European Spine Journal

, Volume 25, Issue 7, pp 1971–1999 | Cite as

Are non-invasive interventions effective for the management of headaches associated with neck pain? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration

  • Sharanya Varatharajan
  • Brad Ferguson
  • Karen Chrobak
  • Yaadwinder Shergill
  • Pierre CôtéEmail author
  • Jessica J. Wong
  • Hainan Yu
  • Heather M. Shearer
  • Danielle Southerst
  • Deborah Sutton
  • Kristi Randhawa
  • Craig Jacobs
  • Sean Abdulla
  • Erin Woitzik
  • Andrée-Anne Marchand
  • Gabrielle van der Velde
  • Linda J. Carroll
  • Margareta Nordin
  • Carlo Ammendolia
  • Silvano Mior
  • Arthur Ameis
  • Maja Stupar
  • Anne Taylor-Vaisey
Review Article



To update findings of the 2000–2010 Bone and Joint Decade Task Force on Neck Pain and its Associated Disorders and evaluate the effectiveness of non-invasive and non-pharmacological interventions for the management of patients with headaches associated with neck pain (i.e., tension-type, cervicogenic, or whiplash-related headaches).


We searched five databases from 1990 to 2015 for randomized controlled trials (RCTs), cohort studies, and case–control studies comparing non-invasive interventions with other interventions, placebo/sham, or no interventions. Random pairs of independent reviewers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria to determine scientific admissibility. Studies with a low risk of bias were synthesized following best evidence synthesis principles.


We screened 17,236 citations, 15 studies were relevant, and 10 had a low risk of bias. The evidence suggests that episodic tension-type headaches should be managed with low load endurance craniocervical and cervicoscapular exercises. Patients with chronic tension-type headaches may also benefit from low load endurance craniocervical and cervicoscapular exercises; relaxation training with stress coping therapy; or multimodal care that includes spinal mobilization, craniocervical exercises, and postural correction. For cervicogenic headaches, low load endurance craniocervical and cervicoscapular exercises; or manual therapy (manipulation with or without mobilization) to the cervical and thoracic spine may also be helpful.


The management of headaches associated with neck pain should include exercise. Patients who suffer from chronic tension-type headaches may also benefit from relaxation training with stress coping therapy or multimodal care. Patients with cervicogenic headache may also benefit from a course of manual therapy.


Non-invasive interventions Tension-type headache Cervicogenic headache Headache attributed to whiplash injury Systematic review 



We would like to acknowledge and thank all of the individuals who have made important contributions to this review: Robert Brison, Poonam Cardoso, J. David Cassidy, Laura Chang, Douglas Gross, Murray Krahn, Michel Lacerte, Gail Lindsay, Patrick Loisel, Mike Paulden, Roger Salhany, John Stapleton, Angela Verven, and Leslie Verville. We would also like to thank Trish Johns-Wilson at the University of Ontario Institute of Technology for her review of the search strategy.

Compliance with ethical standards

Conflict of interest

Dr. Pierre Côté has received a grant from the Ontario government, Ministry of Finance, funding from the Canada Research Chairs program, personal fees from National Judicial Institute for lecturing, and personal fees from European Spine Society for teaching. Drs. Silvano Mior and Margareta Nordin have received reimbursement for travel expenses to attend meetings for the study. The remaining authors report no declarations of interest.


This work was supported by the Ontario Ministry of Finance and the Financial Services Commission of Ontario [RFP# OSS_00267175]. The funding agency had no involvement in the study design, collection, analysis, interpretation of data, writing of the manuscript or decision to submit the manuscript for publication. The research was undertaken, in part, thanks to funding from the Canada Research Chairs program to Dr. Pierre Côté, Canada Research Chair in Disability Prevention and Rehabilitation at the University of Ontario Institute of Technology.

