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Abstract：
To develop an evidence-based guideline for the non-pharmacological management of persistent headaches associated with neck pain (i.e., tension-type or cervicogenic).
This guideline is based on systematic reviews of high-quality studies. A multidisciplinary expert panel considered the evidence of clinical benefits, cost-effectiveness, societal and ethical values, and patient experiences when formulating recommendations. Target audience includes clinicians; target population is adults with persistent headaches associated with neck pain.
When managing patients with headaches associated with neck pain, clinicians should (a) rule out major structural or other pathologies, or migraine as the cause of headaches; (b) classify headaches associated with neck pain as tension-type headache or cervicogenic headache once other sources of headache pathology has been ruled out; (c) provide care in partnership with the patient and involve the patient in care planning and decision making; (d) provide care in addition to structured patient education; (e) consider low-load endurance craniocervical and cervicoscapular exercises for tension-type headaches (episodic or chronic) or cervicogenic headaches >3 months duration; (f) consider general exercise, multimodal care (spinal mobilization, craniocervical exercise and postural correction) or clinical massage for chronic tension-type headaches; (g) do not offer manipulation of the cervical spine as the sole form of treatment for episodic or chronic tension-type headaches; (h) consider manual therapy (manipulation with or without mobilization) to the cervical and thoracic spine for cervicogenic headaches >3 months duration. However, there is no added benefit in combining spinal manipulation, spinal mobilization and exercises; and (i) reassess the patient at every visit to assess outcomes and determine whether a referral is indicated.
Our evidence-based guideline provides recommendations for the conservative management of persistent headaches associated with neck pain. The impact of the guideline in clinical practice requires validation.
Neck pain and headaches are very common comorbidities in the population. Tension-type and cervicogenic headaches can be treated effectively with specific exercises. Manual therapy can be considered as an adjunct therapy to exercise to treat patients with cervicogenic headaches. The management of tension-type and cervicogenic headaches should be patient-centred.
This guideline is based on systematic reviews of high-quality studies. A multidisciplinary expert panel considered the evidence of clinical benefits, cost-effectiveness, societal and ethical values, and patient experiences when formulating recommendations. Target audience includes clinicians; target population is adults with persistent headaches associated with neck pain.
When managing patients with headaches associated with neck pain, clinicians should (a) rule out major structural or other pathologies, or migraine as the cause of headaches; (b) classify headaches associated with neck pain as tension-type headache or cervicogenic headache once other sources of headache pathology has been ruled out; (c) provide care in partnership with the patient and involve the patient in care planning and decision making; (d) provide care in addition to structured patient education; (e) consider low-load endurance craniocervical and cervicoscapular exercises for tension-type headaches (episodic or chronic) or cervicogenic headaches >3 months duration; (f) consider general exercise, multimodal care (spinal mobilization, craniocervical exercise and postural correction) or clinical massage for chronic tension-type headaches; (g) do not offer manipulation of the cervical spine as the sole form of treatment for episodic or chronic tension-type headaches; (h) consider manual therapy (manipulation with or without mobilization) to the cervical and thoracic spine for cervicogenic headaches >3 months duration. However, there is no added benefit in combining spinal manipulation, spinal mobilization and exercises; and (i) reassess the patient at every visit to assess outcomes and determine whether a referral is indicated.
Our evidence-based guideline provides recommendations for the conservative management of persistent headaches associated with neck pain. The impact of the guideline in clinical practice requires validation.
Neck pain and headaches are very common comorbidities in the population. Tension-type and cervicogenic headaches can be treated effectively with specific exercises. Manual therapy can be considered as an adjunct therapy to exercise to treat patients with cervicogenic headaches. The management of tension-type and cervicogenic headaches should be patient-centred.
摘要：
为与颈部疼痛相关的持续性头痛的非药物管理制定循证指南（即，张力型或子宫颈）。
本指南基于对高质量研究的系统评价。一个多学科专家小组考虑了临床益处的证据，成本效益，社会和道德价值观，和患者在制定建议时的经验。目标受众包括临床医生；目标人群是患有与颈部疼痛相关的持续性头痛的成年人。
在治疗与颈部疼痛相关的头痛患者时，临床医生应（a）排除主要的结构或其他病症，或偏头痛是头痛的原因；（b）一旦排除了其他头痛病理来源，将与颈部疼痛相关的头痛分类为紧张型头痛或宫颈源性头痛；（c）与患者合作提供护理，并使患者参与护理计划和决策；（d）除对患者进行结构化教育外，还提供护理；（e）考虑低负荷耐力颅颈和颈capsocular运动治疗紧张型头痛（持续时间>3个月）；多模式护理(脊柱动员，颅颈锻炼和姿势矫正）或慢性紧张型头痛的临床按摩；（g）不提供颈椎操作作为发作性或慢性紧张型头痛的唯一治疗形式；（h）对于颈源性头痛>3个月，考虑对颈椎和胸椎进行手动治疗（有或没有动员的操作）。然而,结合脊柱操作没有额外的好处，脊柱动员和锻炼;(i)在每次就诊时重新评估患者以评估结果并确定是否需要转诊。
我们的循证指南为与颈部疼痛相关的持续性头痛的保守治疗提供了建议。指南在临床实践中的影响需要验证。
颈部疼痛和头痛是人群中非常常见的合并症。紧张型和宫颈源性头痛可以通过特定的锻炼有效治疗。手动疗法可以被认为是运动治疗颈源性头痛患者的辅助疗法。紧张型和颈源性头痛的治疗应以患者为中心。
本指南基于对高质量研究的系统评价。一个多学科专家小组考虑了临床益处的证据，成本效益，社会和道德价值观，和患者在制定建议时的经验。目标受众包括临床医生；目标人群是患有与颈部疼痛相关的持续性头痛的成年人。
在治疗与颈部疼痛相关的头痛患者时，临床医生应（a）排除主要的结构或其他病症，或偏头痛是头痛的原因；（b）一旦排除了其他头痛病理来源，将与颈部疼痛相关的头痛分类为紧张型头痛或宫颈源性头痛；（c）与患者合作提供护理，并使患者参与护理计划和决策；（d）除对患者进行结构化教育外，还提供护理；（e）考虑低负荷耐力颅颈和颈capsocular运动治疗紧张型头痛（持续时间>3个月）；多模式护理(脊柱动员，颅颈锻炼和姿势矫正）或慢性紧张型头痛的临床按摩；（g）不提供颈椎操作作为发作性或慢性紧张型头痛的唯一治疗形式；（h）对于颈源性头痛>3个月，考虑对颈椎和胸椎进行手动治疗（有或没有动员的操作）。然而,结合脊柱操作没有额外的好处，脊柱动员和锻炼;(i)在每次就诊时重新评估患者以评估结果并确定是否需要转诊。
我们的循证指南为与颈部疼痛相关的持续性头痛的保守治疗提供了建议。指南在临床实践中的影响需要验证。
颈部疼痛和头痛是人群中非常常见的合并症。紧张型和宫颈源性头痛可以通过特定的锻炼有效治疗。手动疗法可以被认为是运动治疗颈源性头痛患者的辅助疗法。紧张型和颈源性头痛的治疗应以患者为中心。
