Short summary

To optimize the management of patients with headaches in primary care, we need to determine the characteristics of patients with headaches, their clinical course in practice, and how other health conditions influence prognosis and treatment effects. This knowledge can be achieved through a large clinical cohort study of patients with headaches. The aim is to profile chiropractic patients with headaches, investigate their clinical course and prognosis, and explore trajectory patterns of headaches

Rationale

The first part of the Headache in Chiropractic Practice (HIK) project revealed that Danish chiropractors manage a substantial number of patients with headaches and provided us with knowledge about management strategies and diagnoses used by chiropractors. Current guidelines1-3 support non-pharmacological interventions such as patient education, physical activity and exercise, and manual therapy; all modalities are included in chiropractic care. However, guidelines conclude that the evidence is sparse regarding the effect of non-pharmacological interventions and that better studies are warranted. Furthermore, to optimize the management of chiropractic patients with headaches, we need to determine the characteristics of patients with headaches, their clinical course in chiropractic practice, and how other health conditions influence prognosis and treatment effects. This knowledge can be achieved through a large clinical cohort study of patients with headaches in chiropractic practice. The large proportion of chiropractic patients with headaches identified in the first part of the Headache in Chiropractic Practice (HIK) project makes a cohort study on headache patients not only feasible but also timely and essential. This new follow-up project will be based on the results from the first project and the experience and knowledge of both researchers and clinicians who participated. The study will create the basis for answering various research questions significant to clinicians and patients. The main research focus will be on headaches, but questions related to neck pain (with or without radiating symptoms to the arm) and other musculoskeletal complaints in patients with headaches will also be addressed. This cohort will be unique and large enough to provide sufficient statistical power to answer research questions that currently cannot be adequately addressed. The overall purpose is to profile chiropractic primary care patients with headaches, investigate their clinical course and prognosis, and explore trajectory patterns of headaches. The aims are: i. To characterise patients who seek chiropractic care for their headaches, and specifically: a. To describe, for each headache type, the characteristics within the following domains sociodemographic, general health, headache characteristics, and treatment. ii. To investigate the clinical course for patients with headaches followed for one year, and specifically: a. To assess outcomes within the following domains: general health (e.g. pain intensity, function, QOL), headache impact (e.g. number and duration of episodes, global perceived effect, impact on daily life), and treatment (e.g. use of medication, side effects). b. To explore the agreement between chiropractors and patients on the perceived effect of treatment. iii. To examine prognostic factors of outcome, and specifically: a. To identify potential prognostic factors that may influence the course of headache (for each headache type) in the context of chiropractic care in the following domains: sociodemographic, general health, headache characteristics, and treatment. b. To explore whether a new index of burden based on how social factors affect patients can be established and whether this can be used as a prognostic factor. iv. To identify trajectories in patients with headaches, and specifically: a. To explore if different trajectories adhere to different headache types. b. To investigate if these trajectories are associated with outcomes within the following domains: general health (e.g. pain intensity, function, QOL), headache impact (e.g. number and duration of episodes, global perceived effect, impact on daily life), and treatment (e.g. use of medication, side effects). v. to examine health care utilization patterns: a. to investigate the patterns of healthcare utilization among patients with headaches receiving chiropractic care, including visits to other healthcare providers, and medication usage.

Description of the cohort

Longitudinelt observational kohorte studie med 1000 hovedpinepatienter (>18 år) set i kiropraktor praksis. Deltagerne følges over et år.

Data and biological material

Patient data: Baseline spørgeskemaer omkring socioøkonomi, generelt helbred, hovedpine karakteristika og håndtering, livskvalitet, fysisk aktivitet, mentalt helbred og forventning til forløb. Followup spørgeskemaer ved 2, 4, 6, 8, 10 uger (antal dage med hovedpine, smerte intensitet, medicin forbrug, bivirkninger) + 3 og 6 og 12 måneder (samme som baseline + effekt af behandling). Kliniker data: Baseline spørgeskema om kiropraktor (antal år i praksis, alder, køb, hvilken region der praktiseres i). Kliniker rapporterede undersøgelsesfund, sygehistorie og diagnose.

Collaborating researchers and departments

Department of Sports Science and Clinical Biomechanics, University of Southern Denmark

• Henrik Hein Lauridsen