Supplementary material

586_2016_4376_MOESM1_ESM.pdf (52 kb)
Supplementary material 1 (PDF 51 kb)
586_2016_4376_MOESM2_ESM.jpg (1010 kb)
Fig. 1a Flow chart for manual therapy (JPEG 1011 kb)
586_2016_4376_MOESM3_ESM.jpg (1 mb)
Fig. 1b Flow chart for exercise (JPEG 1040 kb)
586_2016_4376_MOESM4_ESM.jpg (994 kb)
Fig. 1c Flow chart for acupuncture (JPEG 995 kb)
586_2016_4376_MOESM5_ESM.jpg (965 kb)
Fig. 1d Flow chart for multimodal care (JPEG 966 kb)
586_2016_4376_MOESM6_ESM.jpg (942 kb)
Fig. 1e Flow chart for work disability prevention interventions (JPEG 942 kb)
586_2016_4376_MOESM7_ESM.jpg (995 kb)
Fig. 1f Flow chart for structured patient education and self-management, passive physical modalities, and soft-tissue therapy (JPEG 995 kb)
586_2016_4376_MOESM8_ESM.jpg (949 kb)
Fig. 1 g Flow chart for updated search in 2015 of all non-invasive interventions (manual therapy, exercise, acupuncture, multimodal care, work disability prevention interventions, education and self-management, passive physical modalities, and soft-tissue therapy) (JPEG 950 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Sharanya Varatharajan
    • 1
    • 2
    • 3
  • Brad Ferguson
    • 4
  • Karen Chrobak
    • 4
  • Yaadwinder Shergill
    • 5
  • Pierre Côté
    • 1
    • 6
    • 7
    Email author
  • Jessica J. Wong
    • 1
    • 2
  • Hainan Yu
    • 1
    • 2
  • Heather M. Shearer
    • 1
    • 2
  • Danielle Southerst
    • 1
    • 8
  • Deborah Sutton
    • 1
    • 2
  • Kristi Randhawa
    • 1
    • 2
    • 3
  • Craig Jacobs
    • 1
    • 9
  • Sean Abdulla
    • 4
  • Erin Woitzik
    • 4
  • Andrée-Anne Marchand
    • 10
  • Gabrielle van der Velde
    • 11
    • 12
    • 13
  • Linda J. Carroll
    • 14
  • Margareta Nordin
    • 15
  • Carlo Ammendolia
    • 7
    • 13
    • 16
  • Silvano Mior
    • 2
    • 7
  • Arthur Ameis
    • 17
  • Maja Stupar
    • 1
  • Anne Taylor-Vaisey
    • 1
  1. 1.UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC)TorontoCanada
  2. 2.Division of Graduate Education and Research ProgramsCanadian Memorial Chiropractic College (CMCC)TorontoCanada
  3. 3.Division of Undergraduate EducationCanadian Memorial Chiropractic College (CMCC)TorontoCanada
  4. 4.Department of Graduate StudiesCanadian Memorial Chiropractic College (CMCC)TorontoCanada
  5. 5.University of Ottawa Centre for Interdisciplinary Pain Research, Ottawa Hospital Research Institute, The Ottawa Hospital General CampusOttawaCanada
  6. 6.Canada Research Chair in Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), University of Ontario Institute of Technology (UOIT)OshawaCanada
  7. 7.Faculty of Health SciencesUniversity of Ontario Institute of Technology (UOIT)OshawaCanada
  8. 8.Rebecca MacDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai HospitalTorontoCanada
  9. 9.Division of Clinical EducationCanadian Memorial Chiropractic College (CMCC)TorontoCanada
  10. 10.Département d’anatomieUniversité du Québec à Trois-RivièresTrois-RivièresCanada
  11. 11.Toronto Health Economics and Technology Assessment (THETA) CollaborativeTorontoCanada
  12. 12.Leslie Dan Faculty of PharmacyUniversity of TorontoTorontoCanada
  13. 13.Institute for Work and HealthTorontoCanada
  14. 14.Injury Prevention Centre and School of Public HealthUniversity of AlbertaEdmontonCanada
  15. 15.Departments of Orthopedic Surgery and Environmental MedicineOccupational and Industrial Orthopedic Center, NYU School of Medicine, New York UniversityNew YorkUSA
  16. 16.Institute for Health Policy, Management and Evaluation, University of TorontoTorontoCanada
  17. 17.Certification Program in Insurance Medicine and Medico-legal Expertise, Faculty of MedicineUniversity of MontrealMontrealCanada

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