An Outcomes Based Approach to the Management of Headache

Boline P, Nelson CProceedings of the Int’l Conference of Spinal Manipulation 1993 : 123

Headache is recognized as a significant public health problem with millions of people suffering disabling headaches. Relatively little attention has been paid to developing a systematized approach to the management of this problem. This presentation examines an effort to order and systematize the treatment of headache. The effort centers around two initiatives: the creation of a diagnostic and therapeutic algorithm for headache management and the concurrent conduct of clinical trials examining the effectiveness of various headache treatments. Clinicians at Northwestern College of Chiropractic have developed a diagnostic and treatment algorithm for headaches which has been implemented in the outpatient clinic. The protocol defined by this algorithm emphasizes a multidisciplinary approach to headache management as well as providing a standardized set of assessment and outcomes measures. The development of this algorithm is discussed as well as the assessment and outcome measures that are used. A randomized clinical trial was recently completed at the Center for Clinical Studies which compared amitriptyline and chiropractic care for the treatment of chronic recurrent tension headaches. The outcome measures in this study included paint ratings, use of over the counter medications, headache frequency, and the SF-36D. 150 subjects were recruited into the study. Each subject was enrolled in a twelve-week program; two-week baseline period, six-week treatment period, and a four-week follow-up period. The results of this study will be discussed. Following the completion of this study, a second randomized controlled trial comparing the effectiveness of chiropractic and medical therapy for the treatment of migraine headache was begun. The design of this study will be discussed as well as some of the preliminary data.

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