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Are non-invasive interventions effective for the management of headaches associated with neck pain? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration

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Abstract

Purpose

To update findings of the 2000–2010 Bone and Joint Decade Task Force on Neck Pain and its Associated Disorders and evaluate the effectiveness of non-invasive and non-pharmacological interventions for the management of patients with headaches associated with neck pain (i.e., tension-type, cervicogenic, or whiplash-related headaches).

Methods

We searched five databases from 1990 to 2015 for randomized controlled trials (RCTs), cohort studies, and case–control studies comparing non-invasive interventions with other interventions, placebo/sham, or no interventions. Random pairs of independent reviewers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria to determine scientific admissibility. Studies with a low risk of bias were synthesized following best evidence synthesis principles.

Results

We screened 17,236 citations, 15 studies were relevant, and 10 had a low risk of bias. The evidence suggests that episodic tension-type headaches should be managed with low load endurance craniocervical and cervicoscapular exercises. Patients with chronic tension-type headaches may also benefit from low load endurance craniocervical and cervicoscapular exercises; relaxation training with stress coping therapy; or multimodal care that includes spinal mobilization, craniocervical exercises, and postural correction. For cervicogenic headaches, low load endurance craniocervical and cervicoscapular exercises; or manual therapy (manipulation with or without mobilization) to the cervical and thoracic spine may also be helpful.

Conclusions

The management of headaches associated with neck pain should include exercise. Patients who suffer from chronic tension-type headaches may also benefit from relaxation training with stress coping therapy or multimodal care. Patients with cervicogenic headache may also benefit from a course of manual therapy.

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Acknowledgments

We would like to acknowledge and thank all of the individuals who have made important contributions to this review: Robert Brison, Poonam Cardoso, J. David Cassidy, Laura Chang, Douglas Gross, Murray Krahn, Michel Lacerte, Gail Lindsay, Patrick Loisel, Mike Paulden, Roger Salhany, John Stapleton, Angela Verven, and Leslie Verville. We would also like to thank Trish Johns-Wilson at the University of Ontario Institute of Technology for her review of the search strategy.

Author information

Authors and Affiliations

  1. UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada

    Sharanya Varatharajan, Pierre Côté, Jessica J. Wong, Hainan Yu, Heather M. Shearer, Danielle Southerst, Deborah Sutton, Kristi Randhawa, Craig Jacobs, Maja Stupar & Anne Taylor-Vaisey

  2. Division of Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada

    Sharanya Varatharajan, Jessica J. Wong, Hainan Yu, Heather M. Shearer, Deborah Sutton, Kristi Randhawa & Silvano Mior

  3. Division of Undergraduate Education, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada

    Sharanya Varatharajan & Kristi Randhawa

  4. Department of Graduate Studies, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada

    Brad Ferguson, Karen Chrobak, Sean Abdulla & Erin Woitzik

  5. University of Ottawa Centre for Interdisciplinary Pain Research, Ottawa Hospital Research Institute, The Ottawa Hospital General Campus, 501 Smyth Rd, Box 249-B, Ottawa, ON, K1H 8L6, Canada

    Yaadwinder Shergill

  6. Canada Research Chair in Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), University of Ontario Institute of Technology (UOIT), 2000 Simcoe Street North, Oshawa, ON, L1H 7L7, Canada

    Pierre Côté

  7. Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), 2000 Simcoe Street North, Oshawa, ON, L1H 7L7, Canada

    Pierre Côté, Carlo Ammendolia & Silvano Mior

  8. Rebecca MacDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, Joseph and Wolf Lebovic Health Complex, 60 Murray Street, 2nd Floor (Main), Toronto, ON, M5T 3L9, Canada

    Danielle Southerst

  9. Division of Clinical Education, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada

    Craig Jacobs

  10. Département d’anatomie, Université du Québec à Trois-Rivières, 3351 Boul. des Forges, C.P. 500, Trois-Rivières, QUÉBEC, G9A 5H7, Canada

