Headache is one of the most frequently reported illnesses in all age groups. It is something that all physical therapists will come across, so it is important that you recognize different types of headache but also the essential treatments that are available to you.
The most common types of headache physiotherapists will see during clinical practice are tension headache (TTH) migraine and cervicogenic headache (CGH) . These headache types have a worldwide prevalence of 38%, 10% and 2.5%, respectively.
Numerous physiotherapeutic clinical interventions can be used to treat any of these types of headache and have been shown to be effective in several studies. However, these studies tend to be of poor quality and care should be taken when interpreting them.
Because of this, it was difficult to create guidelines. Part of the challenge in treating headache is the subtle overlap in symptoms between different types, making choosing a treatment based on the underlying causes difficult.
Learn to differentiate between types of headache
Something that would aid in the creation of higher quality research into the assessment and physiotherapy of various types of headache is an expert-led consensus for the treatment of headaches. Once consensus has been reached among these experts, the argumentation model could be incorporated into randomized clinical trials to assess the effectiveness of the treatment.
This is exactly what a new study in Musculoskeletal Science and Practice has set itself the goal of.
Methods
This study is a 2-phase sequence design of a Delphi study by an expert group that was carried out to achieve consensus on the physiotherapeutic treatment of tension-type headaches, migraines and cervicogenic headache.
Before the Delphi survey, two panels of experts were set up. Expert group 1, consisting of five clinicians who, from a medical point of view, focused on the diagnostic criteria and the role of physical therapists in the diagnosis and treatment of headaches. Group 2 focused on the design of the Dephi study. Both groups were moderated by the first author, as a discussion took place during a 4-hour meeting with the groups.
4 survey rounds then took place via a personalized link to a website. The first survey focused on asking participants to list subjective and physical examination criteria that they found indicative of starting a particular treatment. They were then asked to suggest treatments that they found useful. These answers were then used for the second round.
The second and third rounds focused on assessing the consensus among participants about the treatments that physiotherapists use for patients with headache and the clinical criteria used to make a treatment decision.
The experts were asked to rate the level to which they considered the proposed treatments
useful using a 5-point Likert scale ranging from
from 0: definitely not useful to 4: definitely useful for any treatment option
. Mutual agreement on the usefulness of a treatment was set at a threshold of at least 80% or more of the participants who had to rate the treatment option as either definitely useful (4) or useful (3).
During the fourth round, the experiments tick the clinical indicators they found useful to take into account in a subjective and physical examination in order to begin a certain (consensual) treatment.
For more details on the methods and experts, see the article available free of charge from the link at the end of this post.
What is a Delphi study?
A Delphi Study (also known as the Delphi Technique) is a quantitative research method that aims to achieve consensus through an iterative process of answering questions.
The focus of the process is a reflection process in which members of the group are given the opportunity to use diagrams as a trigger for a deeper analysis .
The questions are often asked by email or questionnaire, but this varies depending on the topic. For example, this technique is often used in government policy or white papers where a round table discussion may be appropriate.
Results and clinical implications
The Panel of Experts agreed that tiered active hands-off treatments and education are more useful than hand-on treatments for all types of headache.
However, manual therapy and practical treatment can be useful tools in some cases. For example, consensus has been reached that cervical spine mobilizations and motion mobilizations are useful treatments for cervicogenic headaches. Tigger point techniques are also useful for tension-type headaches.
Lifestyle advice is recommended for all 3 types of common headaches in clinical practice. These include caffeine reduction, stress reduction, and weight loss are good examples.
Brief summary of the Delphi study on the treatment of headaches
Lifestyle and psychological intervention can be useful for migraines.
Trigger point and manual therapy in combination with movement can be useful for tension-type headaches
Manual therapy can be useful for cervicogenic headaches
Caffeine Reduction, Weight Loss, and Mindfulness are useful lifestyle change techniques
The results of this Delphi study are consistent with the existing literature on the treatment of headaches.
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It is important to acknowledge that only 14 experts participated in the entirety of the study and the limited involvement of Asian clinicians. The panel, which is composed entirely of musculoskeletal clinicians, also rejects interventions that may not have been included in the review. This is especially relevant for migraine headaches.
You can find out more about cervicogenic headaches with Ari Kaplan in a new and exclusive Physioplus course.
