Abstract
Headaches were one of the most prevalent neurological conditions worldwide and a frequent reason for consulting health services, due to their negative impact on the quality of life, work performance and emotional well-being of those who suffered from them. The purpose of this study was to analyse the clinical characteristics of headaches and examine the role of dry needling as a therapeutic alternative within the kinesiological approach, with special emphasis on tension headaches and other headaches of musculoskeletal origin. The main types of headaches were described according to the classification of the International Headache Society, highlighting migraine and tension headaches due to their high prevalence and association with factors such as stress, muscle tension, and postural overload. The pathophysiological mechanisms involved were also addressed, including genetic predisposition, central sensitisation, and the influence of emotional and environmental triggers. Dry needling was analysed as a technique based on neurophysiological and myofascial models, aimed at deactivating trigger points and modulating nociceptive afferents. Its effects at the peripheral and central levels were demonstrated, such as decreased referred pain, reduced muscle sensitivity, and improved motor function. The evidence reviewed showed that the application of dry needling was associated with significant reductions in pain intensity and frequency, as well as relevant improvements in patients' quality of life. In conclusion, dry needling was presented as an effective and promising intervention for the comprehensive management of chronic headaches, justifying its inclusion in multidisciplinary therapeutic strategies.
References
1. Adachi K, Sakai N, Kimpara K, Arizono S. The effect of physical therapy integrated with pharmacotherapy on tension-type headache and migraine in children and adolescents. BMC Neurology 2024;24. https://doi.org/10.1186/s12883-024-03833-7.
2. Al-Khazali HM, Krøll LS, Ashina H, Melo-Carrillo A, Burstein R, Amin FM, et al. Neck pain and headache: Pathophysiology, treatments and future directions. Musculoskeletal Science and Practice 2023;66. https://doi.org/10.1016/j.msksp.2023.102804.
3. Alnwick GM, Clewley D, Beuning B, Koppenhaver S. Improvements after dry needling for craniofacial pain in a patient with chronic rhinosinusitis: a case report. Physiotherapy Theory and Practice 2023;39:2740–9. https://doi.org/10.1080/09593985.2022.2085218.
4. Chys M, de Meulemeester K, de Greef I, Murillo C, Kindt W, Kouzouz Y, et al. Clinical Effectiveness of Dry Needling in Patients with Musculoskeletal Pain—An Umbrella Review. Journal of Clinical Medicine 2023;12. https://doi.org/10.3390/jcm12031205.
5. Demont A, Lafrance S, Gaska C, Kechichian A, Bourmaud A, Desmeules F. Efficacy of physiotherapy interventions for the management of adults with cervicogenic headache: A systematic review and meta-analyses. PM and R 2023;15:613–28. https://doi.org/10.1002/pmrj.12856.
6. Fernández De Las Peñas C, Cook C, Cleland JA, Lima Florencio LL. The cervical spine in tension type headache. Musculoskeletal Science and Practice 2023;66. https://doi.org/10.1016/j.msksp.2023.102780.
7. Geist K, Frierson E, Hudson O, Lavin S, Myers M, McDaniel L, et al. The utilization of dry needling and an upper extremity exercise program for individuals with cervicogenic headaches: A pilot study. Cranio - Journal of Craniomandibular Practice 2024;42:470–80. https://doi.org/10.1080/08869634.2021.1994226.
8. Gong Z, Guo Y, Liu X, Ai K, Li W, Li J. Bibliometric Analysis of Research Trends on Tuina Manipulation for Neck Pain Treatment Over the Past 10 Years. Journal of Pain Research 2023;16:2063–77. https://doi.org/10.2147/JPR.S410603.
9. Gonzalez-Martinez A, Ray JC, Haghdoost F, Ashraf U, Cerrahoǧlu Şirin T, Dantes MC, et al. Time and headache: Insights into timing processes in primary headache disorders for diagnosis, underlying pathophysiology and treatment implications. Cephalalgia 2024;44. https://doi.org/10.1177/03331024241297652.
10. Kandeel M, Morsy MA, Alkhodair KM, Alhojaily S. Dry needling techniques as a treatment for improving disability and pain in patients with different types of headache: A systematic review and meta-analysis. Complementary Therapies in Medicine 2024;86. https://doi.org/10.1016/j.ctim.2024.103085.
11. Kużdzał A, Ernst E, Posadzki P, Wroński Z. Dry needling for orofacial pain: a systematic review and meta-analysis of randomized clinical trials. Pain Reports 2024;9:e1208. https://doi.org/10.1097/PR9.0000000000001208.
12. Leonardi G, Alito A, Portaro S, Di Matteo B, Respizzi S, Kon E, et al. Intramuscular injections of botulinum toxin for the treatment of upper back myofascial pain syndrome: A systematic review of randomized controlled trials. European Journal of Pain 2024;28:369–81. https://doi.org/10.1002/ejp.2198.
13. Li B, Ma R, Xia P, Zhang T, Yang M, He J, et al. Effectiveness of manual therapy combined with dry needling in the treatment of cervicogenic headache: A systematic review and meta-analysis. Neurology Asia 2024;29:413–20. https://doi.org/10.54029/2024rif.
