Headache: Difference between revisions
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!'''Largest effect from PT treatment''' | !'''Largest effect from PT treatment''' | ||
Spinal manipulations in Soft Tissues – C/S and T/S is beneficial. <ref name=":4">Fernandez M, Moore C, Tan J, Lian D, Nguyen J, Bacon A, Christie B, Shen I, Waldie T, Simonet D, Bussières A . Spinal manipulation for the | Spinal manipulations in Soft Tissues – C/S and T/S is beneficial. <ref name=":4">Fernandez M, Moore C, Tan J, Lian D, Nguyen J, Bacon A, Christie B, Shen I, Waldie T, Simonet D, Bussières A . [https://pubmed.ncbi.nlm.nih.gov/32621321/ Spinal manipulation for the | ||
management of cervicogenic headache: A systematic review and meta‐analysis. European Journal of Pain, 2020:24(9):1687-1702.</ref><ref name=":5">Dunning J.R, Butts R, Mourad F, Young I, Fernandez-de-Las Peñas C, Hagins M, Stanislawski T, Donley J, Buck D, Hooks T.R. Cleland J.A. Upper cervical and upper thoracic manipulation versus mobilization and exercise in patients with cervicogenic headache: a multi-center randomized clinical trial. BMC musculoskeletal disorders, 2016:17(1):1-12.</ref> | management of cervicogenic headache: A systematic review and meta‐analysis.] European Journal of Pain, 2020:24(9):1687-1702.</ref><ref name=":5">Dunning J.R, Butts R, Mourad F, Young I, Fernandez-de-Las Peñas C, Hagins M, Stanislawski T, Donley J, Buck D, Hooks T.R. Cleland J.A. [https://pubmed.ncbi.nlm.nih.gov/26852024/ Upper cervical and upper thoracic manipulation versus mobilization and exercise in patients with cervicogenic headache: a multi-center randomized clinical trial.] BMC musculoskeletal disorders, 2016:17(1):1-12.</ref> | ||
Effectively conducted mobilisations have the same effect as manipulations. <ref name=":4" /> | Effectively conducted mobilisations have the same effect as manipulations. <ref name=":4" /> | ||
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|Cervicogenic - unhelpful | |Cervicogenic - unhelpful | ||
|No benefit of other Manual Therapy - massage, dry needling, mobilisations. | |No benefit of other Manual Therapy - massage, dry needling, mobilisations. | ||
Limited evidence of exercises – however there is good effect of combinations of manual therapy and exercise. <ref name=":5" /><ref>Jull G, Trott P, Potter H, Zito G, Niere K, Shirley D, Emberson J, Marschner I, Richardson C. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine, 2002:27(17):1835-1843.</ref> | Limited evidence of exercises – however there is good effect of combinations of manual therapy and exercise. <ref name=":5" /><ref>Jull G, Trott P, Potter H, Zito G, Niere K, Shirley D, Emberson J, Marschner I, Richardson C. [https://pubmed.ncbi.nlm.nih.gov/12221344/ A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache.] Spine, 2002:27(17):1835-1843.</ref> | ||
|- | |- | ||
|Migraines - Helpful | |Migraines - Helpful | ||
|'''Physical Therapy treatment is especially effective with migraines''' | |'''Physical Therapy treatment is especially effective with migraines''' | ||
Low–Moderate evidence that aerobic exercises have a benefit. <ref name=":3">Krøll L.S, Hammarlund C.S, Linde M, Gard G, Jensen R.H. The effects of aerobic exercise for persons with migraine and co-existing tension-type headache and neck pain. A randomized, controlled, clinical trial. Cephalalgia. 2018:38(12):1805–1816.</ref><ref>Touche R.L, Fernández Pérez J.J, Acosta A.P, Campodónico L.G, García S.M, Juárez D.A, García B.S, Angulo-Díaz-Parreño S, Cuenca-Martínez F, Luis Suso-Martí, Paris-Alemany A. Is aerobic exercise helpful in patients with migraine? A systematic review and meta-analysis. Scandinavian Journal of Medical Science & Sports. 2020:30:965–982. </ref><ref>Lemmens J, De Pauw J, Van Soom T, Michiels S, Versijpt J, Van Breda E, Castien R, De Hertogh W. The effect of aerobic exercise on the number of migraine days, duration and pain intensity in migraine: a systematic literature review and meta-analysis. The journal of headache and pain. 2019: 20(1):1-9.</ref> | Low–Moderate evidence that aerobic exercises have a benefit. <ref name=":3">Krøll L.S, Hammarlund C.S, Linde M, Gard G, Jensen R.H. [https://pubmed.ncbi.nlm.nih.gov/29333870/ The effects of aerobic exercise for persons with migraine and co-existing tension-type headache and neck pain.] A randomized, controlled, clinical trial. Cephalalgia. 