Please select the eligibility criteria that correspond to the clinical trial below.
Title: A Prospective Randomised Clinical Trial to Investigate the Management of Headache Disorders. Study to Identify Prognostic Patient Characteristics and to Investigate the Additional Value of Physio-/Manual Therapy
Brief Summary: The management of headache disorders is too often based upon trial and error or on personal beliefs and opinions. Seldom it is based on scientific arguments. Therefore the identification of prognostic patient characteristics is mandatory as this will lead to a more precise referral of headache patients.A prospective cohortstudy is designed to identify these prognostic patient characteristics. After testing, 186 headache patients (migraine, tension type headache and cervicogenic headache) will be randomly allocated to one of two treatment groups. Testing includes the fulfillment of questionnaires (Headache Diagnosis Questionnaire, Headache Inventory Questionnaire and the Headache Impact Test) and physical tests (Thermal Stimuli, Cervical Spine examination and Pressure Algometry). Treatment groups are a usual care group (administered by a medical doctor) and a usual care plus physio-/ manual therapy treatment. After six weeks of treatment subjects will complete the headache inventory list and the Headache Impact Test a second time. The perceived effect will be registered allowing the distinction between responders (positive effect) and non-responders (no effect or worse). Logistic regression-analysis will be used to identify the specific patient characteristics of the responders and the non-responders. Secondly the additional value of the physio-/ manual therapy intervention will be examined. Follow-up measurements up to 52 weeks are provided.


Options:
A: Inclusion Criteria:

* Sub-Acute and chronic low back pain (Defined as current episode more than 6 weeks duration.)
* Quebec Task Force classifications 1, 2, 3 and 4. (This includes patients with back pain, stiffness or tenderness, with or without musculoskeletal signs and neurological signs.{1570})
* 65 years of age and older
* Independent ambulation
* Community dwelling (residency outside nursing home)
* Score of 20 or more on Folstein Mini-Mental State Examination{13246}
* Stable prescription medication plan (no changes in prescription medications that affect musculoskeletal pain in previous month)

Exclusion Criteria:

* Referred low back pain from local joint lesions of the lower extremities or from visceral diseases
* Significant infectious disease Determined by history or by referral to supplementary diagnostic tests
* Ongoing treatment for low back pain by other health care providers
* Mean baseline low back pain score of 20 percentage points or less
* Contraindications to exercise Determined by history or by referral to supplementary diagnostic tests (i.e., uncontrolled arrhythmias, third degree heart block, recent ECG changes, unstable angina, acute myocardial infarction, acute congestive heart failure, cardiomyopathy, valvular heart disease, poorly controlled blood pressure, uncontrolled metabolic disease
* Contraindications to spinal manipulation (i.e. Progressive neurological deficits blood clotting disorders; infectious and non-infectious inflammatory or destructive tissue changes of the spine; severe osteoporosis)
B: Inclusion Criteria:

The following inclusion criteria will be used to determine eligibility for this study:

1. Primary complaint of neck pain with or without unilateral upper extremity symptoms
2. Age between 18-60 years old
3. NDI score greater than 10 points

Exclusion Criteria:

The following exclusion criteria will be used to determine ineligibility for this study:

1. Red flags noted in the patient's Neck Medical Screening Questionnaire (i.e. tumor, fracture, metabolic diseases, RA, osteoporosis, prolonged history of steroid use, etc.)
2. History of whiplash injury within the past six weeks
3. Diagnosis of cervical spinal stenosis or bilateral upper extremity symptoms
4. Evidence of central nervous system involvement, to include hyperreflexia, sensory disturbances in the hand, intrinsic muscle wasting of the hands, unsteadiness during walking, nystagmus, loss of visual acuity, impaired sensation of the face, altered taste, the presence of pathological reflexes (i.e. positive Hoffman's and/or Babinski reflexes), etc.
5. Two or more positive neurologic signs consistent with nerve root compression, including any two of the following:
6. Muscle weakness involving a major muscle group of the upper extremity
7. Diminished upper extremity muscle stretch reflex (biceps brachii, brachioradialis, or triceps reflex)
8. Diminished or absent sensation to pinprick in any upper extremity dermatome
C: Inclusion Criteria:

* 65 years of age and older
* independent ambulation and community dwelling
* stable medication plan
* neck-related disability (minimal score of 10% on Neck Disability Index)
* back-related disability (minimal score of 10% on Oswestry Disability Index)
* minimum combined disability score (above) of 25% at first baseline screening
* at least 12 week duration of neck and back related disability

Exclusion Criteria:

* moderate or severe cognitive impairment
* untreated clinical depression
* surgical spinal fusion or multiple incidents of spinal surgery
* contraindications to spinal manipulation or exercise
* ongoing, non-pharmacological treatment for a spinal condition
D: Inclusion Criteria:

* Dutch speaking
* Willing to participate
* At least 18 years old
* Combination of headache and neck pain
* Headache since at least two months and at least twice a month
* A combination of migraine, tension type headache and cervicogenic headache

Exclusion Criteria:

* Clusterheadache
* Trigeminusneuralgia
* Peripheral neuropathy
* A history with neck surgery
* Comorbidity with chronic muskuloskeletal pain like fibromyalgia
* Radicular pain in the upper extremity
* Osteoarthritis
* Down Syndroom
* Physio/ manual therapy treatment in the last 12 months for this headache complaint.
* The use of prescribed medication (like NSAIDs and triptans) for this headache complaint during the last two months
* Pregnancy
* Red flags as described in the Dutch General Practitioners Headache Guideline

Answer: D