical trials, Primary chronic headache, Manual therapies, Massage, Physiotherapy, Chiropractic


From the FULL TEXT Article:

Introduction

Primary chronic headaches i.e. chronic migraine (CM), chronic tension-type headache (CTTH) and chronic cluster headache has significant health, economic and social costs. About 3% of the general population suffers from chronic headache with female predominance [1]. The International Classification of Headache Disorders III β (ICDH–III β) defines CM as ≥15 headache days/month for at least 3 months with features of migraine in ≥8 days/month, CTTH is defined as on average ≥15 days/month with tension-type headache for at least 3 months, and chronic cluster headache as attacks at least every other day for more than 1 year without remission, or with remissions lasting <1 month [2].

There are more articles like this @ our:

Headache and Chiropractic Page

(more…)

Complementary and Integrative Medicine
in the Management of Headache

By |May 19, 2017|Chiropractic Care, Headache|

Complementary and Integrative Medicine
in the Management of Headache

The Chiro.Org Blog


SOURCE:   BMJ. 2017 (May 16); 357: j1805

Denise Millstine, Christina Y Chen, Brent Bauer

Integrative Medicine Section,
Department of General Internal Medicine;
Women’s Health Internal Medicine,
Mayo Clinic, Scottsdale, AZ 85260


Headaches, including primary headaches such as migraine and tension-type headache, are a common clinical problem. Complementary and integrative medicine (CIM), formerly known as complementary and alternative medicine (CAM), uses evidence informed modalities to assist in the health and healing of patients. CIM commonly includes the use of nutrition, movement practices, manual therapy, traditional Chinese medicine, and mind-body strategies. This review summarizes the literature on the use of CIM for primary headache and is based on five meta-analyses, seven systematic reviews, and 34 randomized controlled trials (RCTs).

The overall quality of the evidence for CIM in headache management is generally low and occasionally moderate. Available evidence suggests that traditional Chinese medicine including acupuncture, massage, yoga, biofeedback, and meditation have a positive effect on migraine and tension headaches. Spinal manipulation, chiropractic care, some supplements and botanicals, diet alteration, and hydrotherapy may also be beneficial in migraine headache. CIM has not been studied or it is not effective for cluster headache. Further research is needed to determine the most effective role for CIM in patients with headache.


From the FULL TEXT Article:

Introduction

Headache is one of the most common clinical problems seen by healthcare providers. [1] Primary headache, as defined by the International Classification of Headache Disorders (ICHD), comprises headaches caused by independent pathophysiology, not by secondary causes, and includes tension-type headache, migraine, and cluster headaches. [2]

There are more articles like this @ our:

Headache and Chiropractic Page and the:

Integrated Health Care and Chiropractic Page

(more…)

Intertester Reliability and Diagnostic Validity of the
Cervical Flexion-Rotation Test

By |September 8, 2016|Headache|

Intertester Reliability and Diagnostic Validity of the Cervical Flexion-Rotation Test

The Chiro.Org Blog


SOURCE:   J Manipulative Physiol Ther 2008; 31 (4): 293–300

Toby M. Hall, PT, MS, Kim W. Robinson, PT, BSc,
Osamu Fujinawa, PT, PhD, Kiyokazu Akasaka, PT, PhD,
Elizabeth A. Pyne, PT, MT

School of Physiotherapy,
Curtin University of Technology,
Australia.
halltm@netspace.net.au


OBJECTIVE:   This article evaluates reliability and diagnostic validity of the cervical flexion-rotation test (FRT) to discriminate subjects with headache because of C1/2 dysfunction. In addition, this study evaluates agreement between experienced and inexperienced examiners.

METHODS:   These were 2 single blind comparative measurement study designs. In study 1, 2 experienced blinded examiners evaluated the FRT in 10 asymptomatic controls, 20 subjects with cervicogenic headache (CeH) where C1/2 was the primary dysfunctional level, and 10 subjects with CeH but without C1/2 as the primary dysfunctional level. In study 2, 2 inexperienced and 1 experienced blinded examiners evaluated the FRT in 12 subjects with CeH and 12 asymptomatic controls. Examiners were required to state whether the FRT was positive and also to determine range of rotation using a goniometer. An analysis of variance with planned orthogonal comparison, single measure intraclass correlation coefficient (2,1), and Bland-Altman plot were used to analyze FRT range of rotation between the examiners. Sensitivity, specificity, and examiner agreement for test interpretation were analyzed using cross tabulation and kappa.

RESULTS:   In study 1, sensitivity and specificity of the FRT was 90% and 88% with 92% agreement for experienced examiners (P < .001). Overall diagnostic accuracy was 89% (P < .001) and kappa = 0.85. In study 2, for inexperienced examiners, FRT mobility was significantly greater than for experienced examiners, but sensitivity, specificity, agreement, and kappa values were all within clinically acceptable levels.

There are more articles like this @ our:

Headache and Chiropractic Page

(more…)

Is There a Difference in Head Posture and Cervical Spine Movement in Children With and Without Pediatric Headache?

By |August 27, 2016|Headache, Pediatrics|

Is There a Difference in Head Posture and Cervical Spine Movement in Children With and Without Pediatric Headache?

