Background
Methods
Recruitment and sample
Questionnaire
Statistical analyses
Characteristic | Survey Population | ACORN Database | p-value |
---|---|---|---|
Gender (%) | |||
Male | 64 | 63 | p = 0.379 |
Female | 36 | 37 | |
Place of Practice (%) | p = 0.916 | ||
New South Wales | 35.1 | 34 | |
Victoria | 23.2 | 25 | |
Queensland | 15.2 | 15 | |
Western Australia | 14.7 | 13 | |
South Australia | 8.5 | 9 | |
Australian Capital Territory | 1.6 | 2 | |
Tasmania | 0.9 | 1 | |
Northern Territory | 0.5 | 1 | |
Place of Education (%) | |||
New South Wales | 38.6 | N. A | |
Victoria | 35.6 | N. A | |
Queensland | 0.8 | N. A | |
Western Australia | 9.7 | N. A | |
Other | 15.3 | N. A | |
Years in Practice (mean ± sd) | 18.1 ± 10.9 | 15.6 ± 11.2 | p = 0.003 |
Chiropractic headache classification/assessment | Used diagnostic criteria for primary headache types | |||
---|---|---|---|---|
No (n = 61) | Yes (n = 334) | p-value | ||
Headache classification criteria (views) | % | % | ||
ICHD primary headache diagnostic criteria are distinct for the diagnosis of primary headaches | Strongly disagree | 3 | 1 | < 0.001 |
Disagree | 10 | 4 | ||
Neutral | 34 | 10 | ||
Agree | 46 | 66 | ||
Strongly agree | 7 | 19 | ||
ICHD primary headache diagnostic criteria are easy to follow | Strongly disagree | 5 | 1 | < 0.001 |
Disagree | 5 | 2 | ||
Neutral | 23 | 8 | ||
Agree | 62 | 67 | ||
Strongly agree | 5 | 22 | ||
Patients with primary headache easily fit into ICHD primary headache diagnostic criteria | Strongly disagree | 6 | 1 | < 0.001 |
Disagree | 43 | 17 | ||
Neutral | 25 | 29 | ||
Agree | 23 | 46 | ||
Strongly agree | 3 | 5 | ||
ICHD primary headache diagnostic criteria influences headache management | Strongly disagree | 13 | 2 | < 0.001 |
Disagree | 41 | 9 | ||
Neutral | 28 | 17 | ||
Agree | 18 | 58 | ||
Strongly agree | 0 | 14 | ||
ICHD primary headache diagnostic criteria helps communication with other healthcare professionals | Strongly disagree | 5 | 0 | < 0.001 |
Disagree | 13 | 1 | ||
Neutral | 36 | 14 | ||
Agree | 41 | 60 | ||
Strongly agree | 5 | 25 | ||
ICHD primary headache diagnostic criteria improves decision-making about patient referral or co-management | Strongly disagree | 10 | 1 | < 0.001 |
Disagree | 29 | 4 | ||
Neutral | 36 | 17 | ||
Agree | 23 | 58 | ||
Strongly agree | 2 | 20 | ||
Headache outcome criteria | ||||
Use of Migraine Disability Assessment Test (MIDAS) | Never | 97 | 69 | < 0.001 |
Rarely | 3 | 27 | ||
Often | 0 | 4 | ||
Every new headache patient | 0 | 1 | ||
Use of Headache Disability Inventory (HDI) | Never | 91 | 60 | < 0.001 |
Rarely | 9 | 24 | ||
Often | 0 | 12 | ||
Every new headache patient | 0 | 3 | ||
Use of Headache Diary | Never | 43 | 18 | < 0.001 |
Rarely | 40 | 37 | ||
Often | 14 | 42 | ||
Every new headache patient | 3 | 4 |
Chiropractic headache referral | Used diagnostic criteria for primary headache types | |||
---|---|---|---|---|
No (n = 61) | Yes (n = 334) | p-value | ||
Headache referral (receiving) | % | % | ||
Headache referral from GP | Never | 42 | 27 | < 0.001 |
