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## Complete Summary

#### GUIDELINE TITLE

Head (trauma, headaches, etc., not including stress & mental disorders).

#### BIBLIOGRAPHIC SOURCE(S)

Work Loss Data Institute. Head (trauma, headaches, etc., not including
stress & mental disorders). Corpus Christi (TX): Work Loss Data
Institute; 2008. 152 p. \[171 references\]

#### GUIDELINE STATUS

This is the current release of the guideline.

This guideline updates a previous version: Work Loss Data Institute.
Head (trauma, headaches, etc., not including stress & mental disorders).
Corpus Christi (TX): Work Loss Data Institute; 2007 May 9. 150 p.

The *Official Disability Guidelines* product line, including *ODG
Treatment in Workers Comp*, is updated annually, as it has been since
the first release in 1996.

### COMPLETE SUMMARY CONTENT

 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 CONTRAINDICATIONS\
 QUALIFYING STATEMENTS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

Work-related head trauma and headaches, not including stress and mental
disorders

#### GUIDELINE CATEGORY

Diagnosis\
Evaluation\
Management\
Treatment

#### CLINICAL SPECIALTY

Emergency Medicine\
Family Practice\
Internal Medicine\
Neurological Surgery\
Neurology\
Physical Medicine and Rehabilitation\
Surgery

#### INTENDED USERS

Advanced Practice Nurses\
Health Care Providers\
Health Plans\
Nurses\
Physician Assistants\
Physicians

#### GUIDELINE OBJECTIVE(S)

To offer evidence-based step-by-step decision protocols for the
assessment and treatment of workers\' compensation conditions

#### TARGET POPULATION

Workers with occupational head trauma or headache

#### INTERVENTIONS AND PRACTICES CONSIDERED

The following interventions/procedures were considered and recommended
as indicated in the original guideline document:

1.  Activity restrictions/work modifications

2.  Acupuncture for headaches

3.  Anticonvulsants

4.  Assessment of concussion severity

5.  Bed rest for severe traumatic brain injury (TBI)

6.  Botulinum toxin type A

7.  Chiropractic/manipulation for headache

8.  Cognitive skills retraining

9.  Cognitive/behavioral therapy

10. Computed tomography (CT)

11. Craniectomy/craniotomy for severe TBI

12. Cranioplasty

13. Electroencephalography (EEG) (neurofeedback)

14. Electrodiagnostic studies (electromyography \[EMG\], nerve
    conduction studies \[NGS\], dynamic electromyographies, evoked
    potential responses)

15. Fluid resuscitation

16. Glasgow Coma Scale (GCS)

17. Hearing aids

18. Hyperventilation

19. Hypothermia (mild)

20. Interdisciplinary rehabilitation programs

21. Lumbar puncture

22. Magnetic resonance imaging (MRI)

23. Mannitol

24. Manipulation for prophylactic treatments of headaches

25. Methylphenidate

26. Modified Ashworth Scale (MAS)

27. Multidisciplinary community rehabilitation

28. Neuropsychological testing

29. Nutrition

30. Occupational/physical therapy

31. Relaxation treatment (for tension-type headaches or migraines)

32. Return to work

33. Sedation

34. Sleep aids

35. Triptans for migraine sufferers

36. Vision evaluation

37. X-rays (skull) if CT not available

The following interventions/procedures are under study and are not
specifically recommended:

1.  Antidepressants

2.  Branched-chain amino acids (BCAAs)

3.  Cell transplantation therapy

4.  Greater occipital nerve block (GONB)

5.  Oxygen therapy

6.  Positron emission tomography (PET)

7.  Wilsonii injecta

The following interventions were considered, but are not recommended:

1.  Corticosteroids (for acute traumatic brain injury)

2.  Electrodiagnostic studies (electroretinogram \[ERG\], cognitive
    event-related potential, somatosensory evoked potential \[SSEP\])

