Manipulation and Dry Needling for Cervicogenic Headache

Overseen By Ian Young, DSc, PT

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Alabama Physical Therapy & Acupuncture

Disqualifiers: Concussion, Fibromyalgia, Hypertension, Diabetes, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 1

Duration: 4 weeks

120 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What data supports the effectiveness of this treatment for cervicogenic headache?

Research suggests that combining dry needling with exercises can improve neck pain and headache-related issues in people with cervicogenic headaches. Additionally, dry needling, when added to physical therapy, may enhance long-term outcomes for these headaches. ^{1 2 3 4 5}

Is dry needling and cervical manipulation safe for treating cervicogenic headaches?

Dry needling and cervical manipulation are generally considered safe, but there are rare cases of serious adverse events with cervical manipulation. Most studies report only minor, temporary side effects. ^{1 4 6 7 8}

How does the treatment of manipulation and dry needling for cervicogenic headache differ from other treatments?

This treatment is unique because it combines dry needling (using thin needles to target muscle knots) and thrust manipulation (a quick, controlled movement to adjust the spine), which may address both muscle tension and spinal alignment issues, unlike other treatments that might focus on just one aspect. ^{9 10 11 12 13}

What is the purpose of this trial?

The purpose of this research is to compare two different approaches for treating patients with cervicogenic headaches associated with type II whiplash associated disorder: non-thrust mobilization and exercise versus thrust manipulation and dry needling. Physical therapists commonly use all of these techniques to treat cervicogenic headaches. This study is attempting to find out if one treatment strategy is more effective than the other.

Research Team

James Dunning, PhD, DPT

Principal Investigator

American Academy of Manipulative Therapy

Eligibility Criteria

This trial is for individuals with cervicogenic headaches, which are often caused by neck issues and can follow a whiplash injury (WAD II). Participants should have these specific types of headaches to qualify.

Inclusion Criteria

I have had headaches at least once a week since my whiplash injury.

Neck Disability Index score of greater than 10/50 on the NDI

My headaches are more intense than a mild ache.

Exclusion Criteria

I have been diagnosed with fibromyalgia.

I have been diagnosed with or am showing signs of a concussion.

Positive screen for cervical radiography (Canadian C-Spine Rules)

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive either dry needling and thrust manipulation or exercise and non-thrust mobilization for cervicogenic headaches and type II whiplash associated disorder

4 weeks

1-2 visits per week (up to 8 sessions total)

Follow-up

Participants are monitored for changes in headache intensity, frequency, and other outcomes

3 months

Treatment Details

Interventions

• Dry Needling
• Exercise
• Non-thrust Mobilization
• Thrust Manipulation

Trial Overview The study compares two treatment methods for cervicogenic headaches: one combines non-thrust mobilization and exercise; the other uses thrust manipulation and dry needling. The goal is to see which strategy works better.

Participant Groups

Group I: Dry Needling,Thrust Manipulation Experimental Treatment 1 Intervention

Dry needling to the craniofacial, upper cervical, and cervicothoracic regions. High-velocity thrust manipulation to the upper cervical spine, mid/lower cervical spine, and cervicothoracic spinal regions.

Group II: Exercise,Non-thrust Mobilization Active Control 1 Intervention

Nonthrust joint mobilization to the upper cervical spine, mid/lower cervical spine, and cervicothoracic spinal regions. Cranio-cervical flexion exercises, peri-scapular progressive resistance exercises, and electrothermal modalities

Dry Needling is already approved in United Kingdom, United States for the following indications:

Approved in United Kingdom as Dry Needling for:

• Knee osteoarthritis pain management
• Muscle strength improvement
• Leg function enhancement

Approved in United States as Dry Needling for:

• Chronic knee pain relief
• Musculoskeletal pain management
• Myofascial pain syndrome treatment

Who Is Running the Clinical Trial?

Alabama Physical Therapy & Acupuncture

Lead Sponsor

Trials

15

Recruited

2,200+

Universidad Rey Juan Carlos

Collaborator

Trials

137

Recruited

10,300+

Findings from Research

In a study involving 7 participants with cervicogenic headache, a combination of dry needling and neuromuscular reeducation exercises led to significant improvements in cervical range of motion and neck pain-related disability over a 4-week treatment period.

