This week we are focusing on a problem that 27 million Americans suffer from – headaches (1).

The American Academy of Family Physicians (2) recommends that clinicians conduct a thorough history and neurologic examination to determine if a headache is primary or secondary according to the International Headache Society (3).

Primary headaches include migraines, tension-type headaches and cluster headaches. These are typically benign, recurrent and have no organic disease as their cause. (3)

Secondary headaches on the other hand, are caused by an underlying organic disease ranging from sinusitis or hemorrhage and should be adequately assessed prior to initiation of treatment by a doctor of chiropractic (2). Identifying “Red Flags” is an important component of the headache evaluation and management process in order to identify rare but serious pathologies, such as space occupying lesions, or potential cervical arterial dissection.

1. Differential Diagnosis and Management for the Chiropractor: Fifth Edition. Souza, Thomas A; 2016.
2. Walling A. Frequent Headaches: Evaluation and Management. Am Fam Physician. 2020 Apr 1;101(7):419-428. PMID: 32227826.
3. Olesen J, et al. The International Classification of Headache Disorders, 3rd edition. Cephalgia: Headache Classification Committee of the International Headache Society (IHS); 2018.
4. 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. Non-pharmacological management of persistent headaches associated with neck pain: A clinical practice guideline from the Ontario protocol for
traffic injury management (OPTIMa) collaboration. Eur J Pain. 2019 Jul;23(6):1051- 1070. doi: 10.1002/ejp.1374. Epub 2019 Feb 28. PMID: 30707486.

Please note references are for both image and text.