3.  Quantitative electroencephalogram (QEEG) (brain mapping)

4.  Single photon emission computed tomography (SPECT)

#### MAJOR OUTCOMES CONSIDERED

-   Sensitivity and specificity of diagnostic tests

-   Effectiveness of treatments for relief of pain and symptoms

### METHODOLOGY

#### METHODS USED TO COLLECT/SELECT EVIDENCE

Hand-searches of Published Literature (Primary Sources)\
Searches of Electronic Databases

#### DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

Work Loss Data Institute (WLDI) conducted a comprehensive medical
literature review (now ongoing) with preference given to high quality
systematic reviews, meta-analyses, and clinical trials published since
1993, plus existing nationally recognized treatment guidelines from the
leading specialty societies. WLDI primarily searched MEDLINE and the
Cochrane Library. In addition, WLDI also reviewed other relevant
treatment guidelines, including those in the National Guideline
Clearinghouse, as well as state guidelines and proprietary guidelines
maintained in the WLDI guideline library. These guidelines were also
used to suggest references or search terms that may otherwise have been
missed. In addition, WLDI also searched other databases, including MD
Consult, eMedicine, CINAHL, and conference proceedings in occupational
health (i.e., American College of Occupational and Environmental
Medicine \[ACOEM\]) and disability evaluation (i.e., American Academy of
Disability Evaluating Physicians \[AADEP\], American Board of
Independent Medical Examiners \[ABIME\]). Search terms and questions
were diagnosis, treatment, symptom, sign, and/or body-part driven,
generated based on new or previously indexed existing evidence,
treatment parameters and experience.

In searching the medical literature, answers to the following questions
were sought: (1) If the diagnostic criteria for a given condition have
changed since 1993, what are the new diagnostic criteria? (2) What
occupational exposures or activities are associated causally with the
condition? (3) What are the most effective methods and approaches for
the early identification and diagnosis of the condition? (4) What
historical information, clinical examination findings or ancillary test
results (such as laboratory or x-ray studies) are of value in
determining whether a condition was caused by the patient\'s employment?
(5) What are the most effective methods and approaches for treating the
condition? (6) What are the specific indications, if any, for surgery as
a means of treating the condition? (7) What are the relative benefits
and harms of the various surgical and non-surgical interventions that
may be used to treat the condition?  (8) What is the relationship, if
any, between a patient\'s age, gender, socioeconomic status and/or
racial or ethnic grouping and specific treatment outcomes for the
condition? (9) What instruments or techniques, if any, accurately assess
functional limitations in an individual with the condition? (10) What is
the natural history of the disorder? (11) Prior to treatment, what are
the typical functional limitations for an individual with the condition?
(12) Following treatment, what are the typical functional limitations
for an individual with the condition? (13) Following treatment, what are
the most cost-effective methods for preventing the recurrence of signs
or symptoms of the condition, and how does this vary depending upon
patient-specific matters such as underlying health problems?

**Criteria for Selecting the Evidence**

Preference was given to evidence that met the following criteria: (1)
The article was written in the English language, and the article had any
of the following attributes: (2) It was a systematic review of the
relevant medical literature, or (3) The article reported a controlled
trial -- randomized or controlled, or (4) The article reports a cohort
study, whether prospective or retrospective, or (5) The article reports
a case control series involving at least 25 subjects, in which the
assessment of outcome was determined by a person or entity independent
from the persons or institution that performed the intervention the
outcome of which is being assessed.

More information about the selection of evidence is available in
\"Appendix A. ODG Treatment in Workers\' Comp. Methodology description
using the AGREE instrument\" (see \"Availability of Companion
Documents\" field).

