Updated Guidelines for Headaches

The National Institute of Clinical Excellence (NICE) has recently published new guidelines on the management of headaches. This will be welcome news to the 10 million people who frequently suffer from headaches in the UK.

Clinical Guideline 150 “Headaches – Diagnosis and management of headaches in young people and adults” received input from both the British Chiropractic Association and the Anglo European College of Chiropractic to provide up-to-date, evidence-based advice on the diagnosis and management of tension headaches, migraine, cluster headaches and medication over-use headaches in children and adults.

Whilst there is no specific recommendation for manual therapy for the management of primary headaches, in several studies the clinical trials suggest that manual therapy is at least as good as conventional care for headaches. More recent trials, not yet considered by NICE, show more favourable outcomes (1) (2).

However, the guidelines also highlight the fact that taking medications, like painkillers, particularly for a prolonged period of time can actually worsen the symptoms, rather than alleviate them. It was reported that up to 1 in 50 people experience headaches that result from taking medication frequently. In light of these findings, it may be that manual therapy is a suitable low risk intervention that may offer relief to those who do not wish to take medication.

There is a need for a lot more research into the management of this often debilitating condition. In particular, further investigation in needed in the class of cervicogenic headaches, responsible for 1 in 6 cases of headache, which has not been included in this NICE guideline.

References
(1). Effectiveness of manual therapy for chronic tension-type headache: a pragmatic, randomised, clinical trial. Castien RF, van der Windt DA, Grooten A, Dekker J. Cephalalgia. 2011 Jan;31(2):133-43.
(2) Dose response and efficacy of spinal manipulation for chronic cervicogenic headache: a pilot randomized controlled trial. Haas M, Spegman A, Peterson D, Aickin M & Vavrek D. The Spine Journal 2010; 10:117-128.

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