Headache is among the leading causes of disability worldwide, and many patients seek help in primary care. A new survey among Danish chiropractors shows that to a large extent the profession has integrated systematic diagnostic approaches and evidence-based treatment strategies in the management of headache patients.
The study, which includes 100 Danish chiropractors, shows that the majority use international diagnostic criteria (ICHD-3) for both primary and secondary headaches. At the same time, most report that their clinical practice follows the profession-specific Danish clinical guideline for headache.
An important player in primary care
Previous studies have shown that approximately one in eight consultations in Danish chiropractic practice relates to headache issues.
The results support that chiropractors can contribute to earlier diagnosis, more targeted treatment, and potentially relieve pressure on other parts of the healthcare system by managing headache patients earlier in their care pathway. This should be explored further in future research.
In particular, the use of structured diagnostic criteria is highlighted as central. More than nine out of ten participating chiropractors reported using ICHD-3 criteria when diagnosing primary headaches.
Ongoing challenges with red flags and monitoring
However, the study also identifies challenges. Chiropractors showed limited familiarity with several so-called red flags—symptoms that may indicate serious underlying disease and the need for urgent assessment.
Only a few indicators achieved a high level of recognition among participants, which, according to the researchers, highlights the need for strengthened continuing education and more systematic implementation of clinical guidelines.
In addition, the results showed that systematic monitoring tools such as headache diaries are rarely used, even though such tools are recommended in clinical guidelines.
Need for continued development
The researchers emphasize that the results should be interpreted with caution, as the study had a relatively low response rate, which may mean that chiropractors with a particular interest in headache are overrepresented.
Despite this, the overall findings suggest that Danish chiropractors already constitute an important part of headache management in primary care, but that continued competency development, implementation efforts, and interdisciplinary collaboration will be crucial to further strengthen the field.
Jeppe Pihl Skovbjerg, Henrik Hein Lauridsen, Henrik Wulff Christensen, Rikke Krüger Jensen, Kristina Boe Dissing. Diagnostic approach and management of patients with headache in Danish chiropractic practice. Chiropractic & Manual Therapies 2026.
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