Rarely | 46 | 40 | ||
Sometimes | 7 | 29 | ||
Often | 5 | 4 | ||
Headache referral from medical specialist (neurologist, rheumatologist, orthopaedic, psychiatrist) | Never | 89 | 77 | < 0.001 |
Rarely | 9 | 19 | ||
Sometimes | 2 | 4 | ||
Often | 0 | 1 | ||
Headache referral from Psychologist | Never | 89 | 68 | < 0.001 |
Rarely | 9 | 19 | ||
Sometimes | 2 | 11 | ||
Often | 0 | 2 | ||
Headache referral from Dentist | Never | 67 | 40 | 0.002 |
Rarely | 21 | 33 | ||
Sometimes | 9 | 23 | ||
Often | 4 | 5 | ||
Headache referral from Physiotherapist | Never | 74 | 67 | 0.684 |
Rarely | 19 | 21 | ||
Sometimes | 7 | 10 | ||
Often | 0 | 2 | ||
Headache referral from Osteopath | Never | 89 | 78 | 0.154 |
Rarely | 11 | 16 | ||
Sometimes | 0 | 5 | ||
Often | 0 | 1 | ||
Headache referral from CAM practitioners (inc. acupuncturist, herbalist, naturopath, massage therapist, counsellor) | Never | 28 | 11 | < 0.001 |
Rarely | 28 | 19 | ||
Sometimes | 35 | 47 | ||
Often | 9 | 23 | ||
Headache referral (sending) | ||||
Headache referral to GP | Never | 19 | 7 | < 0.001 |
Rarely | 46 | 29 | ||
Sometimes | 33 | 55 | ||
Often | 2 | 9 | ||
Headache referral to medical specialist (neurologist, rheumatologist, orthopaedic, psychiatrist) via GP | Never | 25 | 17 | < 0.001 |
Rarely | 58 | 36 | ||
Sometimes | 18 | 42 | ||
Often | 0 | 4 | ||
Headache referral to Psychologist | Never | 74 | 47 | 0.004 |
Rarely | 19 | 34 | ||
Sometimes | 7 | 16 | ||
Often | 0 | 2 | ||
Headache referral to Dentist | Never | 39 | 15 | 0.001 |
Rarely | 32 | 42 | ||
Sometimes | 26 | 37 | ||
ften | 4 | 5 | ||
Headache referral to Physiotherapist | Never | 72 | 54 | 0.106 |
Rarely | 21 | 31 | ||
Sometimes | 7 | 13 | ||
Often | 0 | 2 | ||
Headache referral to Osteopath | Never | 91 | 74 | 0.025 |
Rarely | 7 | 21 | ||
Sometimes | 2 | 4 | ||
Often | 0 | 0 | ||
Headache referral to CAM practitioners (eg. acupuncturist, naturopath, massage therapist, counsellor) | Never | 23 | 7 | 0.001 |
Rarely | 28 | 23 | ||
Sometimes | 33 | 50 | ||
Often | 16 | 20 | ||
Headache referral (reasons) | ||||
Headache referral to confirm headache diagnosis | Never | 54 | 21 | < 0.001 |
Rarely | 32 | 43 | ||
Sometimes | 12 | 32 | ||
Often | 2 | 4 | ||
Headache referral to improve coping skills and headache disability management | Never | 39 | 11 | < 0.001 |
Rarely | 26 | 31 | ||
Sometimes | 33 | 47 | ||
Often | 2 | 10 | ||
Headache referral to investigate headache red-flag | Never | 0 | 1 | < 0.001 |
Rarely | 42 | 12 | ||
Sometimes | 42 | 51 | ||
Often | 16 | 36 | ||
Headache referral to provide pain relief for acute headache attacks | Never | 26 | 10 | 0.004 |
Rarely | 33 | 29 | ||
Sometimes | 33 | 48 | ||
Often | 7 | 12 | ||
Headache referral to help provide headache prevention | Never | 37 | 17 | 0.004 |
Rarely | 33 | 35 | ||
Sometimes | 25 | 39 | ||
Often | 5 | 9 |
Chiropractic headache management/treatment | Used diagnostic criteria for primary headache types | |||
---|---|---|---|---|
No (n = 61) | Yes (n = 334) | p-value | ||
Importance of treatment outcomes | % | % | ||
