###### Abstract  
(1) Background: Periosteal dry needing (PDN) involves clinicians using a solid filiform needle to stimulate bone for analgesic purposes. This case report presents the use of PDN to the cervical articular pillars (CAPs) in an 85-year-old female with chronic neck pain and headache. (2) Case description: PDN was applied to the right C2-C3 articular pillars, following trigger point dry needling (TrPDN) and manual therapy, in order to provide a direct sensory stimulus to the corresponding slenderness. PDN added over two treatments led to improved cervical range of motion and eliminated the patient's neck pain and headache at 1 week follow-up. (3) Outcomes: At discharge, clinically relevant improvements were demonstrated on the numeric pain rating scale (NPRS), which improved from an 8/10 on intake to a 0/10 at rest and with all movements. In addition, the patient exceeded the risk adjusted predicted four-point score improvement and the minimal clinically important improvement (MCII) value of four points on the Focus on Therapeutic Outcomes (FOTO) Neck Functional Status (Neck FS). At one month post-discharge, the patient remained symptom-free. (4) Discussion: In the context of an evidence-informed approach for neck pain and headache, PDN led to marked improvements in pain and function. Patient outcomes exceeded predictive analytic expectations for functional gains and efficient utilization of visits and time in days. Combined with other interventions, PDN to the CAPs could be a viable technique to treat chronic neck pain with headache.  
periosteal; dry; needling; neck; pain +
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-radical symptomatology is attributed to cervical facet joints, intervertebral discs, and trigger points, among others [12; 13; 14]. According to [PERSON] et al. chronic neck pain of facet joint origin is estimated to range from 36% to 60% [15]. Clinically, hypersensitivity to the cervical articular pillars is common and has been described in elderly female patients with chronic neck pain [16]. It may be due to sensitization of skeletal nociceptors due to release of nerve growth factors and inflammatory mediators [17; 18].  
Multimodal approaches show a positive effect on pain outcomes for patients with chronic neck pain [19], with manual therapy and exercise being the most frequently utilized by physical therapists [20]. Yet, adding trigger point dry needles (TrPDN) has been shown to amplify therapeutic effects [21], with benefits comparable to manual therapy [22; 23]. In recent systematic reviews and meta-analyses, TrPDN produced significant reductions in pain intensity as a stand-alone intervention [24] or when added to other interventions for treating neck pain [25]. Although TrPDN is practiced more widely by clinicians [26], earlier studies report the therapeutic effects of periosteal needing in patients with neck pain [3; 27; 28]. However, the therapeutic outcomes resulting from periosteal needing specifically to the cervical articular pillars (CAPs) in isolation were not analyzed. Furthermore, to the authors' knowledge, no studies in the literature have investigated the effects of PDN to the upper (C2-C3) CAPs in patients with chronic neck pain or headache. This case report is the first to present the successful use of PDN to the upper CAPs as an adjunct intervention in an elderly patient with chronic neck pain and headache. The CARE guidelines framework for writing case reports was followed (File S1: CARE checklist).