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Tension-type and Cervicogenic Headache Care Pathway

Date of last update: April, 2024

Prognosis

Clinical Cornerstone:

  • In Canada,  individuals  with  disabling  neck  pain  are  10  times  more   likely   to   suffer   from   co‐morbid   headaches   than   those  without  neck  pain. The impact on quality-of-life from cervicogenic headaches is substantial, and comparable to tension-type and migraine headaches. Cervicogenic headaches tend to be chronic and recurrent. In most cases, specific exercises are effective in managing tension-type and cervicogenic headaches. Adjunct interventions can be considered depending on the type of headache and it’s chronicity.

Negative Prognostic Factors: Associated with a poorer outcome or longer duration of pain and disability. The presence of one or more of these factors does not necessarily mean that a patient will have a poor outcome, but they can be used to guide treatment and set realistic expectations.

 

1. Lifestyle-related factors: Passive coping strategies.

2. Baseline pain intensity: Higher initial pain levels.

3. Belief about pain duration: Patients who believe that their neck pain will last a long time.

 

4. Psychological factors: Symptoms of depression or anxiety, Fear avoidance, Somatization.

5. Age: Patients of older age with cervicogenic headache are more likely to demonstrate positive outcomes from conservative therapy.

6. Duration of symptoms: Chronic symptoms (lasting more than 12 weeks).

 

7. Work-related factors: Job dissatisfaction, heavy physical work demands, lack of job flexibility, disputed compensation claims.

8. Previous episodes of neck pain

9. Functional impairment: Limitations in daily activities due to pain, a belief that the pain is disabling.

Disclaimer:
These care pathways are intended to provide information to practitioners who provide care to people with musculoskeletal conditions. The care pathways on this website are 'living' documents, reflecting the state of clinical practice and research evidence to our best knowledge at the time of development. As knowledge and healthcare practices evolve, these pathways may be updated to ensure they remain current and evidence driven. These pathways are not intended to replace advice from a qualified healthcare provider.

Conduct patient assessment

Red flags or Orange flags present

Red flags or Orange flags present

click to learn more

Refer to appropriate emergency or healthcare provider

No

Yes

Diagnosis

Diagnosis

(Diagnosis of tension-type headaches,

diagnosis of cervicogenic headaches, prognosis)

Headache Associated with Neck Pain

  • Structured patient education

  • Assurance

  • Self care

  • Emotional/social support

Additionally for Persistent Tension-type Headaches

  • Specific neck and shoulder exercises

  • Manual therapy

Additionally for Persistent Cervicogenic Headaches

  • Specific neck and shoulder exercises

  • Manual therapy

Major symptom/sign change

Goals not achieved

Re-evaluate

Adjust treatment and management plan or refer

Differential Diagnosis

Differential Diagnosis

(Primary headaches, secondary headaches, cranial neuralgias)

Discharge

No

Yes

References or links to primary sources

  • Bussières A.E, et al. Diagnostic imaging practice guidelines for musculoskeletal complaints in adults-an evidence-based approach-part 3: spinal disorders. Journal of manipulative and physiological therapeutics. 2008;31(1):33-88. doi:10.1016/j.jmpt.2007.11.003.

  • Bussières A.E, et al. The treatment of neck pain -associated disorders and whiplash-associated disorders: A clinical practice guideline. J Man Phys Ther. 2016; 39(8):P523-564.

  • Berman D., et al Comparison of Clinical Guidelines for Authorization of MRI in the Evaluation of Neck Pain and Cervical Radiculopathy in the United States. Journal of the American Academy of Orthopaedic Surgeons 31(2):p 64-70, January 15, 2023. | DOI: 10.5435/JAAOS-D-22-00517.

  • Côté P, et al. Non-pharmacological management of persistent headaches associated with neck pain: A clinical practice guideline from the Ontario protocol for traffic injury management (OPTIMa) collaboration. European journal of pain (London, England). 2019;23(6):1051-1070.

  • Côté P, et al. Management of neck pain and associated disorders: A clinical practice guidelines from the Ontario Protocol for Traffic Injury (OPTIMa) Collaboration. Eur Spine J. 2016; 28:2000-2022.

  • Demont A., et al. Cervicogenic headache, an easy diagnosis? A systematic review and meta-analysis of diagnostic studies. Musculoskelet Sci Pract. 2022 Dec;62:102640.

  • Fernandez M., et al. Spinal manipulation for the management of cervicogenic headache: A systematic review and meta-analysis. European Journal of Pain. 2020;24(9):1687-1702.

  • Knackstedt H, et al. Cervicogenic headache in the general population: the Akershus study of chronic headache. Cephalalgia : an international journal of headache. 2010;30(12):1468-147.

  • Núñez CP, Leirós RR. Effectiveness of manual therapy in the treatment of cervicogenic headache: A systematic review. Headache: The Journal of Head & Face Pain. 2022;62(3):271-283.

  • Rubio-Ochoa J., et al.  Physical examination tests for screening and diagnosis of cervicogenic headache: A systematic review. Manual Therapy. 2016;21:35-40.

  • Shearer H.M., et al. The course and factors associated with recovery of whiplash-associated disorders: an updated systematic review by the Ontario protocol for traffic injury management (OPTIMa) collaboration. European Journal of Physiotherapy. 2021 Sep 3;23(5):279-94.

  • Sjaastad O, Bakketeig LS. Prevalence of cervicogenic headache: Vågå study of headache epidemiology. Acta neurologica Scandinavica. 2008;117(3):173-180.

  • Stiell I.G., et al. The Canadian C-Spine Rule for Radiography in Alert and Stable Trauma Patients. JAMA. 2001;286(15):1841–1848. doi:10.1001/jama.286.15.1841.

  • Stovner LJ,, et al. Global, regional, and national burden of migraine and tension-type headache, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet Neurology. 2018 Nov 1;17(11):954-76.

  • Stovner LJ, et al. The global prevalence of headache: an update, with analysis of the influences of methodological factors on prevalence estimates. The journal of headache and pain. 2022 Dec;23(1):34.

Contact information for further inquiries or feedback

carolina.cancelliere@ontariotechu.ca

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