Dry Needling for Cervicogenic Headache

Study Overview
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Brief Summary
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Currently, it is unknown if dry needling when performed to the trigeminal innervation field improves neck pain and or headache for patients with cervicogenic headaches. The aim of this study is to determine if dry needling of the trigeminal innervation field improves pain, pain-pressure thresholds, and neck mobility in patients with cervicogenic headaches, with or without migraine.

Detailed Description
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Dry needling is a widely used intervention performed by physical therapists for a wide range of musculoskeletal and neurological conditions. Dry needling has been shown to be beneficial for cervicogenic headaches but treatment is typically applied to the neck. It is well-established that cervical pain can upregulate the trigeminal nerve and vice versa in various forms of headaches. Thus, it is plausable that reducing inflammation and irritation of the trigeminal nerve may in fact reduce neck pain and impairments. This study aims to look investigate whether dry needling the trigeminal innervation field will reduce pain and impairments known to exist in patients with cervicogenic headaches compared to a sham comparator. The study is a pilot trial for a larger RCT and will look at immediate effects only.

Official Title
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Dry Needling of the Trigeminal Nerve Innervation Field for Cervicogenic Eadache: A Pilot Study

Conditions
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Headache

Intervention / Treatment
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* Other: Dry Needling
* Other: Sham Dry Needling


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Aged 18 or older Symptoms: (1)Unilateral pain starting in the neck and radiating to the frontotemporal region or posterior fossa, (2) pain aggravated by neck movement, (3) restricted cervical range of motion, (4) non-throbbing and non-lancinatingnpain, 5) dysfunction/headache pain in at least one of the joints of the upper cervical spine(C0-C4), and (6) headache frequency of at least 1 per week over a period greater than 3 months. Exclusion Criteria Pain <2/10 Contraindications to the interventions Whiplash associated disorder within 6 weeks Pending litigation for neck pain and/or headache.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Double blinded, sham controlled, randomized trial.
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Dry needling<br>Experimental Group | Other: Dry Needling<br>* 1/2 needles will placed into defined innervation fields of the trigeminal nerve and rotated. Total time will be 5-7 minutes.<br>|
| Sham Comparator: Sham Needling<br>Sham Group | Other: Sham Dry Needling<br>* Needle handles inside of guide tubes will be tapped in a way similar to an actual needle being set but the sham needles will be blunted.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Headache or neck pain intensity on a Numeric pain rating scale (0-10) | 0-10 scale pain intensity | <1 hour | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Active Range of Motion of the Cervical Spine in degrees of measurement | Active range of motion will be measured in the most painful and or limited plane of movement. | <1 hour | 
| Flexion-rotation test in degrees of measurement | Flexion-rotation test for CGH will be measured to determine any change in measure for c1-c2 mobility. | <1 hour | 
| Pain-pressure threshold in lbs of pressure | Pain-pressure threshold will be measured using an algometer at the innervation zones of the trigeminal nerve and the upper cervical spine. | <1 hour |