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

Abstract

Purpose

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).

Methods

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.

Results

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.

Conclusions

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.

This is a preview of subscription content, log in to check access.

References

  1. 1.

    Carroll LJ, Cassidy JD, Cote P (2006) Frequency, timing, and course of depressive symptomatology after whiplash. Spine 31(16):E551–E556. doi:10.1097/01.brs.0000225979.26966.9e

    Article  PubMed  Google Scholar 

  2. 2.

    Carroll LJ, Liu Y, Holm LW, Cassidy JD, Cote P (2011) Pain-related emotions in early stages of recovery in whiplash-associated disorders: their presence, intensity, and association with pain recovery. Psychosom Med 73(8):708–715. doi:10.1097/PSY.0b013e31822f991a

    Article  PubMed  Google Scholar 

  3. 3.

    Hincapie CA, Cassidy JD, Cote P, Carroll LJ, Guzman J (2010) Whiplash injury is more than neck pain: a population-based study of pain localization after traffic injury. J Occup Environ Med 52(4):434–440. doi:10.1097/JOM.0b013e3181bb806d

    Article  PubMed  Google Scholar 

  4. 4.

    Haldeman S, Carroll LJ, Cassidy JD (2008) The empowerment of people with neck pain: introduction: the bone and joint decade 2000–2010 task force on neck pain and its associated disorders. Spine 33(4 Suppl):S8–S13. doi:10.1097/BRS.0b013e3181643f51

    Article  PubMed  Google Scholar 

  5. 5.

    Cote P, Cassidy JD, Carroll L (2000) The factors associated with neck pain and its related disability in the Saskatchewan population. Spine 25(9):1109–1117

    CAS  Article  PubMed  Google Scholar 

  6. 6.

    Hagen K, Einarsen C, Zwart JA, Svebak S, Bovim G (2002) The co-occurrence of headache and musculoskeletal symptoms amongst 51 050 adults in Norway. Eur J Neurol 9(5):527–533

    CAS  Article  PubMed  Google Scholar 

  7. 7.

    Cassidy JD, Carroll LJ, Cote P, Lemstra M, Berglund A, Nygren A (2000) Effect of eliminating compensation for pain and suffering on the outcome of insurance claims for whiplash injury. N Engl J Med 342(16):1179–1186. doi:10.1056/nejm200004203421606

    CAS  Article  PubMed  Google Scholar 

  8. 8.

    The international classification of headache disorders, 2nd edition (2004). Cephalalgia 24 (1):1–151. doi:10.1177/0333102413485658

  9. 9.

    Posadzki P, Ernst E (2012) Spinal manipulations for tension-type headaches: a systematic review of randomized controlled trials. Complement Ther Med 20(4):232–239

    CAS  Article  PubMed  Google Scholar 

  10. 10.

    Jensen R, Stovner LJ (2008) Epidemiology and comorbidity of headache. Lancet Neurol 7(4):354–361. doi:10.1016/s1474-4422(08)70062-0

    Article  PubMed  Google Scholar 

  11. 11.

    Ertas M, Baykan B, Orhan EK, Zarifoglu M, Karli N, Saip S, Onal AE, Siva A (2012) One-year prevalence and the impact of migraine and tension-type headache in Turkey: a nationwide home-based study in adults. J Headache Pain 13(2):147–157. doi:10.1007/s10194-011-0414-5

    Article  PubMed  PubMed Central  Google Scholar 

  12. 12.

    Andersen LL, Mortensen OS, Zebis MK, Jensen RH, Poulsen OM (2011) Effect of brief daily exercise on headache among adults—secondary analysis of a randomized controlled trial. Scand J Work Environ Health 37(6):547–550. doi:10.5271/sjweh.3170

    Article  PubMed  Google Scholar 

  13. 13.

    Nilsson N (1995) The prevalence of cervicogenic headache in a random population sample of 20–59 year olds. Spine 20(17):1884–1888

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Hurwitz EL, Carragee EJ, van der Velde G, Carroll LJ, Nordin M, Guzman J, Peloso PM, Holm LW, Cote P, Hogg-Johnson S, Cassidy JD, Haldeman S (2009) Treatment of neck pain: noninvasive interventions: results of the bone and joint decade 2000–2010 task force on neck pain and its associated disorders. J Manip Physiol Ther 32(2 Suppl):S141–S175. doi:10.1016/j.jmpt.2008.11.017

    Article  Google Scholar 

  15. 15.