#### NUMBER OF SOURCE DOCUMENTS

Not stated

#### METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Weighting According to a Rating Scheme (Scheme Given)

#### RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

**Ranking by Type of Evidence**

1.  Systematic Review/Meta-Analysis

2.  Controlled Trial-Randomized (RCT) or Controlled

3.  Cohort Study-Prospective or Retrospective

4.  Case Series

5.  Unstructured Review

6.  Nationally Recognized Treatment Guideline (from
    [www.guideline.gov](http://www.guideline.gov/))

7.  State Treatment Guideline

8.  Other Treatment Guideline

9.  Textbook

10. Conference Proceedings/Presentation Slides

11. Case Reports and Descriptions

**Ranking by Quality within Type of Evidence**

a.  High Quality

b.  Medium Quality

c.  Low Quality

#### METHODS USED TO ANALYZE THE EVIDENCE

Review of Published Meta-Analyses\
Systematic Review

#### DESCRIPTION OF THE METHODS USED TO ANALYZE THE EVIDENCE

The Work Loss Data Institute (WLDI) reviewed each article that was
relevant to answering the question at issue, with priority given to
those that met the following criteria: (1) The article was written in
the English language, and the article had any of the following
attributes: (2) It was a systematic review of the relevant medical
literature, or (3) The article reported a controlled trial -- randomized
or controlled, or (4) The article reported a cohort study, whether
prospective or retrospective, or (5) The article reported a case control
series involving at least 10 subjects, in which the assessment of
outcome was determined by a person or entity independent from the
persons or institution that performed the intervention the outcome of
which is being assessed.

Especially when articles on a specific topic that met the above criteria
were limited in number and quality, WLDI also reviewed other articles
that did not meet the above criteria, but all evidence was ranked
alphanumerically (see the Rating Scheme of the Strength of Evidence
field) so that the quality of evidence could be clearly determined when
making decisions about what to recommend in the Guidelines. Articles
with a Ranking by Type of Evidence of Case Reports and Case Series were
not used in the evidence base for the Guidelines. These articles were
not included because of their low quality (i.e., they tend to be
anecdotal descriptions of what happened with no attempt to control for
variables that might affect outcome). Not all the evidence provided by
WLDI was eventually listed in the bibliography of the published
Guidelines. Only the higher quality references were listed. The criteria
for inclusion was a final ranking of 1a to 4b (the original inclusion
criteria suggested the methodology subgroup), or if the Ranking by Type
of Evidence was 5 to 10, the quality ranking should be an \"a.\"

#### METHODS USED TO FORMULATE THE RECOMMENDATIONS

Not stated

#### RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

Not applicable

#### COST ANALYSIS

The guideline developers reviewed published cost analyses.

#### METHOD OF GUIDELINE VALIDATION

External Peer Review

#### DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

Prior to publication, select organizations and individuals making up a
cross-section of medical specialties and typical end-users externally
reviewed the guideline.

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

**[Initial Diagnosis and Treatment \-- Head Injuries]{.underline}**

The first priority for the head-injured patient is complete and rapid
physiologic resuscitation.

Most minor injuries will regain normal consciousness in the field or
emergency department, and if the patient has normal neurological
findings on examination and neuroradiological studies when appropriate,
he/she may be discharged home with close supervision for the initial
twenty-four hours.

Sedation and neuromuscular blockade can be useful in optimizing
transport of the head injury patient. However, both treatments interfere
with the neurological examination.

**Initial Diagnosis**

In addition to a physical examination by a practiced practitioner, the
following should be part of the process to determine the initial
diagnosis in a head-injured patient:

*Glasgow Coma Scale Score*

The Glasgow Coma Scale (GCS) when performed in the emergency department
may aid in predicting the level of traumatic brain injury. Individuals
with mild traumatic brain injuries may have a normal score on the GCS.
Serial GCS scores may be helpful when intoxication may be a factor.

*Neurological Examination*

A neurological examination and neuropsychological assessment should be
performed by a qualified practitioner to evaluate central nervous system
function and diagnose specific behavioral or cognitive deficits or
disorders.

*Imaging*

Computed axial tomography (CT) is a well-established, non-invasive brain
imaging x-ray study that should reveal the presence of blood, skull
fracture, and/or structural changes in the brain. It should be performed
on all patients sustaining a transient neurologic deficit secondary to
trauma.

Magnetic resonance imaging (MRI) scans are more sensitive than CT for
detecting traumatic cerebral injury. Initially, MRI scans are clinically
useful in the following situations to:

-   Determine neurological deficits not explained by CT

-   Evaluate prolonged interval of disturbed consciousness

-   Define evidence of acute changes super-imposed on previous trauma or
    disease

*Lumbar Puncture*

Lumbar puncture (LP) is a well-established diagnostic procedure for
examination of cerebrospinal fluid (CSF) in neurological disease and
injury. The procedure should be performed by qualified and trained
physicians under sterile conditions.