    Andrée-Anne Marchand

  11. Toronto Health Economics and Technology Assessment (THETA) Collaborative, 6th Floor, Room 658, 144 College Street, Toronto, ON, M5S 3M2, Canada

    Gabrielle van der Velde

  12. Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, M5S 3M2, Canada

    Gabrielle van der Velde

  13. Institute for Work and Health, 481 University Avenue, Toronto, ON, M5G 2E9, Canada

    Gabrielle van der Velde & Carlo Ammendolia

  14. Injury Prevention Centre and School of Public Health, University of Alberta, 3-300 ECHA, 11405-87 Ave, Edmonton, AB, T6G 1C9, Canada

    Linda J. Carroll

  15. Departments of Orthopedic Surgery and Environmental Medicine, Occupational and Industrial Orthopedic Center, NYU School of Medicine, New York University, 550 1st Avenue, New York, NY, 10016, USA

    Margareta Nordin

  16. Institute for Health Policy, Management and Evaluation, University of Toronto, 4th Flodior, 155 College St, Toronto, ON, M5T 3M6, Canada

    Carlo Ammendolia

  17. Certification Program in Insurance Medicine and Medico-legal Expertise, Faculty of Medicine, University of Montreal, N-414, Roger-Gaudry Building, 2900, Boulevard Edouard-Montpetit, Montreal, QC, H3T 1J4, Canada

    Arthur Ameis

Authors
  1. Sharanya Varatharajan

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  2. Brad Ferguson

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  3. Karen Chrobak

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  4. Yaadwinder Shergill

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  5. Pierre Côté

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  6. Jessica J. Wong

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  7. Hainan Yu

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  8. Heather M. Shearer

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  9. Danielle Southerst

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  10. Deborah Sutton

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  11. Kristi Randhawa

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  12. Craig Jacobs

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  13. Sean Abdulla

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  14. Erin Woitzik

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  15. Andrée-Anne Marchand

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  16. Gabrielle van der Velde

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  17. Linda J. Carroll

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  18. Margareta Nordin

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  19. Carlo Ammendolia

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  20. Silvano Mior

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  21. Arthur Ameis

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  22. Maja Stupar

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  23. Anne Taylor-Vaisey

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Corresponding author

Correspondence toPierre Côté.

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Conflict of interest

Dr. Pierre Côté has received a grant from the Ontario government, Ministry of Finance, funding from the Canada Research Chairs program, personal fees from National Judicial Institute for lecturing, and personal fees from European Spine Society for teaching. Drs. Silvano Mior and Margareta Nordin have received reimbursement for travel expenses to attend meetings for the study. The remaining authors report no declarations of interest.

Funding

This work was supported by the Ontario Ministry of Finance and the Financial Services Commission of Ontario [RFP# OSS_00267175]. The funding agency had no involvement in the study design, collection, analysis, interpretation of data, writing of the manuscript or decision to submit the manuscript for publication. The research was undertaken, in part, thanks to funding from the Canada Research Chairs program to Dr. Pierre Côté, Canada Research Chair in Disability Prevention and Rehabilitation at the University of Ontario Institute of Technology.

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Systematic Review Registration Number: CRD42013004848, CRD42013004901, CRD42013004687, CRD42013006940.

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Fig. 1f Flow chart for structured patient education and self-management, passive physical modalities, and soft-tissue therapy (JPEG 995 kb)

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Fig. 1 g Flow chart for updated search in 2015 of all non-invasive interventions (manual therapy, exercise, acupuncture, multimodal care, work disability prevention interventions, education and self-management, passive physical modalities, and soft-tissue therapy) (JPEG 950 kb)

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Varatharajan, S., Ferguson, B., Chrobak, K.et al. Are non-invasive interventions effective for the management of headaches associated with neck pain? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.Eur Spine J25, 1971–1999 (2016). https://doi.org/10.1007/s00586-016-4376-9

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