2018:38(12):1805–1816.</ref><ref>Touche R.L, Fernández Pérez J.J, Acosta A.P, Campodónico L.G, García S.M, Juárez D.A, García B.S, Angulo-Díaz-Parreño S, Cuenca-Martínez F, Luis Suso-Martí, Paris-Alemany A. [https://pubmed.ncbi.nlm.nih.gov/31904889/ Is aerobic exercise helpful in patients with migraine? A systematic review and meta-analysis.] Scandinavian Journal of Medical Science & Sports. 2020:30:965–982. </ref><ref>Lemmens J, De Pauw J, Van Soom T, Michiels S, Versijpt J, Van Breda E, Castien R, De Hertogh W. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6734345/ The effect of aerobic exercise on the number of migraine days, duration and pain intensity in migraine: a systematic literature review and meta-analysis.] The journal of headache and pain. 2019: 20(1):1-9.</ref> | ||
Higher quality evidence favors exercises - type/duration/intensity unspecified. <ref name=":2">Luedtke K, Allers A, Schulte L.H, May A. Efficacy of interventions used by physiotherapists for patients with headache and migraine—systematic review and meta-analysis. Cephalalgia. 2016:36(5):474–492. </ref> | Higher quality evidence favors exercises - type/duration/intensity unspecified. <ref name=":2">Luedtke K, Allers A, Schulte L.H, May A. [https://pubmed.ncbi.nlm.nih.gov/26229071/ Efficacy of interventions used by physiotherapists for patients with headache and migraine—systematic review and meta-analysis.] Cephalalgia. 2016:36(5):474–492. </ref> | ||
'''Manual therapy''' is beneficial with migraines. <ref>Chaibi A, Tuchin P.J, Russell M.B. Manual therapies for migraine: a systematic review. The journal of headache and pain. 2011:12(2):127-133.</ref> | '''Manual therapy''' is beneficial with migraines. <ref>Chaibi A, Tuchin P.J, Russell M.B. [https://pubmed.ncbi.nlm.nih.gov/21298314/ Manual therapies for migraine: a systematic review.] The journal of headache and pain. 2011:12(2):127-133.</ref> | ||
|- | |- | ||
|Tension Type Headaches -Helpful | |Tension Type Headaches -Helpful | ||
|Manual Therapy has a moderate effect on soft tissues, '''Manipulation has''' no benefit. '''Soft tissue therapy''' and '''dry needling''' is beneficial on pain intensity and frequency. <ref>Kamonseki D.H, Lopes E.P, van der Meer H.A, Calixtre L.B. Effectiveness of manual therapy in patients with tension-type headache. A systematic review and meta-analysis. Disability and Rehabilitation. 2022:44(10):1780-1789.</ref><ref>Ferragut-Garcias A, Plaza-Manzano G, | |Manual Therapy has a moderate effect on soft tissues, '''Manipulation has''' no benefit. '''Soft tissue therapy''' and '''dry needling''' is beneficial on pain intensity and frequency. <ref>Kamonseki D.H, Lopes E.P, van der Meer H.A, Calixtre L.B. [https://pubmed.ncbi.nlm.nih.gov/32924640/ Effectiveness of manual therapy in patients with tension-type headache. A systematic review and meta-analysis.] Disability and Rehabilitation. 2022:44(10):1780-1789.</ref><ref>Ferragut-Garcias A, Plaza-Manzano G, | ||
Rodriguez-Blanco C, Velasco-Roldan O, Pecos-Martin D, Oliva-Pascual-Vaca J, Llabres-Bennasar B, Oliva-Pascual-Vaca A. Effectiveness of a Treatment Involving Soft Tissue Techniques and/or Neural Mobilization Techniques in the Management of Tension-Type Headache: A Randomized Controlled Trial. Archives of Physical Medicine and Rehabilitation. 2017:98:211-219.</ref><ref>Pourahmadi M, Dommerholt J, Fernández-de-Las-Peñas C, Koes B.W, Mohseni-Bandpei M.A, Mansournia M.A, Delavari S, Keshtkar A, Bahramian M. Dry needling for the treatment of tension-type, cervicogenic, or migraine headaches: a systematic review and meta-analysis. Physical Therapy. 2021:1-31.</ref> | Rodriguez-Blanco C, Velasco-Roldan O, Pecos-Martin D, Oliva-Pascual-Vaca J, Llabres-Bennasar B, Oliva-Pascual-Vaca A. [https://pubmed.ncbi.nlm.nih.gov/27623523/ Effectiveness of a Treatment Involving Soft Tissue Techniques and/or Neural Mobilization Techniques in the Management of Tension-Type Headache: A Randomized Controlled Trial.] Archives of Physical Medicine and Rehabilitation. 2017:98:211-219.</ref><ref>Pourahmadi M, Dommerholt J, Fernández-de-Las-Peñas C, Koes B.W, Mohseni-Bandpei M.A, Mansournia M.A, Delavari S, Keshtkar A, Bahramian M. [https://pubmed.ncbi.nlm.nih.gov/33609358/ Dry needling for the treatment of tension-type, cervicogenic, or migraine headaches: a systematic review and meta-analysis.] Physical Therapy. 2021:1-31.</ref> | ||
