Do evidence-based practice guidelines exist to support physiotherapists in the approach of patients with episodic headache?

Abstract

The International Classification of Headache Disorders provides an extensive framework to classify headaches as primary or secondary. Physiotherapy is indicated if neuro-musculoskeletal dysfunctions are assumed to be related to the pathophysiological process. Mostly patients suffering from episodic migraine, cervicogenic and tension-type headache consult physiotherapists. Various interventions such as manual therapy, relaxation and exercise therapy are applied in such patients. Yet, clinical outcomes following physiotherapy tend to vary. Methods National and international physiotherapy guidelines concerning the treatment of headache were searched in the databases Pubmed, Web of Science, Pedro and the Cochrane library from January to May 2017. The following Topics or Medical subject heading terms were combined: 'Headache', 'Adult', 'Physiotherapy or Physical Therapy','(EBM/EBP) Guidelines' and 'Recommendations'. Guidelines as well as meta-analyses and (systematic) reviews in English and Dutch were included. Results Guidelines focus primarily on the pharmacological management of headache. From only two evidence-based physiotherapy guidelines it was concluded that effectiveness of interventions will depend on clinical reasoning since not all interventions are equally effective for all headache types.