Exercise and Manipulative Therapy for Older Persons With Headache
Exercise and Manipulative Therapy for Older Persons With Headache
The presence of cervical musculoskeletal impairment is not specific to cervicogenic headache
 but other various frequent intermittent headache types (i.e. migraine and tension-type
 headache) in the elderly population. There has been no trial to date which has investigated
 the effectiveness of physiotherapy treatment specifically for older persons with various
 types of headache with associated neck pain and cervical musculoskeletal impairment. Thus,
 the purpose of study investigate the efficacy of physiotherapy treatment for older persons
 who have headache concomitant with neck pain and musculoskeletal impairment
Headache is a common health problem that affects quality of life in an older population and
 imposes substantial economic costs. Headache changes with age. Features of headache become
 less typical and neck pain is more frequently associated with headache in older persons. We
 recently demonstrated that the presence of cervical musculoskeletal impairment is not
 specific to cervicogenic headache (headache caused by the neck). Rather it was present in
 various frequent intermittent headache types in elders when compared to elders without
 headache. Changes in headache characteristics with age play an important role not only in
 diagnosis but also in treatment choice. Impairment in cervical musculoskeletal function found
 in older persons with headache has implications for headache management choices as the
 evidence indicates that physiotherapy management methods such as manual therapy and
 therapeutic exercise are an effective management approach for headache associated with the
 neck. Physiotherapy treatment would be a safe therapeutic option and may have a beneficial
 effect for elders with headache who have neck pain and concomitant cervical musculoskeletal
 dysfunction. This is particularly relevant as there are widespread concerns about medication
 overuse, adverse drug events and drug interactions in older persons. The effective management
 of older persons with headache in particular of those with atypical features of headache
 remains a challenge. Physiotherapy is indicated in those older persons diagnosed with
 cervicogenic headache but could also be adjunct treatment for those with cervical
 musculoskeletal signs who are suspected of having transitional headache. At present, there
 has been no trial to date which has investigated the effectiveness of physiotherapy treatment
 specifically for older persons with various types of headache with associated neck pain and
 cervical musculoskeletal impairment. A clinical trial of treatment of cervical
 musculoskeletal impairment in older persons with various headache types may help guide
 management of headache in attempts to lesson medication use and cost in this population.
 Physiotherapy management may be a worthy treatment option particularly in older persons with
 headache who do not respond well to medication.
Inclusion Criteria:

 -  Volunteers suffering from frequent intermittent headache (either migraine,
 tension-type headache or cervicogenic headache) at least one per month over a period
 of 3 months or longer

 -  Aged 50 years or older, female or male

 -  A score of ≥ 3/10 on visual analogue scale (VAS) of neck pain

 -  Evidence of cervical musculoskeletal impairment: restriction in active range of
 cervical motion in extension and rotation and join tenderness in at least one of the
 upper joint as detected by manual palpation

 Exclusion Criteria:

 -  Headache diagnosed as following: temporal arteritis, trigeminal neuralgia, cluster
 headache, chronic paroxysmal hemicrania/hemicranias continua, temporomandibular joint
 dysfunction

 -  Other diagnosed disorders: cerebrovascular disease, Parkinson disease, cognitive
 disturbance

 -  Previous history of head or neck surgery

 -  Lack of willingness to receive either pragmatic treatment or usual care

 -  Physiotherapy or chiropractic treatment for headache in previous 6 months