'''CBT''' has some evidence on impact on headaches, not intensity or frequency| perception of headache affected by CBT. <ref>Martin P.R, Aiello R, Gilson K, Meadows G, | '''CBT''' has some evidence on impact on headaches, not intensity or frequency| perception of headache affected by CBT. <ref>Martin P.R, Aiello R, Gilson K, Meadows G, | ||
Milgrom J, Reece J. Cognitive behavior therapy for comorbid migraine and/or tension type headache and major depressive disorder: An exploratory randomized controlled trial. Behaviour Research and Therapy. 2015:73:8-18. </ref> | Milgrom J, Reece J. [https://pubmed.ncbi.nlm.nih.gov/26226090/ Cognitive behavior therapy for comorbid migraine and/or tension type headache and major depressive disorder: An exploratory randomized controlled trial.] Behaviour Research and Therapy. 2015:73:8-18. </ref> | ||
'''Aerobic exercises''' have an impact on capacity, not pain - increased capacity, but didn’t change pain, frequency, intensity. <ref name=":3" /><ref name=":2" /> | '''Aerobic exercises''' have an impact on capacity, not pain - increased capacity, but didn’t change pain, frequency, intensity. <ref name=":3" /><ref name=":2" /> | ||
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|- | |- | ||
|Tension Type Headaches - Unhelpful | |Tension Type Headaches - Unhelpful | ||
|'''Strength training had''' no benefit compared to posture correction, neither technique was beneficial either. <ref>Madsen B.K, Søgaard K, Andersen L.L, Tornøe B, Jensen R.H. Efficacy of strength training on | |'''Strength training had''' no benefit compared to posture correction, neither technique was beneficial either. <ref>Madsen B.K, Søgaard K, Andersen L.L, Tornøe B, Jensen R.H. [https://pubmed.ncbi.nlm.nih.gov/28750588/ Efficacy of strength training on | ||
tension-type headache: A randomised controlled study. Cephalalgia. 2018:38(6):1071–1080.</ref> | tension-type headache: A randomised controlled study.] Cephalalgia. 2018:38(6):1071–1080.</ref> | ||
|} | |} | ||
Revision as of 17:09, 28 July 2023
Original Editor - Rachael Lowe
Top Contributors - Admin, Kapil Narale, Kim Jackson, Fasuba Ayobami, Jo Etherton, Vidya Acharya, Evan Thomas and WikiSysop
Classification[edit | edit source]
The most recognised classification for headache is from the International Headache Society[1]. The 3rd edition of International Classification of Headache Disorders (ICHD) is an in-depth hierarchical classification of headaches containing explicit diagnostic criteria for headache disorders. They classify headaches into primary, secondary, Painful cranial neuropathies, other facial pain and other headaches outlined below:
Primary Headaches[1][edit | edit source]
- Migraine
- Tension-type headache
- Trigeminal autonomic cephalalgias
- Other primary headache disorders
Secondary Headaches[1][edit | edit source]
- Headache attributed to trauma or injury to the head and/or neck
- Headache attributed to cranial and/or cervical vascular disorder
- Headache attributed to non-vascular intracranial disorder
- Headache attributed to a substance or its withdrawal
- Headache attributed to infection
- Headache attributed to disorder of homoeostasis
- Headache or facial pain attributed to disorder of the cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cranial structure
- Headache attributed to psychiatric disorder
Painful Cranial Neuropathies, Other Facial Pain and Other Headaches[1][edit | edit source]
- Painful lesions of the cranial nerves and other facial pain
- Other headache disorders
Physical Therapy Management[edit | edit source]
It is the most commonly used non-pharmacologic treatment of TTH[2]. Cervical exercises, relaxation, massage, postural exercises, cranio-cervical techniques, thermotherapy, vertebral mobilization and stretching are effective in reducing TTH symptoms such as pain frequency and intensity. In the studies that have applied joint mobilization, cervical range of motion has improved. Other parameters such as quality of life, impact and pain disability and psychological aspects have improved with MT[3].
