Jul 2016
Neck Pain and Headache
Introduction
Assist primary care providers in differentiating and assessing neck pain or headache using the Clinically Organized Relevant Exam (CORE) Neck Tool and Headache Navigator. The CORE Neck Tool and Headache Navigator provide discrete approaches to neck pain and headache management.
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Media
In The Know: Neck Pain and Headache
Our video on the CORE Neck Tool and Headache Navigator, featuring Dr. Julia Alleyne and Dr. Arun Radhakrishnan, with information about how it can support primary care providers in better managing patients with neck pain and headache. Visit: effectivepractice.org/neckheadpain
Information
About the tool
Primary care providers told us that headache and neck pain are challenging to treat, especially when presented together. The Clinically Organized Relevant Exam (CORE) Neck Tool and Headache Navigator was developed to assist primary care providers in differentiating and assessing neck pain or headache.
Because neck pain and headache often have overlapping presentation of symptoms, this tool uses discrete approaches that help rule out other underlying conditions.
The Clinically Organized Relevant Exam (CORE) Neck Tool guides the recognition of common mechanical neck pain and screen for other conditions.
The CORE Neck Tool has been divided into four components:
- History
- Physical Examination
- Management Matrix
- Referrals
The Headache Navigator is based on the Primary Care Management of Headache in Adults clinical practice guideline and quick reference algorithm that was produced by Towards Optimized Practice(TOP). It assists primary care providers in managing primary headache disorders.
Clinical leads
Julia Alleyne
MD, CAC (SEM), FCFP
Dr. Julia Alleyne is a family physician practising Sport and Exercise Medicine at the Toronto Rehabilitation Institute, University Health Network. In addition, she trained as a physiotherapist and maintained an active license for 30 years. She is appointed at the University of Toronto, Department of Family and Community Medicine as an associate clinical professor.
In 2009, she completed her Masters with a focus in Health Professions Education. Since that time, she has been active as an educational curriculum consultant including acting as the clinical lead for Ontario’s Low Back Pain Strategy and program designer for the MSK Initiative in British Columbia. In 2013, she was appointed as the first Family Physician to be chair of Bone and Joint Canada.
In addition, Dr. Alleyne’s work in the area of back care includes being an educational consultant for curriculum and tool development for provincial MSK initiatives in Ontario and British Columbia. She has co-authored a series of spine related articles for Current Concepts in Care and is the co-chair for the Spine Quality Based Pathway. Dr. Alleyne has worked with the Centre for Effective Practice for a decade in the area of Primary Care Musculoskeletal tool development and education.
Arun Radhakrishnan
MD, CM, MSC, CCFP
Dr. Arun Radhakrishnan is a family physician with a focused clinical practice in chronic pain. He is an Assistant Professor with the Department of Family Medicine at the University of Ottawa and the University of Toronto. He is affiliated with The Ottawa Hospital and the Elisabeth Bruyere hospital and is an investigator at the Bruyere Research Institute and the Equity in Health Systems Lab. His research and education interests are in knowledge translation mentoring and digital health technologies. He has led the development of several award-winning educational programs, clinical practice tools and resources to support primary care management of chronic pain. He is a past AMS Phoenix Fellow and is currently the Medical Director of the Adaptive Mentoring Networks with the Centre for Effective Practice.
Dr. Radhakrishnan provided clinical leadership for the development of the chronic non-cancer pain topic and was offered compensation for his role.
Clinical Working Group
A clinical working group comprised of family physicians, chiropractors, primary care nurse practitioners and a pharmacist oversaw the development of this tool. Members include:
- Michelle Acorn, Nurse Practitioner
- John Axler, Family Physician
- Craig Bauman, Chiropractor
- Kerri Deir, Kinesiologist
- David Dos Santos, Chiropractor
- Dale Guenter, Family Physician
- Bruce Hobson, Family Physician
- Jessica Munro, Nurse Practitioner
- Steve Radke, Family Physician
- Hema Rajawat, Pharmacist
- Inge Schabort, Family Physician
- Murray Townsend, Chiropractor
- Kathy Tripp, Nurse Practitioner
- Xu Wang, Family Physician
- Jennifer Young, Family Physician
Thank you to all of our members for their work.
Conflict of interest
Clinical leads received compensation for their role.
Focus group and usability participants received a small token of appreciation (e.g. gift certificate).
Expert Reviewers
In addition to our clinical working group, CEP sought expert input to inform specific aspects of the Neck Pain and Headache Tools including terminology, physical assessment and the management components. We are grateful to the following individuals for their time and expertise.
- Pierre Côté DC, PhD
- Jonathan Gladstone, MD
- Hamilton Hall MD, FRCSC
- Christine Lay, MD
- Raja Rampersaud, MD, FRCSC