Indications for LP:

-   Neurological disease and injury with no radiographic evidence of
    extra-axial hemorrhage, mass effect, or impending brain herniation

-   With suspected or known increased intra-cranial pressure, LP should
    be preceded by fundoscopic examination and by a CT scan or MRI.

-   Adult patients with headache exhibiting signs of increased
    intracranial pressure including papilledema, absent venous
    pulsations on funduscopic examination, altered mental status, or
    focal neurologic deficits should undergo a neuroimaging study before
    having a LP.

Contraindications for LP:

-   Acute trauma to the spinal column

-   Certain infections

-   Increased intracranial pressure due to space occupying lesions

-   Some coagulation disorders or defects

-   Cutaneous infections in the region of the puncture site

-   If CT or MRI shows intracerebral, intra-ventricular, or subarachnoid
    blood, LP should be withheld until neurological consultation is
    obtained.

+-----------------------------------------------------------------------+
| **Official Disability Guidelines (ODG) Return-To-Work Pathways**\     |
| \                                                                     |
| *Concussion*                                                          |
|                                                                       |
| Mild concussion: 3 to 7 days                                          |
|                                                                       |
| Severe concussion, non-cognitive/modified work: 14 days to indefinite |
|                                                                       |
| Severe concussion, cognitive work: 84 days to indefinite              |
|                                                                       |
| *Skull fracture*                                                      |
|                                                                       |
| Without brain injury, clerical/modified work: 7 days                  |
|                                                                       |
| Manual work: 21 days                                                  |
|                                                                       |
| Heavy manual work: 49 days                                            |
|                                                                       |
| (See ODG Capabilities & Activity Modifications for Restricted Work    |
| under \"Work\" in Procedure Summary of the original guideline         |
| document)                                                             |
+-----------------------------------------------------------------------+

**Initial Management**

*Hypotension*

Hypotension (systolic blood pressure \[SBP\] \<90 mm Hg) or hypoxia
(apnea, cyanosis, or an oxygen (O~2~) saturation \<90% in the field or a
PaO~2~ \<60 mm Hg) must be monitored and scrupulously avoided, if
possible, or corrected immediately in severe traumatic brain injury
patients.

-   Mean arterial blood pressure should be maintained above 90 mm Hg
    through the infusion of fluids throughout the patient\'s course to
    attempt to maintain cerebral perfusion pressure (CPP) greater than
    60 mm Hg.

-   Patients with a Glasgow Coma Scale score less than 9, who are unable
    to maintain their airway or who remain hypoxemic despite
    supplemental O~2~, require that their airway be secured, preferably
    by endotracheal intubation.

*Hypertension*

If there are signs of transtentorial herniation or progressive
neurological deterioration (not attributable to extracranial
explanations), assume that intracranial hypertension is present and
treat it aggressively. Hyperventilation should be rapidly established.

*Hyperventilation*

In the absence of increased intracranial pressure (ICP), avoid
unnecessary or prophylactic hyperventilation (PaCO~2~ less than 26), in
the first 24-hours after injury.

Hyperventilation therapy may be necessary for brief periods when there
is:

-   Acute neurologic deterioration not attributable to systemic
    pathology (i.e., hypotension)

Hyperventilation therapy may be necessary for longer periods if there
is:

-   Intracranial hypertension refractory to sedation

-   Paralysis

-   Cerebrospinal fluid drainage

-   Osmotic diuretics

*Intracranial Pressure*

Intracranial pressure should be monitored in all patients with severe
head injury following an abnormal CT scan. Abnormal findings may include
one or more of the following:

-   Hematomas

-   Contusions

-   Edema

-   Compressed basal cisterns

In the absence of abnormal CT findings, ICP should also be monitored if
two or more of the following are noted at admission:

-   Patient is over 40 years old

    -   Unilateral or bilateral motor posturing

-   Systolic blood pressure of less than 90 mm Hg

Interpretation and treatment of ICP should be corroborated by frequent
clinical examination and cerebral perfusion pressure (CPP) data. In
general, it is desirable to:

1.  Maintain ICP less than 20 to 25 mm Hg.

2.  Maintain mean arterial pressure (MAP) above 90.

3.  Maintain CPP (MAP at head level minus ICP) at or above 70 mm Hg.

Mannitol in doses ranging from 0.25 g/kg to 1 g/kg body weight is
effective for control of raised ICP after severe head injury.