Various treatment options are available for treating headaches; however, since the clinical effectiveness is unclear, a Delphi study[4] was conducted to obtain consensus on physiotherapy treatment for tension-type headaches, migraine, and cervicogenic headaches. The study concluded that:
- Active mobilisation exercises, upper cervical spine mobilisations, passive mobilisation with movement (MWM), work-related ergonomic training, and active MWM can be used to treat cervicogenic headaches and
- Life-style advice, manual trigger point techniques, and work-related ergonomic training for migraine and tension-type headaches[4].
Physical therapy interventions have the largest effect on Migraines and Cervicogenic Headaches:
| Cervicogenic - helpful | Largest effect from PT treatment
Spinal manipulations in Soft Tissues – C/S and T/S is beneficial. [5][6] Effectively conducted mobilisations have the same effect as manipulations. [5] |
|---|---|
| Cervicogenic - unhelpful | No benefit of other Manual Therapy - massage, dry needling, mobilisations.
Limited evidence of exercises – however there is good effect of combinations of manual therapy and exercise. [6][7] |
| Migraines - Helpful | Physical Therapy treatment is especially effective with migraines
Low–Moderate evidence that aerobic exercises have a benefit. [8][9][10] Higher quality evidence favors exercises - type/duration/intensity unspecified. [11] Manual therapy is beneficial with migraines. [12] |
| Tension Type Headaches -Helpful | Manual Therapy has a moderate effect on soft tissues, Manipulation has no benefit. Soft tissue therapy and dry needling is beneficial on pain intensity and frequency. [13][14][15]
Aerobic exercises have an impact on capacity, not pain - increased capacity, but didn’t change pain, frequency, intensity. [8][11] Psychological and aerobic – teach the patient how to live with the headache. [8] |
| Tension Type Headaches - Unhelpful | Strength training had no benefit compared to posture correction, neither technique was beneficial either. [17] |
Resources[edit | edit source]
The International Headache Classification (ICHD-2)
WHO Factsheet on Headache Disorders
AHS Guidelines and Position Statements
References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. (2018). Cephalalgia, 38(1), 1–211. https://doi.org/10.1177/0333102417738202
- ↑ Chowdhury D. Tension type headache. Ann Indian Acad Neurol. 2012;15(Suppl 1):S83–S88. doi:10.4103/0972-2327.100023
- ↑ Espí-López GV, Arnal-Gómez A, Arbós-Berenguer T, González ÁA, Vicente-Herrero T. Effectiveness of Physical Therapy in Patients with Tension-type Headache: Literature Review. J Jpn Phys Ther Assoc. 2014;17(1):31–38. doi:10.1298/jjpta.17.31
- ↑ 4.0 4.1 De Pauw R, Dewitte V, de Hertogh W, Cnockaert E, Chys M, Cagnie B. Consensus among musculoskeletal experts for the management of patients with headache by physiotherapists? A delphi study. Musculoskeletal Science and Practice. 2021 Apr 1;52:102325.
