Diagnostic approach and management of patients with headache in Danish chiropractic practice

Headache disorders are among the leading causes of disability globally. In primary care, including chiropractic practice, clinicians often serve as the first point of contact for patients seeking evaluation and management of headache. Despite this, limited evidence exists regarding how Danish chiropractors assess, diagnose, and manage headache in routine practice. This study aimed to examine how Danish chiropractors adopt a profession-specific clinical care standard, conduct clinical assessments, apply the ICHD-3 diagnostic criteria, and manage patients presenting with headache.

A cross-sectional, questionnaire-based study was conducted between May 2022 and August 2022 among Danish chiropractors. The Danish Headache Questionnaire was used covering aspects such as diagnostic knowledge, clinical assessments and management. Descriptive statistics were used to characterise respondents and their clinical practices. A predefined threshold of ≥ 70% was applied to indicate acceptable adherence to the clinical care standard and sufficient familiarity with the ICHD-3 criteria.

A total of 100 chiropractors completed the questionnaire, corresponding to a response rate of 14.4%. Self-reported data indicated that a larger percentage of Danish chiropractors demonstrate adequate knowledge of and adhere well to the clinical care standard. However, a proportion of respondents reported modest familiarity with specific elements of the standard and knowledge of red flags was limited. Overall familiarity with, and use of, the ICHD-3 diagnostic criteria was high. Management approaches largely aligned with guideline-supported strategies, with most chiropractors reporting the use of manual therapy, exercise, and patient education. In contrast, structured monitoring tools - such as headache diaries - were seldom used.

Respondents generally appear to follow the profession-specific clinical care standard, demonstrate good familiarity with ICHD-3 criteria, and deliver guideline-aligned management for patients with headache. These findings suggest that chiropractors may play a meaningful role in primary-care headache management and potentially help reduce the burden on other health-care providers, although the low response rate warrants caution in generalising these findings. Identified gaps in knowledge and practice indicate a need for targeted postgraduate education, enhanced implementation strategies to support consistent use of clinical care standards and guidelines, and policy initiatives that facilitate the integration of chiropractors into interdisciplinary headache care pathways.