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.
Highlights
Headache management is common within chiropractic clinical settings; little is yet known about how this provider group manage headache sufferers
In direct response to this important research gap, this paper reports on a) the prevalence of patients who present to chiropractors with headache and b) how chiropractors approach keys aspects of headache patient management appropriate to primary care settings including the use of headache diagnostic criteria, headache assessment tools, approach to headache treatment and interdisciplinary engagement with other headache providers
When comparing survey participants to the Australian Chiropractic Research Network (ACORN) data-base, survey respondents are generally representative for gender (64% male vs 63%) (p = 0.379), and place of practice: New South Wales (35.1% vs 34%), Victoria (23.2% vs 25%), Queensland (15.2% vs 15.0%), Western Australia (14.7% vs 13%), South Australia (8.5% vs 9.0%), Australian Capital Territory (1.6% vs 2%), Tasmania (0.9% vs 1%) and Northern Territory (0.5% vs 1%) (p = 0.916) [16]
Summary
Headache management is common within chiropractic clinical settings; 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. In the collaborative study between the World Health Organisation (WHO) and the ‘Lifting The Burden’ campaign, survey information was collected from neurologists and general practitioners in order to better understand how these providers approach headache diagnosis and management [9]. While headache is most often managed by general practitioners and neurologists, the report found headache patients report a clear preference for the use of complementary and alternative treatments for headaches including physical based therapies and acupuncture. In a recent national US study, manipulative-based physical therapies were reported to be the most frequently used complementary and alternative treatments for migraine and headache patients [10]. One international study found chiropractors to be the second and third most common health care provider by those with migraine in Australia and the United States respectively [13]
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