- ↑ 5.0 5.1 Fernandez M, Moore C, Tan J, Lian D, Nguyen J, Bacon A, Christie B, Shen I, Waldie T, Simonet D, Bussières A . [https://pubmed.ncbi.nlm.nih.gov/32621321/ Spinal manipulation for the management of cervicogenic headache: A systematic review and meta‐analysis.] European Journal of Pain, 2020:24(9):1687-1702.
- ↑ 6.0 6.1 Dunning J.R, Butts R, Mourad F, Young I, Fernandez-de-Las Peñas C, Hagins M, Stanislawski T, Donley J, Buck D, Hooks T.R. Cleland J.A. Upper cervical and upper thoracic manipulation versus mobilization and exercise in patients with cervicogenic headache: a multi-center randomized clinical trial. BMC musculoskeletal disorders, 2016:17(1):1-12.
- ↑ Jull G, Trott P, Potter H, Zito G, Niere K, Shirley D, Emberson J, Marschner I, Richardson C. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine, 2002:27(17):1835-1843.
- ↑ 8.0 8.1 8.2 Krøll L.S, Hammarlund C.S, Linde M, Gard G, Jensen R.H. The effects of aerobic exercise for persons with migraine and co-existing tension-type headache and neck pain. A randomized, controlled, clinical trial. Cephalalgia. 2018:38(12):1805–1816.
- ↑ Touche R.L, Fernández Pérez J.J, Acosta A.P, Campodónico L.G, García S.M, Juárez D.A, García B.S, Angulo-Díaz-Parreño S, Cuenca-Martínez F, Luis Suso-Martí, Paris-Alemany A. Is aerobic exercise helpful in patients with migraine? A systematic review and meta-analysis. Scandinavian Journal of Medical Science & Sports. 2020:30:965–982.
- ↑ Lemmens J, De Pauw J, Van Soom T, Michiels S, Versijpt J, Van Breda E, Castien R, De Hertogh W. The effect of aerobic exercise on the number of migraine days, duration and pain intensity in migraine: a systematic literature review and meta-analysis. The journal of headache and pain. 2019: 20(1):1-9.
- ↑ 11.0 11.1 Luedtke K, Allers A, Schulte L.H, May A. Efficacy of interventions used by physiotherapists for patients with headache and migraine—systematic review and meta-analysis. Cephalalgia. 2016:36(5):474–492.
- ↑ Chaibi A, Tuchin P.J, Russell M.B. Manual therapies for migraine: a systematic review. The journal of headache and pain. 2011:12(2):127-133.
- ↑ Kamonseki D.H, Lopes E.P, van der Meer H.A, Calixtre L.B. Effectiveness of manual therapy in patients with tension-type headache. A systematic review and meta-analysis. Disability and Rehabilitation. 2022:44(10):1780-1789.
- ↑ Ferragut-Garcias A, Plaza-Manzano G, Rodriguez-Blanco C, Velasco-Roldan O, Pecos-Martin D, Oliva-Pascual-Vaca J, Llabres-Bennasar B, Oliva-Pascual-Vaca A. Effectiveness of a Treatment Involving Soft Tissue Techniques and/or Neural Mobilization Techniques in the Management of Tension-Type Headache: A Randomized Controlled Trial. Archives of Physical Medicine and Rehabilitation. 2017:98:211-219.
- ↑ Pourahmadi M, Dommerholt J, Fernández-de-Las-Peñas C, Koes B.W, Mohseni-Bandpei M.A, Mansournia M.A, Delavari S, Keshtkar A, Bahramian M. Dry needling for the treatment of tension-type, cervicogenic, or migraine headaches: a systematic review and meta-analysis. Physical Therapy. 2021:1-31.
- ↑ Martin P.R, Aiello R, Gilson K, Meadows G, Milgrom J, Reece J. Cognitive behavior therapy for comorbid migraine and/or tension type headache and major depressive disorder: An exploratory randomized controlled trial. Behaviour Research and Therapy. 2015:73:8-18.
- ↑ Madsen B.K, Søgaard K, Andersen L.L, Tornøe B, Jensen R.H. [https://pubmed.ncbi.nlm.nih.gov/28750588/ Efficacy of strength training on tension-type headache: A randomised controlled study.] Cephalalgia. 2018:38(6):1071–1080.