Treatment aimed to prevent headache episodes | Very unimportant | 11 | 5 | 0.317 |
Somewhat unimportant | 0 | 0 | ||
Neutral | 0 | 1 | ||
Somewhat important | 13 | 10 | ||
Very important | 77 | 84 | ||
Treatment aimed to improve recovery from episode of headaches | Very unimportant | 9 | 4 | 0.043 |
Somewhat unimportant | 2 | 1 | ||
Neutral | 0 | 1 | ||
Somewhat important | 27 | 16 | ||
Very important | 62 | 78 | ||
Treatment aimed at pain relief during headache episode | Very unimportant | 9 | 3 | 0.049 |
Somewhat unimportant | 0 | 1 | ||
Neutral | 5 | 3 | ||
Somewhat important | 41 | 32 | ||
Very important | 45 | 61 | ||
Treatment aimed to improve headache coping skills | Very unimportant | 7 | 2 | 0.001 |
Somewhat unimportant | 11 | 3 | ||
Neutral | 16 | 8 | ||
Somewhat important | 32 | 35 | ||
Very important | 34 | 52 | ||
Treatment aimed to improve overall health and well-being | Very unimportant | 9 | 4 | 0.411 |
Somewhat unimportant | 0 | 2 | ||
Neutral | 2 | 3 | ||
Somewhat important | 12 | 16 | ||
Very important | 77 | 75 |
Chiropractic headache management | Used diagnostic criteria for primary headache types | |||
---|---|---|---|---|
No (n = 61) | Yes (n = 334) | p-value | ||
Chiropractic headache management - migraine | % | % | ||
Manual adjusting/manipulation (including Diversified, Gonstead) | Never | 7 | 5 | 0.751 |
Rarely | 14 | 12 | ||
Often | 45 | 51 | ||
Almost every migraine patient | 34 | 32 | ||
Non-thrust spinal mobilisations | Never | 18 | 9 | 0.001 |
Rarely | 37 | 19 | ||
Often | 34 | 58 | ||
Almost every migraine patient | 11 | 14 | ||
Instrument adjusting | Never | 14 | 9 | 0.407 |
Rarely | 18 | 18 | ||
Often | 48 | 58 | ||
Almost every migraine patient | 20 | 14 | ||
Drop piece, Thompson or similar | Never | 29 | 29 | 0.944 |
Rarely | 34 | 37 | ||
Often | 22 | 28 | ||
Almost every migraine patient | 5 | 6 | ||
Massage, myofascial technique, stretching or trigger-points to neck/shoulder area | Never | 9 | 2 | < 0.001 |
Rarely | 25 | 9 | ||
Often | 48 | 42 | ||
Almost every migraine patient | 18 | 47 | ||
Electro-physical therapies (TENS, ultrasound etc) | Never | 89 | 77 | 0.236 |
Rarely | 9 | 15 | ||
Often | 2 | 7 | ||
Almost every migraine patient | 0 | 2 | ||
Soft tissue or exercise therapy to temporomandibular region | Never | 29 | 5 | < 0.001 |
Rarely | 20 | 27 | ||
Often | 41 | 54 | ||
Almost every migraine patient | 11 | 14 | ||
Prescriptive exercises for the neck/shoulder region | Never | 14 | 2 | < 0.001 |
Rarely | 20 | 14 | ||
Often | 46 | 52 | ||
Almost every migraine patient | 20 | 33 | ||
Advice on stress management | Never | 2 | 0 | 0.019 |
Rarely | 16 | 9 | ||
Often | 59 | 51 | ||
Almost every migraine patient | 23 | 41 | ||
Advice on diet or fitness | Never | 2 | 1 | 0.057 |
Rarely | 12 | 14 | ||
Often | 64 | 49 | ||
Almost every migraine patient | 21 | 37 | ||
Advice on Headache triggers | Never | 0 | 0 | 0.005 |
Rarely | 14 | 5 | ||
Often | 52 | 45 | ||
Almost every migraine patient | 34 | 50 | ||
Chiropractic headache management - tension headache | ||||