Mild or moderate head injury does not need to be monitored for ICP
unless the conscious patient has traumatic mass lesions.

*Cerebral Perfusion Pressure (CPP)*

CPP should be maintained at a minimum of 60 mm Hg (60 to 70). In the
absence of cerebral ischemia, aggressive attempts to maintain cerebral
perfusion pressure above 70 mm Hg with fluids and pressors should be
avoided because of the risk of adult respiratory distress syndrome.

*Nutrition*

Nutritional support should be aggressively initiated as soon as
practicable. Preferable route is jejunal by gastrojejunostomy.

*Anticonvulsants*

Anticonvulsant treatment may be used to prevent early posttraumatic
seizures in the high-risk individual, and are usually administered for
one week in those with intracranial hemorrhage.

Prevention of early seizures has no statistically significant impact on
long-term outcome or the development of late seizures or chronic
epilepsy although the prevention of early seizures usually helps to
reduce seizure-associated complications during acute management.

**Operative Procedures**

*Craniectomy*

Recommended for diffuse brain swelling, midline shift, and/or elevated
ICP refractory to medical management and not fully alleviated by
evacuation of mass lesion/hematoma (or in the absence of mass
lesion/hematoma) \-- (bone flap stored in freezer, or in the
individual\'s abdominal wall).

*Craniotomy*

If there is immediate onset of total facial paralysis (uncommon) or if
the electroneuronography (EnoG) shows greater than 90% degeneration of
the facial nerve, exploration of the path of the facial nerve is
indicated. This usually involves a middle fossa craniotomy and
mastoidectomy in order to completely decompress the facial nerve.

+-----------------------------------------------------------------------+
| **ODG Return-To-Work Pathways**                                       |
|                                                                       |
| Without neurologic deficit, medical treatment: 14 days                |
|                                                                       |
| Aneurysmectomy, clerical/modified work: 28 days                       |
|                                                                       |
| Aneurysmectomy, manual work: 42 days                                  |
|                                                                       |
| Craniectomy, clerical/modified work: 28 days                          |
|                                                                       |
| Craniectomy, manual work: 42 days                                     |
|                                                                       |
| Craniotomy, clerical/modified work: 28 days                           |
|                                                                       |
| Craniotomy, manual work: 42 days                                      |
+-----------------------------------------------------------------------+

**Long-term Management**

*Postconcussion Syndrome*

Approximately 38% of patients who sustain head trauma characterized by a
brief disturbance of consciousness and clinically unremarkable
neuroradiologic findings meet International Classification of Diseases
10th edition (ICD-10) diagnostic criteria for postconcussion syndrome
(PCS). Symptoms could involve complaints of irritability, fatigue,
headache, difficulty concentrating, dizziness and memory problems.
Anxiety and depression are also frequently present, especially later in
its course.

Although PCS has often been thought to reflect a psychological response
to injury, there is considerable recent evidence to suggest that it is
primarily a physiologic disturbance. For most individuals, treatment
consists primarily of education of the patient and his/her family, along
with supportive counseling regarding emerging problems at work or at
home. A subgroup of patients, however, may require psychopharmacologic
intervention. Avoid attempts of multiple parallel processing in a
postconcussive stage.

Widely accepted treatments for post-traumatic headache may include, but
are not limited to, interdisciplinary treatment, pharmacology, joint
manipulation, physical therapy, massage, acupuncture, biofeedback,
psychotherapy, and diet. These procedures should only be continued if
functional gains are documented.

