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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
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:
- Physical Examination
- Management Matrix
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.
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.
Dr. Arun Radhakrishnan is a family physician with a focused practice in chronic pain and is the current co-chair of the Collaborative Mental Health Network and the Medical Mentoring for Addictions and Pain Network at the Ontario College of Family Physicians. He is also an adjunct assistant professor with the Department of Family and Community Medicine at the University of Toronto.
In 2013, Arun completed a Master’s degree at the University of Toronto in Health Services Research focusing on the value of information and communication technologies to enable knowledge translation activities in the areas of pain, mental health and addictions to support community physicians. His interests also include teaching and curriculum development around the integration of technology into the clinical encounter.
Dr. Radhakrishnan provided clinical leadership for the opioid therapy for chronic non-cancer pain, non-pharmacological and non-opioid options for chronic non-cancer pain and opioid use disorder topics.
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).
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