Manual adjusting/manipulation (including Diversified, Gonstead) | Never | 9 | 4 | 0.291 |
Rarely | 11 | 7 | ||
Often | 36 | 42 | ||
Almost every tension headache patient | 45 | 47 | ||
Non-thrust spinal mobilisations | Never | 27 | 11 | 0.003 |
Rarely | 27 | 21 | ||
Often | 38 | 52 | ||
Almost every tension headache patient | 9 | 16 | ||
Instrument adjusting | Never | 14 | 11 | 0.810 |
Rarely | 20 | 18 | ||
Often | 48 | 55 | ||
Almost every tension headache patient | 18 | 16 | ||
Drop piece, Thompson or similar | Never | 32 | 35 | 0.662 |
Rarely | 25 | 27 | ||
Often | 38 | 30 | ||
Almost every tension headache patient | 5 | 8 | ||
Massage, myofascial technique, stretching or trigger-points to neck/shoulder area | Never | 5 | 3 | < 0.001 |
Rarely | 27 | 6 | ||
Often | 43 | 40 | ||
Almost every tension headache patient | 25 | 51 | ||
Electro-physical therapies (TENS, ultrasound etc) | Never | 89 | 79 | 0.374 |
Rarely | 9 | 13 | ||
Often | 2 | 6 | ||
Almost every tension headache patient | 0 | 2 | ||
Soft tissue or exercise therapy to temporo- mandibular region | Never | 18 | 8 | 0.017 |
Rarely | 32 | 25 | ||
Often | 43 | 50 | ||
Almost every tension headache patient | 7 | 18 | ||
Prescriptive exercises for the neck/shoulder region | Never | 11 | 1 | < 0.001 |
Rarely | 20 | 8 | ||
Often | 45 | 45 | ||
Almost every tension headache patient | 25 | 46 | ||
Advice on stress management | Never | 2 | 0 | 0.002 |
Rarely | 14 | 9 | ||
Often | 59 | 42 | ||
Almost every tension headache patient | 25 | 49 | ||
Advice on diet or fitness | Never | 2 | 2 | 0.480 |
Rarely | 11 | 11 | ||
Often | 59 | 48 | ||
Almost every tension headache patient | 29 | 39 | ||
Headache triggers advice | Never | 7 | 0 | < 0.001 |
Rarely | 14 | 7 | ||
Often | 46 | 47 | ||
Almost every tension headache patient | 32 | 46 |
Factors | Odds Ratio | 95% C.I. | p-value | |
---|---|---|---|---|
ICHD primary headache diagnostic criteria influences headache management | Strongly Disagree/Disagree/Neutral | 1.00 | ||
Agree/Strongly Agree | 7.86 | 3.15, 19.60 | < 0.001 | |
ICHD primary headache diagnostic criteria improves decision-making about headache patient referral/co-management | Strongly Disagree/Disagree/Neutral | 1.00 | ||
Agree/Strongly Agree | 2.35 | 1.01, 5.47 | 0.046 | |
Referral to investigate a headache red-flag | Never/Rarely/Sometimes | 1.00 | ||
Often | 2.67 | 1.02, 6.96 | 0.045 | |
Referral to assist headache prevention | Never/Rarely/Sometimes | 1.00 | ||
Often | 0.16 | 0.03, 0.80 | 0.026 | |
ICHD primary headache diagnostic criteria are distinct for the diagnosis of primary headaches | Strongly Disagree/Disagree/Neutral | 1.00 | ||
Agree/Strongly Agree | 3.64 | 1.58, 8.39 | 0.002 | |
Massage, myofascial technique, stretching or trigger-points to neck/shoulder area for tension headache management | Never/rarely | 1.00 | ||
Often/Almost every new patient with tension headache | 4.33 | 1.67, 11.19 | 0.003 | |
Headache diary | Never/Rarely | 1.00 | ||
Often/Every new patient with headache | 3.52 | 1.41, 8.77 | 0.007 |