    Jull G, Trott P, Potter H, Zito G, Niere K, Shirley D, Emberson J, Marschner I, Richardson C (2002) A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine 27(17):1835–1843 (discussion 1843)

    Article  PubMed  Google Scholar 

  16. 16.

    Carroll LJ, Hurwitz EL, Cote P, Hogg-Johnson S, Carragee EJ, Nordin M, Holm LW, van der Velde G, Cassidy JD, Guzman J, Peloso PM, Haldeman S (2009) Research priorities and methodological implications: the bone and joint decade 2000–2010 task force on neck pain and its associated disorders. J Manip Physiol Ther 32(2 Suppl):S244–S251. doi:10.1016/j.jmpt.2008.11.024

    Article  Google Scholar 

  17. 17.

    Sjaastad O, Fredriksen TA, Pfaffenrath V (1998) Cervicogenic headache: diagnostic criteria. The cervicogenic headache international study group. Headache 38(6):442–445

    CAS  Article  PubMed  Google Scholar 

  18. 18.

    Aker PD, Gross AR, Goldsmith CH, Peloso P (1996) Conservative management of mechanical neck pain: systematic overview and meta-analysis. BMJ 313(7068):1291–1296

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  19. 19.

    van Tulder MW, Koes BW, Bouter LM (1997) Conservative treatment of acute and chronic nonspecific low back pain. A systematic review of randomized controlled trials of the most common interventions. Spine (Phila Pa 1976) 22(18):2128–2156

    Article  Google Scholar 

  20. 20.

    Norman GR, Streiner DL (2008) Biostatistics: the bare essentials, 3rd edn. BC Decker, Hamilton

    Google Scholar 

  21. 21.

    Sampson M, McGowan J, Cogo E, Grimshaw J, Moher D, Lefebvre C (2009) An evidence-based practice guideline for the peer review of electronic search strategies. J Clin Epidemiol 62(9):944–952. doi:10.1016/j.jclinepi.2008.10.012

    Article  PubMed  Google Scholar 

  22. 22.

    McGowan J, Sampson M, Lefebvre C (2010) An evidence based checklist for the peer review of electronic search strategies (PRESS EBC). Evid Based Libr Inf Pract 5(1):149–154

    Article  Google Scholar 

  23. 23.

    Harbour R, Miller J (2001) A new system for grading recommendations in evidence based guidelines. BMJ 323(7308):334–336. doi:10.1136/bmj.323.7308.334

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  24. 24.

    van der Velde G, van Tulder M, Côté P, Hogg-Johnson S, Aker P, Cassidy JD, Carragee E, Carroll L, Guzman J, Haldeman S, Holm L, Hurwitz E, Nordin M, Peloso P (2007) The sensitivity of review results to methods used to appraise and incorporate trial quality into data synthesis. Spine (Phila Pa 1976) 32(7):796–806. doi:10.1097/01.brs.0000258903.67718.d5

    Article  Google Scholar 

  25. 25.

    Spitzer WO, Skovron ML, Salmi LR, Cassidy JD, Duranceau J, Suissa S, Zeiss E (1995) Scientific monograph of the Quebec task force on whiplash-associated disorders: redefining “whiplash” and its management. Spine 20(8 Suppl):1S–73S

    CAS  PubMed  Google Scholar 

  26. 26.

    Carroll LJ, Cassidy JD, Peloso PM, Giles-Smith L, Cheng CS, Greenhalgh SW, Haldeman S, van der Velde G, Hurwitz EL, Cote P, Nordin M, Hogg-Johnson S, Holm LW, Guzman J, Carragee EJ (2009) Methods for the best evidence synthesis on neck pain and its associated disorders: the bone and joint decade 2000–2010 task force on neck pain and its associated disorders. J Manip Physiol Ther 32(2 Suppl):S39–S45. doi:10.1016/j.jmpt.2008.11.009

    Article  Google Scholar 

  27. 27.

    Carroll LJ, Cassidy JD, Peloso PM, Garritty C, Giles-Smith L (2004) Systematic search and review procedures: results of the WHO Collaborating centre task force on mild traumatic brain injury. J Rehabil Med (43 Suppl):11–14

  28. 28.

    Cote P, Cassidy JD, Carroll L, Frank JW, Bombardier C (2001) A systematic review of the prognosis of acute whiplash and a new conceptual framework to synthesize the literature. Spine 26(19):E445–E458

    CAS  Article  PubMed  Google Scholar 

  29. 29.