*Electroencephalography (EEG)*

Electroencephalography is not generally indicated in the immediate
period of emergency response, evaluation, and treatment. Following
initial assessment and stabilization, the individual\'s course should be
monitored. If during this period there is failure to improve, or the
medical condition deteriorates, an EEG may be indicated to assist in the
diagnostic evaluation.

*Physical Therapy*

Patient rehabilitation after traumatic brain injury is divided into two
periods: acute and subacute. In the beginning of rehabilitation,
physical therapist evaluates patient\'s functional status; later he uses
methods and means of treatment and evaluates effectiveness of
rehabilitation. Early ambulation is very important for patients with
coma. Physical therapy consists of prevention of complications,
improvement of muscle force and range of motions, balance, movement
coordination, endurance, and cognitive functions. Early rehabilitation
is necessary for traumatic brain injury patients and use of physical
therapy methods can help to regain lost functions and to return to
society.

#### CLINICAL ALGORITHM(S)

None provided

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

During the comprehensive medical literature review, preference was given
to high quality systematic reviews, meta-analyses, and clinical trials
over the past ten years, plus existing nationally recognized treatment
guidelines from the leading specialty societies.

The heart of each Work Loss Data Institute guideline is the Procedure
Summary (see the original guideline document), which provides a concise
synopsis of effectiveness, if any, of each treatment method based on
existing medical evidence. Each summary and subsequent recommendation is
hyper-linked into the studies on which they are based, in abstract form,
which have been ranked, highlighted and indexed.

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### POTENTIAL BENEFITS

These guidelines unite evidence-based protocols for medical treatment
with normative expectations for disability duration. They also bridge
the interests of the many professional groups involved in diagnosing and
treating work-related head trauma or headaches.

#### POTENTIAL HARMS

-   Hypothermia increases the risk of pneumonia and has other
    potentially harmful side effects.

-   All patients taking methylphenidate should be monitored because a
    few individuals experienced significant changes in vital signs and
    adverse effects.

### CONTRAINDICATIONS

#### CONTRAINDICATIONS

**Contraindications for Lumbar Puncture (LP)**

-   Acute trauma to the spinal column

-   Certain infections

-   Increased intracranial pressure due to space occupying lesions

-   Some coagulation disorders or defects

-   Cutaneous infections in the region of the puncture site

-   If computed tomography (CT) or magnetic resonance imaging (MRI)
    shows intracerebral, intra-ventricular, or subarachnoid blood, LP
    should be withheld until neurological consultation is obtained.

**Contraindications for Hyperventilation**

-   Avoid prophylactic hyperventilation (if PaCo~2~ is less than 30 mm)
    in the absence of intracranial pressure (ICP) monitoring or with
    normal ICP and within the first 24 hours after severe brain injury
    to reduce the risk of secondary ischemia

-   Avoid chronic hyperventilation to PaCo~2~ less than 26

### QUALIFYING STATEMENTS

#### QUALIFYING STATEMENTS

The Treatment Planning sections outline the most common pathways to
recovery, but there is no single approach that is right for every
patient and these protocols do not mention every treatment that may be
recommended. See the Procedure Summaries (in the original guideline
document) for complete lists of the various options that may be
available, along with links to the medical evidence.

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

An implementation strategy was not provided.

#### IMPLEMENTATION TOOLS

Patient Resources

For information about
[availability](#identifying-information-and-availability), see the
\"Availability of Companion Documents\" and \"Patient Resources\" fields
below.

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

Getting Better

#### IOM DOMAIN

Effectiveness\
Patient-centeredness

### IDENTIFYING INFORMATION AND AVAILABILITY

#### BIBLIOGRAPHIC SOURCE(S)

Work Loss Data Institute. Head (trauma, headaches, etc., not including
stress & mental disorders). Corpus Christi (TX): Work Loss Data
Institute; 2008. 152 p. \[171 references\]

#### ADAPTATION

Not applicable: The guideline was not adapted from another source.