The results suggest that this treatment approach could effectively reduce pain and disability in individuals suffering from cervicogenic headaches.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The utilization of dry needling and an upper extremity exercise program for individuals with cervicogenic headaches: A pilot study. Geist, K., Frierson, E., Hudson, O., et al.[2022]

Three studies indicated that dry needling, when added to conventional physiotherapy, resulted in statistically significant improvements in tension-type and cervicogenic headaches, particularly noting a 45 mm reduction in pain intensity on the VAS scale.

While no significant differences were found between groups, and no adverse events were reported, the evidence suggests that dry needling could be a beneficial adjunct to physiotherapy for headache management, warranting further research for stronger conclusions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evidence for the use of dry needling and physiotherapy in the management of cervicogenic or tension-type headache: a systematic review. France, S., Bown, J., Nowosilskyj, M., et al.[2022]

Both dry needling and manual pressure release techniques effectively reduced pain intensity and improved cervical range of motion in individuals with chronic neck pain, but the effects on muscle performance were limited.

Dry needling significantly increased pressure pain thresholds compared to manual pressure release, suggesting it may offer a more effective option for pain management in this context.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Immediate Effects of Dry Needing or Manual Pressure Release of Upper Trapezius Trigger Points on Muscle Activity During the Craniocervical Flexion Test in People with Chronic Neck Pain: A Randomized Clinical Trial. Rodríguez-Jiménez, J., Ortega-Santiago, R., Bonilla-Barba, L., et al.[2022]

In a study of 30 participants with cervicogenic headaches, both superficial and deep dry needling techniques significantly reduced headache severity and tenderness at trigger points.

Deep dry needling was found to be more effective than superficial needling, leading to greater improvements in cervical range of motion and overall functional ability.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparison of acute effects of superficial and deep dry needling into trigger points of suboccipital and upper trapezius muscles in patients with cervicogenic headache. Sedighi, A., Nakhostin Ansari, N., Naghdi, S.[2018]

In a study involving 69 patients with cervicogenic headache, dry needling combined with conventional physiotherapy significantly reduced headache intensity and neck disability compared to both sham and control groups, with improvements observed at multiple follow-up points (1, 3, and 6 months).

The dry needling group also showed greater cervical range of motion and better performance of deep cervical flexor muscles compared to the other groups, indicating its potential benefits in managing cervicogenic headaches, although the overall clinical significance of these improvements was considered small.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Effect of Adding Dry Needling to Physical Therapy in the Treatment of Cervicogenic Headache: A Randomized Controlled Trial. Mousavi-Khatir, SR., Fernández-de-Las-Peñas, C., Saadat, P., et al.[2022]

Cervical manipulation and mobilization techniques for neck pain are generally effective but can be associated with rare serious adverse events, as highlighted by a review of studies from 1998 to 2009.

The review found that while 17 out of 76 studies reported no major adverse events, minor adverse events like transient neurological symptoms and increased neck pain were noted, indicating a need for better reporting of adverse events in manual therapy research.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adverse events associated with the use of cervical manipulation and mobilization for the treatment of neck pain in adults: a systematic review. Carlesso, LC., Gross, AR., Santaguida, PL., et al.[2022]

Combining dry needling with other physical therapy interventions significantly reduces pain intensity in the short-term and midterm for individuals with neck pain related to trigger points, with a standardized mean difference of -1.46 at short-term.

The combination also shows a small positive effect on pain-related disability and improves pressure pain thresholds in the short-term, but no significant long-term benefits were observed.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Is Dry Needling Effective When Combined with Other Therapies for Myofascial Trigger Points Associated with Neck Pain Symptoms? A Systematic Review and Meta-Analysis. Fernández-De-Las-Peñas, C., Plaza-Manzano, G., Sanchez-Infante, J., et al.[2023]

Dry needling significantly reduces pain intensity in individuals with neck pain associated with trigger points, showing immediate and short-term benefits compared to sham treatments and other physical interventions, based on a review of 28 trials.

The evidence suggests that dry needling can improve pain-related disability in the short term, but it does not show significant effects on cervical range of motion or pressure pain sensitivity compared to other therapies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effectiveness of Dry Needling for Myofascial Trigger Points Associated with Neck Pain Symptoms: An Updated Systematic Review and Meta-Analysis. Navarro-Santana, MJ., Sanchez-Infante, J., Fernández-de-Las-Peñas, C., et al.[2020]

A pilot randomized control trial was conducted to compare the effectiveness of 'Bug Busting' wet combing against a single application of an insecticide for treating head lice, addressing a gap in existing literature.