    Hayden JA, Cote P, Bombardier C (2006) Evaluation of the quality of prognosis studies in systematic reviews. Ann Intern Med 144(6):427–437

    Article  PubMed  Google Scholar 

  30. 30.

    Hayden JA, van der Windt DA, Cartwright JL, Cote P, Bombardier C (2013) Assessing bias in studies of prognostic factors. Ann Intern Med 158(4):280–286. doi:10.7326/0003-4819-158-4-201302190-00009

    Article  PubMed  Google Scholar 

  31. 31.

    Slavin RE (1995) Best evidence synthesis: an intelligent alternative to meta-analysis. J Clin Epidemiol 48(1):9–18

    CAS  Article  PubMed  Google Scholar 

  32. 32.

    Stauffer ME, Taylor SD, Watson DJ, Peloso PM, Morrison A (2011) Definition of nonresponse to analgesic treatment of arthritic pain: an analytical literature review of the smallest detectable difference, the minimal detectable change, and the minimal clinically important difference on the pain visual analog scale. Int J Inflam 2011:231926. doi:10.4061/2011/231926

    Article  PubMed  PubMed Central  Google Scholar 

  33. 33.

    Carroll LJ, Jones DC, Ozegovic D, Cassidy JD (2012) How well are you recovering? The association between a simple question about recovery and patient reports of pain intensity and pain disability in whiplash-associated disorders. Disabil Rehabil 34(1):45–52. doi:10.3109/09638288.2011.587085

    Article  PubMed  Google Scholar 

  34. 34.

    Farrar JT, Young JP Jr, LaMoreaux L, Werth JL, Poole RM (2001) Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain 94(2):149–158

    CAS  Article  PubMed  Google Scholar 

  35. 35.

    McCarthy MJ, Grevitt MP, Silcocks P, Hobbs G (2007) The reliability of the Vernon and Mior neck disability index, and its validity compared with the short form-36 health survey questionnaire. Eur Spine J 16(12):2111–2117. doi:10.1007/s00586-007-0503-y

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  36. 36.

    Sim J, Jordan K, Lewis M, Hill J, Hay EM, Dziedzic K (2006) Sensitivity to change and internal consistency of the northwick park neck pain questionnaire and derivation of a minimal clinically important difference. Clin J Pain 22(9):820–826. doi:10.1097/01.ajp.0000210937.58439.39

    Article  PubMed  Google Scholar 

  37. 37.

    Lauche R, Langhorst J, Dobos GJ, Cramer H (2013) Clinically meaningful differences in pain, disability and quality of life for chronic nonspecific neck pain—a reanalysis of 4 randomized controlled trials of cupping therapy. Complement Ther Med 21(4):342–347. doi:10.1016/j.ctim.2013.04.005

    Article  PubMed  Google Scholar 

  38. 38.

    Abrams KR, Gillies CL, Lambert PC (2005) Meta-analysis of heterogeneously reported trials assessing change from baseline. Stat Med 24(24):3823–3844. doi:10.1002/sim.2423

    Article  PubMed  Google Scholar 

  39. 39.

    Follmann D, Elliott P, Suh I, Cutler J (1992) Variance imputation for overviews of clinical trials with continuous response. J Clin Epidemiol 45(7):769–773

    CAS  Article  PubMed  Google Scholar 

  40. 40.

    Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097. doi:10.1371/journal.pmed.1000097

    Article  PubMed  PubMed Central  Google Scholar 

  41. 41.

    Bove G, Nilsson N (1998) Spinal manipulation in the treatment of episodic tension-type headache: a randomized controlled trial. JAMA J Am Med Assoc 280(18):1576–1579

    CAS  Article  Google Scholar 

  42. 42.

    Castien RF, van der Windt DA, Grooten A, Dekker J (2011) Effectiveness of manual therapy for chronic tension-type headache: a pragmatic, randomised, clinical trial. Cephalalgia 31(2):133–143. doi:10.1177/0333102410377362

    Article  PubMed  Google Scholar 

  43. 43.

    Endres HG, Bowing G, Diener HC, Lange S, Maier C, Molsberger A, Zenz M, Vickers AJ, Tegenthoff M (2007) Acupuncture for tension-type headache: a multicentre, sham-controlled, patient-and observer-blinded, randomised trial. J Headache Pain 8(5):306–314. doi:10.1007/s10194-007-0416-5

    Article  PubMed  PubMed Central  Google Scholar 

  44. 44.

