Treatment and Management

Headache Associated with Neck Pain after Ruling Out Risk Factors for Serious Pathologies

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Clinical Cornerstone:

• A comprehensive approach to managing involves integrating education, assurance, self-care, conservative management, and specific interventions when necessary. This approach should be grounded in evidence-based practice, respectful of cultural nuances, and prioritize patient needs and values. It emphasizes professional collaboration and is continuously fine-tuned based on patient feedback  and progress, ensuring a unified, empathetic, and efficient pathway.

• While passive modalities such as Transcutaneous Electrical Nerve Stimulation (TENS), needling therapies (acupuncture, dry needling), and traction might offer neck pain relief or relaxation, it is essential to integrate these with active management strategies. This combination addresses the multifaceted nature of headache associated with neck pain, fostering sustainable pain management and enhancing function and participation.

Strategy Details

• Patient Education: Focus on patient understanding the nature of the condition, the course of the condition, implementing pain management strategies, and actively participating in the rehabilitation process.

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• Reassure patients that tension-type and cervicogenic headaches typically do not stem from serious pathology. Clarify the biopsychosocial dimensions of pain, address underlying psychosocial factors, and underscore the importance of  active participation in care and setting realistic expectations.

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• Self-care: Crucial for managing LBP and facilitating a return to meaningful activities. Incorporate strategies like goal setting/Brief Action Planning/SMART goals.

  • Utilize techniques like Brief Action Planning to support self-management and promote regular movement and engagement in normal activities, including work.

  • Lifestyle changes: Prioritize a healthy diet, regular physical activity, good sleep habits, maintaining a healthy body weight, and abstaining from smoking.

  • Ergonomics and behaviour change to reduce strain during physical or sedentary work.

  • Engage in social and work activities.

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• Social support: Solicit an appropriate level of personal-network support, engage in social and work activities.

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• Psychological therapy: Referral to an appropriate healthcare provider if needed.

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• Mind-Body Interventions: Techniques like mindfulness, meditation, and cognitive-behavioral therapy (CBT).

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Consider Additional Treatment Strategies for Persistent Tension-Type Headaches:

• Specific Exercise: low-load endurance craniocervical and cervicoscapular exercises with resistance.

• Manual therapy: manual therapy (manipulation with or without mobilization) to the cervical and thoracic spine for Persistent Tension-Type Headaches (no evidence of effectiveness for cervical spine manipulation in Episodic Tension-Type Headaches).

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Consider Additional Treatment Strategies for Chronic Cervicogenic Headaches:

• Specific Exercise: low-load endurance craniocervical and cervicoscapular exercises

• General exercise (including warm-up, neck and shoulder stretching and strengthening, and aerobic exercise).

• Manual therapy: e.g., mobilization, manipulation, clinical massage. (No evidence of effectiveness when manipulation is offered as the sole form of treatment)

• Self-care: Therapist-guided/directed postural correction of the cervical and thoracic spine in a sitting position