Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.
Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.
Musculoskelet Sci Pract. 2021 Apr;52:102325. doi: 10.1016/j.msksp.2021.102325. Epub 2021 Jan 26.
Though a large amount of research on the management of headache has been conducted, the clinical effectiveness of these treatments remains unclear.
To reach consensus among international musculoskeletal experts on what the most appropriate management is in patients that suffer from headache.
Expert group and Delphi-study.
A total of 11 experts participated in the expert panel groups, where the role of physiotherapy in the management of headache was discussed. Afterwards, 14 of the initial 25 participants in the field of headache completed the whole Delphi study, which was conducted over 4 rounds. The first round aimed to identify clinical indicators and treatments that are useful in patients with headache. These questions were then categorized and ranked during the second, third, and fourth rounds. Consensual agreement was set at ≥ 80%.
After the final round, 9 interventions were rated as useful by the participants. In the final extra round, 14 clinical indicators were retrieved as important to decide whether or not to start one of the consensual treatments. The top 3 management strategies were (1) upper cervical spine mobilisations in cervivogenic headache, (2) active mobilisation exercises of the cervical spine in cervivogenic headache, and (3) lifestyle advice in tension-type headache and migraine.
International experts agreed that most scientifically established effective treatments are useful in cervicogenic headache. Consensual agreement on treatments for migraine and tension-type headache were only reached for specific treatments. Their recommendations provide a framework for further research and the clinical management of headache.
尽管已经进行了大量关于头痛管理的研究，但这些治疗方法的临床效果仍不清楚。
在国际肌肉骨骼专家中就头痛患者最合适的治疗方法达成共识。
专家组和德尔菲研究。
共有 11 名专家参加了专家组，讨论了物理治疗在头痛管理中的作用。之后，14 名最初参与头痛领域的 25 名参与者中的 14 名完成了整个德尔菲研究，该研究共进行了 4 轮。第一轮旨在确定对头痛患者有用的临床指标和治疗方法。这些问题随后在第二轮、第三轮和第四轮进行分类和排名。一致同意的标准设定为≥80%。
在最后一轮，9 项干预措施被参与者评为有用。在最后一轮的额外回合中，确定了 14 个重要的临床指标，以便决定是否开始采用共识治疗方法之一。排名前三的管理策略是：（1）颈源性头痛中的颈椎活动度松动；（2）颈源性头痛中的颈椎主动活动练习；（3）紧张型头痛和偏头痛的生活方式建议。
国际专家一致认为，大多数经过科学验证有效的治疗方法对颈源性头痛都有用。对于偏头痛和紧张型头痛的治疗方法，只有在特定治疗方法上达成了共识。他们的建议为进一步的研究和头痛的临床管理提供了框架。