    Haas M, Spegman A, Peterson D, Aickin M, Vavrek D (2010) Dose response and efficacy of spinal manipulation for chronic cervicogenic headache: a pilot randomized controlled trial. Spine J Off J N Am Spine Soc 10(2):117–128. doi:10.1016/j.spinee.2009.09.002

    Article  Google Scholar 

  45. 45.

    Haas M, Schneider M, Vavrek D (2010) Illustrating risk difference and number needed to treat from a randomized controlled trial of spinal manipulation for cervicogenic headache. Chiropr Osteopat 18:9. doi:10.1186/1746-1340-18-9

    Article  PubMed  PubMed Central  Google Scholar 

  46. 46.

    Holroyd KA, O’Donnell FJ, Stensland M, Lipchik GL, Cordingley GE, Carlson BW (2001) Management of chronic tension-type headache with tricyclic antidepressant medication, stress management therapy, and their combination: a randomized controlled trial. JAMA J Am Med Assoc 285(17):2208–2215

    CAS  Article  Google Scholar 

  47. 47.

    Jena S, Witt CM, Brinkhaus B, Wegscheider K, Willich SN (2008) Acupuncture in patients with headache. Cephalalgia 28(9):969–979. doi:10.1111/j.1468-2982.2008.01640.x

    CAS  Article  PubMed  Google Scholar 

  48. 48.

    Melchart D, Streng A, Hoppe A, Brinkhaus B, Witt C, Wagenpfeil S, Pfaffenrath V, Hammes M, Hummelsberger J, Irnich D, Weidenhammer W, Willich SN, Linde K (2005) Acupuncture in patients with tension-type headache: randomised controlled trial. BMJ 331(7513):376–382. doi:10.1136/bmj.38512.405440.8F

    Article  PubMed  PubMed Central  Google Scholar 

  49. 49.

    Soderberg E, Carlsson J, Stener-Victorin E (2006) Chronic tension-type headache treated with acupuncture, physical training and relaxation training. Between-group differences. Cephalalgia 26(11):1320–1329. doi:10.1111/j.1468-2982.2006.01209.x

    CAS  Article  PubMed  Google Scholar 

  50. 50.

    Soderberg EI, Carlsson JY, Stener-Victorin E, Dahlof C (2011) Subjective well-being in patients with chronic tension-type headache: effect of acupuncture, physical training, and relaxation training. Clin J Pain 27(5):448–456. doi:10.1097/AJP.0b013e318208c8fe

    Article  PubMed  Google Scholar 

  51. 51.

    van Ettekoven H, Lucas C (2006) Efficacy of physiotherapy including a craniocervical training programme for tension-type headache; a randomized clinical trial. Cephalalgia 26(8):983–991. doi:10.1111/j.1468-2982.2006.01163.x

    Article  PubMed  Google Scholar 

  52. 52.

    Boline PD, Kassak K, Bronfort G, Nelson C, Anderson AV (1995) Spinal manipulation vs. amitriptyline for the treatment of chronic tension-type headaches: a randomized clinical trial. J Manip Physiol Ther 18(3):148–154

    CAS  Google Scholar 

  53. 53.

    Carlsson J, Fahlcrantz A, Augustinsson LE (1990) Muscle tenderness in tension headache treated with acupuncture or physiotherapy. Cephalalgia 10(3):131–141

    CAS  Article  PubMed  Google Scholar 

  54. 54.

    Carlsson J, Augustinsson LE, Blomstrand C, Sullivan M (1990) Health status in patients with tension headache treated with acupuncture or physiotherapy. Headache 30(9):593–599

    CAS  Article  PubMed  Google Scholar 

  55. 55.

    Karst M, Reinhard M, Thum P, Wiese B, Rollnik J, Fink M (2001) Needle acupuncture in tension-type headache: a randomized, placebo-controlled study. Cephalalgia 21(6):637–642

    CAS  Article  PubMed  Google Scholar 

  56. 56.

    Mousavi SA, Mirbod SM, Khorvash F (2011) Comparison between efficacy of imipramine and transcutaneous electrical nerve stimulation in the prophylaxis of chronic tension-type headache: a randomized controlled clinical trial. J Res Med Sci 16(7):923–927

    PubMed  PubMed Central  Google Scholar 

  57. 57.