#### DATE RELEASED

2006 (revised 2008 Apr 21)

#### GUIDELINE DEVELOPER(S)

Work Loss Data Institute - Public For Profit Organization

#### SOURCE(S) OF FUNDING

Not stated

#### GUIDELINE COMMITTEE

Not stated

#### COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

Editor-in-Chief, Philip L. Denniston, Jr. and Senior Medical Editor,
Charles W. Kennedy, Jr., MD, together pilot the group of approximately
80 members. See the ODG *Treatment in Workers Comp* [Editorial Advisory
Board](http://www.odg-disability.com/editorial_advisory_board.htm).

#### FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

There are no conflicts of interest among the guideline development
members.

#### GUIDELINE STATUS

This is the current release of the guideline.

This guideline updates a previous version: Work Loss Data Institute.
Head (trauma, headaches, etc., not including stress & mental disorders).
Corpus Christi (TX): Work Loss Data Institute; 2007 May 9. 150 p.

The *Official Disability Guidelines* product line, including *ODG
Treatment in Workers Comp*, is updated annually, as it has been since
the first release in 1996.

#### GUIDELINE AVAILABILITY

Electronic copies: Available to subscribers from the [Work Loss Data
Institute Web site](http://www.odg-disability.com/).

Print copies: Available from the Work Loss Data Institute, 169 Saxony
Road, Suite 210, Encinitas, CA 92024; Phone: 800-488-5548, 760-753-9992,
Fax: 760-753-9995; [www.worklossdata.com](http://www.worklossdata.com/).

#### AVAILABILITY OF COMPANION DOCUMENTS

The following are available:

-   Background information on the development of the Official Disability
    Guidelines of the Work Loss Data Institute is available from the
    [Work Loss Data Institute Web
    site](http://www.odg-disability.com/odgtwclist.htm).

-   Appendix A. ODG Treatment in Workers\' Comp. Methodology description
    using the AGREE instrument. Available to subscribers from the [Work
    Loss Data Institute Web
    site](http://www.odg-disability.com/ODG_AGREE.htm).

#### PATIENT RESOURCES

The following is available:

-   Appendix B. ODG Treatment in Workers\' Comp. Patient information
    resources. 2008.

Electronic copies: Available to subscribers from the [Work Loss Data
Institute Web site](http://www.odg-disability.com/).

Print copies: Available from the Work Loss Data Institute, 169 Saxony
Road, Suite 210, Encinitas, CA 92024; Phone: 800-488-5548, 760-753-9992,
Fax: 760-753-9995; [www.worklossdata.com](http://www.worklossdata.com/).

Please note: This patient information is intended to provide health
professionals with information to share with their patients to help them
better understand their health and their diagnosed disorders. By
providing access to this patient information, it is not the intention of
NGC to provide specific medical advice for particular patients. Rather
we urge patients and their representatives to review this material and
then to consult with a licensed health professional for evaluation of
treatment options suitable for them as well as for diagnosis and answers
to their personal medical questions. This patient information has been
derived and prepared from a guideline for health care professionals
included on NGC by the authors or publishers of that original guideline.
The patient information is not reviewed by NGC to establish whether or
not it accurately reflects the original guideline\'s content.

#### NGC STATUS

This NGC summary was completed by ECRI on April 6, 2006. This summary
was updated by ECRI on August 29, 2006, following the U.S. Food and Drug
Administration advisory on Triptans, SSRIs, and SNRIs. This NGC summary
was updated by ECRI Institute on November 9, 2006, March 29, 2007,
August 27, 2007, and December 22, 2008.

#### COPYRIGHT STATEMENT

This NGC summary is based on the original guideline, which is subject to
the guideline developer\'s copyright restrictions.

### DISCLAIMER

#### NGC DISCLAIMER

The National Guideline Clearinghouse™ (NGC) does not develop, produce,
approve, or endorse the guidelines represented on this site.

All guidelines summarized by NGC and hosted on our site are produced
under the auspices of medical specialty societies, relevant professional
associations, public or private organizations, other government
agencies, health care organizations or plans, and similar entities.

Guidelines represented on the NGC Web site are submitted by guideline
developers, and are screened solely to determine that they meet the NGC
Inclusion Criteria which may be found at
<http://www.guideline.gov/about/inclusion.aspx> .

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© 1998-2009 National Guideline Clearinghouse

Date Modified: 1/12/2009