Get FORMED:
The basic take home is that our first task as clinicians is to accomplish an appropriate differential diagnosis for our patients. Headaches [HA] associated with neck pain can indicate any number of potential diagnoses, so first and foremost it is critical to rule out those etiologies that are most dangerous to miss.
- Rule out major structural pathology
- Rule out migraine
- Differentiate those patients who have tension-type HA vs. cervicogenic HA
- Partner with the patient in their own care [create autonomy]
- Provide care and patient education
- Encourage low-intensity/endurance exercise for the deep neck flexors and postural muscles
- For chronic cases, use general exercise in conjunction with manual therapy [cervical & thoracic mobilization/manipulation] in addition to postural/ergonomic correction
- Constantly reassess patients between visits to determine possible need for referral should patient fail to respond to treatment
Non-pharmacological Management of Persistent Headaches Associated with Neck Pain: A Clinical Practice Guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.
Côté P, Yu H, Shearer HM, Randhawa K, Wong JJ, Mior S, Ameis A, Carroll LJ, Nordin M, Varatharajan S, Sutton D, Southerst D, Jacobs C, Stupar M, Taylor-Vaisey A, Gross DP, Brison RJ, Paulden M, Ammendolia C, Cassidy JD, Loisel P, Marshall S, Bohay RN, Stapleton J, Lacerte M.
OBJECTIVES:
To develop an evidence-based guideline for the non-pharmacological management of persistent headaches associated with neck pain (i.e., tension-type or cervicogenic).
METHODS:
This guideline is based on systematic reviews of high-quality studies. A multidisciplinary expert panel considered the evidence of clinical benefits, cost-effectiveness, societal and ethical values, and patient experiences when formulating recommendations. Target audience includes clinicians; target population is adults with persistent headaches associated with neck pain.
RESULTS:
When managing patients with headaches associated with neck pain, clinicians should: 1) rule out major structural or other pathologies, or migraine as the cause of headaches; 2) classify headaches associated with neck pain as tension-type headache or cervicogenic headache once other sources of headache pathology has been ruled out; 3) provide care in partnership with the patient and involve the patient in care planning and decision-making; 4) provide care in addition to structured patient education; 5) consider low load endurance craniocervical and cervicoscapular exercises for tension-type headaches (episodic or chronic) or cervicogenic headaches >3 months duration; 6) consider general exercise, multimodal care (spinal mobilization, craniocervical exercise, and postural correction), or clinical massage for chronic tension-type headaches; 7) do not offer manipulation of the cervical spine as the sole form of treatment for episodic or chronic tension-type headaches; 8) consider manual therapy (manipulation with or without mobilization) to the cervical and thoracic spine for cervicogenic headaches >3 months duration. However, there is no added benefit in combining spinal manipulation, spinal mobilization, and exercises; and 9) reassess the patient at every visit to assess outcomes and determine whether a referral is indicated.
CONCLUSIONS:
Our evidence-based guideline provides recommendations for the conservative management of persistent headaches associated with neck pain. The impact of the guideline in clinical practice requires validation.
physioformed.com 
That is the effect of stress, the aching of head and neck
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It definitely can be! The challenging thing and important thing to remember when addressing headache is appreciate the multifarious underlying possible etiologies. This article highlights the need to perform a thorough differential diagnosis in line with the most current evidence prior to implementing intervention. Thank you for your comment!
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