14. Li Z-Q, Wang X-F, Feng C, Fei Y-T, Liu J-P. Global trends of acupuncture clinical research on analgesia from 2010 to 2023: a bibliometric and visualization analysis. Frontiers in Neurology 2024;15. https://doi.org/10.3389/fneur.2024.1368988.
15. Lychko V, Lychko S, Zhyvotovskyi I, Burtyka M. MASTICATORY MYOFASCIAL PAIN SYNDROME PROVOKED BY SARS-COV-2 INFECTION IN A PATIENT WITH OROFACIAL PATHOLOGY (CLINICAL CASE). Journal of V N Karazin Kharkiv National University Series “Medicine” 2023;2023:57–63. https://doi.org/10.26565/2313-6693-2023-46-06.
16. Monti-Ballano S, Lucha-López MO, Hidalgo-García C, Ferrández-Laliena L, Vicente-Pina L, Sánchez-Rodríguez R, et al. Sex-Based Differences in Pressure Pain Thresholds of Myofascial Trigger Points in Cervical and Cranial Muscles in Tension-Type Headache: A Cross-Sectional Study. Symmetry 2024;16. https://doi.org/10.3390/sym16081087.
17. Monti-Ballano S, Márquez-Gonzalvo S, Lucha-López MO, Ferrández-Laliena L, Vicente-Pina L, Sánchez-Rodríguez R, et al. Effects of Dry Needling on Active Myofascial Trigger Points and Pain Intensity in Tension-Type Headache: A Randomized Controlled Study. Journal of Personalized Medicine 2024;14. https://doi.org/10.3390/jpm14040332.
18. Müller-Thyssen-Uriarte J, Lucha-López MO, Hidalgo-García C, Sánchez-Rodríguez R, Vicente-Pina L, Ferrández-Laliena L, et al. Electromyographic Activity of Cervical Muscles in Patients with Neck Pain and Changes After Dry Needling: A Narrative Review. Journal of Clinical Medicine 2024;13. https://doi.org/10.3390/jcm13237288.
19. Olesiejuk M, Marusiak J, Chalimoniuk M. Myofascial Trigger Points therapy decreases myotonometric tone and stiffness of trapezius muscle, benefits headaches and muscle pain in migraine. NeuroRehabilitation 2023;52:299–310. https://doi.org/10.3233/NRE-220237.
20. Perreault T, Arendt-Nielson L, Fernández De Las Peñas C, Dommerholt J, Herrero P, Hubbard R. Intramuscular Electrical Stimulation for the Treatment of Trigger Points in Patients with Chronic Migraine: A Protocol for a Pilot Study Using a Single-Case Experimental Design. Medicina (Lithuania) 2023;59. https://doi.org/10.3390/medicina59081380.
21. Pillai S, Zhang N. The Role of Manual Therapies in the Treatment of Headache Disorders. Current Neurology and Neuroscience Reports 2023;23:399–405. https://doi.org/10.1007/s11910-023-01279-x.
22. Porter M, Griswold D, Gargano F, Ickert E, Learman K. Immediate effects of superficial dry needling of the trigeminal nerve innervation field for participants with cervicogenic headache. A randomized controlled trial. Physiotherapy Theory and Practice 2024;40:253–61. https://doi.org/10.1080/09593985.2022.2118560.
23. Rezaeian T, Mosallanezhad Z, Saadat Z, Ranjbar P, Mohammadi M. Effectiveness of Exercise Therapy, Manual Therapy, Manipulation, and Dry Needling on Pain Intensity and Functional Disability in Patients with Migraine Headache: A Systematic Review of Randomized Controlled Trials. Critical Reviews in Physical and Rehabilitation Medicine 2023;35:1–22. https://doi.org/10.1615/CritRevPhysRehabilMed.2023047727.
24. Saueressig T, Owen PJ, Pedder H, Tagliaferri S, Kaczorowski S, Altrichter A, et al. The importance of context (placebo effects) in conservative interventions for musculoskeletal pain: A systematic review and meta-analysis of randomized controlled trials. European Journal of Pain 2024;28:675–704. https://doi.org/10.1002/ejp.2222.
25. Trybulski R, Kużdzał A, Kiljański M, Gałęziok K, Matuszczyk F, Kawczyński A, et al. Adverse Reactions to Dry Needling Therapy: Insights from Polish Physiotherapy Practice. Journal of Clinical Medicine 2024;13. https://doi.org/10.3390/jcm13237032.
26. Xu B, Wu M, Yang Y, Wu J, Chen L, Tan W. Effects of acupuncture at myofascial trigger points combined with sling exercise therapy on clinical recovery and cervical spine biomechanics in patients with cervical spondylotic radiculopathy. International Journal of Neuroscience 2024;134:1019–25. https://doi.org/10.1080/00207454.2024.2327402.
27. Young I, Dunning J, Butts R, Bliton P, Zacharko N, Garcia J, et al. Spinal manipulation and electrical dry needling as an adjunct to conventional physical therapy in patients with lumbar spinal stenosis: a multi-center randomized clinical trial. Spine Journal 2024;24:590–600. https://doi.org/10.1016/j.spinee.2023.12.002.

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Copyright (c) 2024 Hugo Rubén Martínez, Cesar Martinez (Author)