The Chiro.Org Blog


SOURCE:   Eur J Pediatr. 2013 (Oct); 172 (10): 1349–1356

Kim Budelmann, Harry von Piekartz, Toby Hall

University of Applied Science,
Osnabrück, Germany


Pediatric headache is an increasingly reported phenomenon. Cervicogenic headache (CGH) is a subgroup of headache, but there is limited information about cervical spine physical examination signs in children with CGH. Therefore, a cross-sectional study was designed to investigate cervical spine physical examination signs including active range of motion (ROM), posture determined by the craniovertebral angle (CVA), and upper cervical ROM determined by the flexion-rotation test (FRT) in children aged between 6 and 12 years. An additional purpose was to determine the degree of pain provoked by the FRT.

Thirty children (mean age 120.70 months [SD 15.14]) with features of CGH and 34 (mean age 125.38 months [13.14]) age-matched asymptomatic controls participated in the study. When compared to asymptomatic controls, symptomatic children had a significantly smaller CVA (p < 0.001), significantly less active ROM in all cardinal planes (p < 0.001), and significantly less ROM during the FRT (p < 0.001), especially towards the dominant headache side (p < 0.001). In addition, symptomatic subjects reported more pain during the FRT (p < 0.001) and there was a significant negative correlation (r = -0.758, p < 0.001) between the range recorded during the FRT towards the dominant headache side and FRT pain intensity score. This study found evidence of impaired function of the upper cervical spine in children with CGH and provides evidence of the clinical utility of the FRT when examining children with CGH.


From the FULL TEXT Article:

Introduction

There are more articles like this @ our:

Chiropractic Pediatrics Section

and our:

Headache and Chiropractic Page

and our:

Forward Head Posture Page

(more…)

Diagnostic Testing Considerations in
Pediatric Cervicogenic Headache

By |August 20, 2016|Cervicogenic, Headache|

Diagnostic Testing Considerations in
Pediatric Cervicogenic Headache

The Chiro.Org Blog


SOURCE:   ACA News ~ May 23, 2016

Robert Vining, DC and Janice Kane, DC

The Neurological Institute,
Taipei Veterans General Hospital,
Taipei, Taiwan.


We are all aware that children commonly complain of headaches, but determining a specific diagnosis can be challenging. That’s partly because pediatric patients may not describe their symptoms as well as adults. Therefore, we asked this question: “Is there a diagnostic test that helps classify headache in pediatric patients in the range of 6-12 years?” If an evidence-based diagnostic test is available, it may help providers diagnose and develop management strategies.

Cervicogenic headache is common in pediatric patients and is defined by the International Headache Society as a condition caused by cervical spine dysfunction that is usually accompanied by neck pain. We chose this type of headache because it is commonly seen in chiropractic offices. With these thoughts in mind, we performed a search for office-based tests to help substantiate a diagnosis of cervicogenic headache diagnosis in a pediatric patient.

An evidence-based consideration

A PubMed search using the terms pediatric AND headache AND posture produced only a few articles. Included in this list is an article authored by Budelmann et al. describing a cross-sectional study entitled:

Is there a difference in head posture and cervical spine movement in children with and without pediatric headache?
Eur J Pediatr. 2013 (Oct);   172 (10):   1349-56

What happened in this study?

Investigators recruited 34 asymptomatic children from a high school and handball club in Germany and 30 symptomatic patients from physiotherapy departments in the Netherlands. Both groups had a mean age of 10 years (range of 6-12 years).

Criteria utilized for probable cervicogenic headaches were patient reports of:

There are more articles like this @ our:

Headache and Chiropractic Page

(more…)

Variations in Patterns of Utilization and Charges for the Care of Headache in North Carolina, 2000-2009: A Statewide Claims’ Data Analysis

By |May 22, 2016|Headache|

Variations in Patterns of Utilization and Charges for the Care of Headache in North Carolina, 2000-2009: A Statewide Claims’ Data Analysis

The Chiro.Org Blog


SOURCE:   J Manip Physiol Ther. 2016 (May); 39 (4): 229–239

Eric L. Hurwitz, DC, PhD, Maria Vassilaki, MD, MPH, PhD,
Dongmei Li, PhD, Michael J. Schneider, DC, PhD,
Joel M. Stevans, DC, Reed B. Phillips, DC, PhD,
Shawn P. Phelan, DC, Eugene A. Lewis, DC, MPH,
Richard C. Armstrong, MS, DC

Office of Public Health Studies,
University of Hawai`i at M?noa,
Honolulu, HI.


OBJECTIVES:   The purpose of the study was to compare patterns of utilization and charges generated by medical doctors (MDs), doctors of chiropractic (DCs), and physical therapists (PTs) for the treatment of headache in North Carolina.

METHODS:   Retrospective analysis of claims data from the North Carolina State Health Plan for Teachers and State Employees from 2000 to 2009. Data were extracted from Blue Cross Blue Shield of North Carolina for the North Carolina State Health Plan using International Classification of Diseases, Ninth Revision, diagnostic codes for headache. The claims were separated by individual provider type, combination of provider types, and referral patterns.

RESULTS:   The majority of patients and claims were in the MD-only or MD plus referral patterns. Chiropractic patterns represented less than 10% of patients. Care patterns with single-provider types and no referrals incurred the least charges on average for headache. When care did not include referral providers or services, MD with DC care was generally less expensive than MD care with PT. However, when combined with referral care, MD care with PT was generally less expensive. Compared with MD-only care, risk-adjusted charges (available 2006-2009) for patients in the middle risk quintile were significantly less for DC-only care.

There are more articles like this @ our:

Headache and Chiropractic Page

(more…)