    Bellamy R (2004) An introduction to patient education: theory and practice. Med Teach 26(4):359–365. doi:10.1080/01421590410001679398

    Article  PubMed  Google Scholar 

  58. 58.

    Group AAMPG (2003) Evidence-based management of acute musculoskeletal pain

  59. 59.

    Abenhaim L, Rossignol M, Valat JP, Nordin M, Avouac B, Blotman F et al. (2000) The role of activity in the therapeutic management of back pain. Report of the International Paris Task Force on Back Pain. Spine (Phila Pa 1976) 25(4 Suppl):1S–33S

  60. 60.

    Rubinstein SM, Terwee CB, Assendelft WJ, de Boer MR, van Tulder MW (2012) Spinal manipulative therapy for acute low-back pain. Cochrane Database Syst Rev 9:CD008880. doi:10.1002/14651858.CD008880.pub2

    PubMed  Google Scholar 

  61. 61.

    Maitland G, Hengeveld E, Banks K, English K (2005) Maitland’s Vertebral Manipulation, 7 edn. Elsevier Butterworth Heinemann, Toronto

    Google Scholar 

  62. 62.

    Peake N, Harte A (2005) The effectiveness of cervical traction. Phys Ther Rev 10:217–229

    Article  Google Scholar 

  63. 63.

    Graham N, Gross AR, Goldsmith C (2006) Mechanical traction for mechanical neck disorders: a systematic review. J Rehabil Med 38(3):145–152. doi:10.1080/16501970600583029

    Article  PubMed  Google Scholar 

  64. 64.

    World Health Organization (2002) Acupuncture: review and analysis of reports on controlled clinical trials. World Health Organization, Geneva

    Google Scholar 

  65. 65.

    Aas RW, Tuntland H, Holte KA, Roe C, Lund T, Marklund S et al. (2011) Workplace interventions for neck pain in workers. Cochrane Database Syst Rev (4):CD008160. doi:10.1002/14651858.CD008160.pub2

  66. 66.

    Burns JW, Higdon LJ, Mullen JT, Lansky D, Wei JM (1999) Relationships among patient hostility, anger expression, depression, and the working alliance in a work hardening program. Ann Behav Med 21(1):77–82. doi:10.1007/bf02895037

    CAS  Article  PubMed  Google Scholar 

  67. 67.

    Schaafsma F, Schonstein E, Ojajarvi A, Verbeek J (2011) Physical conditioning programs for improving work outcomes among workers with back pain. Scand J Work Environ Health 37(1):1–5

    Article  PubMed  Google Scholar 

  68. 68.

    Gardner BT, Pransky G, Shaw WS, Nha Hong Q, Loisel P (2010) Researcher perspectives on competencies of return-to-work coordinators. Disabil Rehabil 32(1):72–78. doi:10.3109/09638280903195278

    Article  PubMed  Google Scholar 

  69. 69.

    Shaw W, Hong QN, Pransky G, Loisel P (2008) A literature review describing the role of return-to-work coordinators in trial programs and interventions designed to prevent workplace disability. J Occup Rehabil 18(1):2–15. doi:10.1007/s10926-007-9115-y

    Article  PubMed  Google Scholar 

  70. 70.

    Driessen MT, Proper KI, van Tulder MW, Anema JR, Bongers PM, van der Beek AJ (2010) The effectiveness of physical and organisational ergonomic interventions on low back pain and neck pain: a systematic review. Occup Environ Med 67(4):277–285. doi:10.1136/oem.2009.047548

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

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.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Pierre Côté.

Ethics declarations

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.

Funding

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.

Additional information

Systematic Review Registration Number: CRD42013004848, CRD42013004901, CRD42013004687, CRD42013006940.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PDF 51 kb)

Fig. 1a Flow chart for manual therapy (JPEG 1011 kb)

Fig. 1b Flow chart for exercise (JPEG 1040 kb)

Fig. 1c Flow chart for acupuncture (JPEG 995 kb)

Fig. 1d Flow chart for multimodal care (JPEG 966 kb)

Fig. 1e Flow chart for work disability prevention interventions (JPEG 942 kb)

Fig. 1f Flow chart for structured patient education and self-management, passive physical modalities, and soft-tissue therapy (JPEG 995 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)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Varatharajan, S., Ferguson, B., Chrobak, K. et al. 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. Eur Spine J 25, 1971–1999 (2016). https://doi.org/10.1007/s00586-016-4376-9

Download citation

Keywords

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