The management of common recurrent headaches by chiropractors: a descriptive analysis of a nationally representative survey

Abstract

BackgroundHeadache management is common within chiropractic clinical settings; however, little is yet known about how this provider group manage headache sufferers. The aim of this study is to report on the prevalence of headache patients found within routine chiropractic practice and to assess how chiropractors approach key aspects of headache management applicable to primary care settings.MethodsA 31-item cross-sectional survey was distributed to a national sample of chiropractors (n = 1050) to report on practitioner approach to headache diagnosis, interdisciplinary collaboration, treatment and outcome assessment of headache patients who present with recurrent headache disorders.ResultsThe survey attracted a response rate of 36% (n = 381). One in five new patients present to chiropractors with a chief complaint of headache. The majority of chiropractors provide headache diagnosis for common primary (84.6%) and secondary (90.4%) headaches using formal headache classification criteria. Interdisciplinary referral for headache management was most often with CAM providers followed by GPs. Advice on headache triggers, stress management, spinal manipulation, soft tissue therapies and prescriptive neck exercises were the most common therapeutic approaches to headache management.ConclusionHeadache patients make up a substantial proportion of chiropractic caseload. The majority of chiropractors managing headache engage in headache diagnosis and interdisciplinary patient management. More research information is needed to understand the headache types and level of headache chronicity and disability common to chiropractic patient populations to further assess the healthcare needs of this patient population.Electronic supplementary materialThe online version of this article (10.1186/s12883-018-1173-6) contains supplementary material, which is available to authorized users.

Chiropractic student diagnosis and management of headache disorders: A survey examining self-perceived preparedness and clinical proficiency

“…Overall estimates suggest that final-year students have a slightly higher self-perceived preparedness and a slightly higher proficiency in headache diagnosis and management compared to those students in the 4th year of study. Since headache patient caseload is substantial within Australian chiropractic clinical practice, 12,24 it is important to better understand graduate student confidence and proficiency in headache patient care.…”

“…9,10 Internationally, headache disorders rank in the top 5 conditions for which people seek help from chiropractors, 11 and 1 in 5 new patients seeking help from Australian chiropractors are reported to have a chief complaint of headache. 12 Accordingly, it is vital that chiropractic students learn to generate a headache diagnoses following internationally recognized classification of criteria 7 and learn to develop a management care plan for those with headaches following an evidence-based rationale. 8 Previous international studies have identified that chiropractic graduate students can perceive themselves to be unprepared within certain clinical competencies, raising concerns about gaps that may exist between student education and practice-ready practitioners.…”

Prevalence and factors associated with the use of primary headache diagnostic criteria by chiropractors

“…These chiropractors include a belief that the use of ICHD primary headache criteria influences their patient management. Previous studies have reported the use of manual therapies, exercise therapies and advice on headache triggers as common to chiropractic headache management [30, 54]. While advice on headache triggers is well recognised as an important aspect of primary headache management [55, 56], the effectiveness of manual and exercise therapies for the prevention of primary headaches requires further evaluation.…”

“…An unexpected finding from our results was that chiropractors engaged in primary headache diagnosis are less likely to undertake patient referral to assist with headache prevention. A recent Australian study showed chiropractors refer headache patients to both complementary health care providers (including acupuncturist, herbalist, naturopath, massage therapist, counsellor) and general practitioners [30]. For tension headache, preventative treatment guidelines advise non-drug management first be considered [64] and provide recommendations for behavioural treatments such as electromyography (EMG) biofeedback (level A), cognitive-behavioral therapy and relaxation training (level C), massage therapy (level C) and acupuncture (level C).…”

“…Headache diagnosis is a key determinant that will influence practitioner decision-making around headache patient care. While a recent study reported the high use of headache diagnosis by chiropractors [30], there is little information regarding how primary headache diagnosis influences the clinical management of headaches by these providers. In direct response, the aim of this study was to draw upon a national sample of chiropractors to identify the headache patient management factors associated with those practitioners who utilise.…”