The study included enzyme analysis to assess insecticide resistance in lice, highlighting the importance of understanding resistance mechanisms in developing effective treatment strategies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The methodology and operation of a pilot randomized control trial of the effectiveness of the Bug Busting method against a single application insecticide product for head louse treatment. Bingham, P., Kirk, S., Hill, N., et al.[2016]

A systematic review of 28 trials on topical treatments for head lice found that only permethrin 1% creme rinse demonstrated consistent efficacy, with a cure rate above 90% in multiple studies.

Other treatments like malathion and carbaryl require more evidence to support their effectiveness, while lindane and natural pyrethrins were deemed insufficiently effective for use.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Systematic review of clinical efficacy of topical treatments for head lice. Vander Stichele, RH., Dezeure, EM., Bogaert, MG.[2019]

Head louse infestation, common in children, is primarily diagnosed by the presence of viable nits and can lead to complications like secondary bacterial infections if misdiagnosed.

Effective treatment includes topical agents like permethrin lotion and wet combing, while severe cases may require oral medications like Ivermectin; environmental fogging is not recommended.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Pediculosis capitis: an update. Madke, B., Khopkar, U.[2012]

The LouseBuster, a device that uses controlled heated air, was found to be highly effective in killing head lice and their eggs, achieving a 94.8% mortality rate after treatment in a study of 56 subjects.

The treatment was safe, with no adverse events reported, and showed consistent efficacy regardless of the operator's experience, hair type, or ambient humidity, making it a promising nonchemical alternative to traditional head lice treatments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy of the LouseBuster, a new medical device for treating head lice (Anoplura:Pediculidae). Bush, SE., Rock, AN., Jones, SL., et al.[2019]

Linkage group II has a confirmed impact on adult DDT-resistance in the Aedes aegypti strain known as Bangkok-MR, indicating a genetic basis for resistance in this specific strain.

However, this linkage group does not influence DDT-resistance in the Bangkok-HR strain, suggesting that different genetic factors may be responsible for resistance in different populations of Aedes aegypti.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effect of larval selection on adult resistance to DDT in two strains of the mosquito Aedes aegypti (L). Margham, JP., Wood, RJ.[2019]

References

1. England pubmed.ncbi.nlm.nih.gov

The utilization of dry needling and an upper extremity exercise program for individuals with cervicogenic headaches: A pilot study. [2022]

2. England pubmed.ncbi.nlm.nih.gov

Evidence for the use of dry needling and physiotherapy in the management of cervicogenic or tension-type headache: a systematic review. [2022]

3. England pubmed.ncbi.nlm.nih.gov

Immediate Effects of Dry Needing or Manual Pressure Release of Upper Trapezius Trigger Points on Muscle Activity During the Craniocervical Flexion Test in People with Chronic Neck Pain: A Randomized Clinical Trial. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

Comparison of acute effects of superficial and deep dry needling into trigger points of suboccipital and upper trapezius muscles in patients with cervicogenic headache. [2018]

5. England pubmed.ncbi.nlm.nih.gov

The Effect of Adding Dry Needling to Physical Therapy in the Treatment of Cervicogenic Headache: A Randomized Controlled Trial. [2022]

6. Scotland pubmed.ncbi.nlm.nih.gov

Adverse events associated with the use of cervical manipulation and mobilization for the treatment of neck pain in adults: a systematic review. [2022]

7. United States pubmed.ncbi.nlm.nih.gov

Is Dry Needling Effective When Combined with Other Therapies for Myofascial Trigger Points Associated with Neck Pain Symptoms? A Systematic Review and Meta-Analysis. [2023]

8. Switzerland pubmed.ncbi.nlm.nih.gov

Effectiveness of Dry Needling for Myofascial Trigger Points Associated with Neck Pain Symptoms: An Updated Systematic Review and Meta-Analysis. [2020]

9. Netherlands pubmed.ncbi.nlm.nih.gov

The methodology and operation of a pilot randomized control trial of the effectiveness of the Bug Busting method against a single application insecticide product for head louse treatment. [2016]

10. England pubmed.ncbi.nlm.nih.gov

Systematic review of clinical efficacy of topical treatments for head lice. [2019]

11. United States pubmed.ncbi.nlm.nih.gov

Pediculosis capitis: an update. [2012]

12. England pubmed.ncbi.nlm.nih.gov

Efficacy of the LouseBuster, a new medical device for treating head lice (Anoplura:Pediculidae). [2019]

13. England pubmed.ncbi.nlm.nih.gov

The effect of larval selection on adult resistance to DDT in two strains of the mosquito Aedes aegypti (L). [2019]