Effectiveness of dry needling for improving pain and disability in adults with tension-type, cervicogenic, or migraine headaches: protocol for a systematic review

Abstract

Background Headache is the most common neurological symptoms worldwide, as over 90% of people have noted at least one headache during their lifetime. Tension-type headaches, cervicogenic headaches, and migraines are common types of headache which can have a significant impact on social, physical, and occupational functioning. Therapeutic management of headaches mainly includes physical therapy and pharmacological interventions. Dry needling is a relatively new therapeutic approach that uses a thin filiform needle without injectate to penetrate the skin and stimulate underlying tissues for the management of neuromusculoskeletal pain and movement impairments. The main objective of this systematic review and meta-analysis is to evaluate the effectiveness of dry needling in comparison to other interventions on pain and disability in patients with tension-type headache, cervicogenic headache, and migraine. Methods/design We will focus on clinical trials with concurrent control group(s) and comparative observational studies assessing the effect of dry needling in patients with tension-type headache, cervicogenic headache, and migraine. Electronic databases from relevant fields of research (PubMed/ Medline, Scopus, Embase®, PEDro, Web of Science, Ovid, AMED, CENTRAL, and Google Scholar) will be searched from inception to June 2019 using defined search terms. No restrictions for language of publication or geographic location will be applied. Moreover, grey literature, citation tracking, and reference lists scanning of the selected studies will be searched manually. Primary outcomes of this study are pain intensity and disability, and secondary outcomes are cervical spine ROM, frequency of headaches, health-related quality of life, and TrPs tenderness. Studies will be selected by three independent reviewers based on prespecified eligibility criteria. Three reviewers will independently extract data in each eligible study using a pre-piloted Microsoft Excel data extraction form. The assessment of risk of bias will be implemented using the Cochrane Back and Neck Review Group 13-item criteria and NOS. Direct meta-analysis will be performed using a fixed or random effects model to estimate effect size such as standardized mean difference (Morris’s dppc) and 95% confidence intervals. Statistical heterogeneity will also be evaluated using the I2 statistic and the χ2 test. All meta-analyses will be performed using Stata V.11 and V.14 softwares. The overall quality of the evidence for the primary outcomes will be assessed using GRADE. Discussion All analyses in this study will be based on the previous published papers. Therefore, ethical approval and patient consent are not required. The findings of this study will provide important information on the value of dry needling for the management of tension-type headache, cervicogenic headache, and migraine. Trial registration PROSPERO registration number: CRD42019124125.

Flexor Digitorum Brevis Muscle Dry Needling Changes Surface and Plantar Pressures: A Pre-Post Study

“…In order to observe differences pre- and post-dry needling on plantar pressures, we used a similar study by authors who investigated the acute effects of intermittent stretching on plantar pressures during bipodal standing [ 26 ]. These authors found rear foot maximum pressure (KPa) decreased after stretching from 106.24 ± 20.89 to 87.45 ± 22.28 ( p = 0.004) [ 23 ]. Thus, to achieve 95% statistical confidence, an 80% statistical power analysis (α = 0.05, β = 20%) and two-tailed test, a total of 18 participants was required.…”

“…Exclusion criteria consisted of several parameters: (1) Diagnosis of lower limb injury, such as plantar fasciitis, tendinopathy, bursitis, ligament injuries [ 27 ]; (2) a history of previous lower extremity surgery [ 28 ]; (3) participants were required not to have undergone ankle stretching or any other treatment [ 23 ]; (4) diabetes due to possible elevation of plantar pressure, [ 30 ]; (5) deformities of the toes, such as hammer toes and hallux valgus due to their possible alteration in plantar pressure [ 31 ]; and (6) receiving anticoagulant therapy [ 4 ]. The permission of the required committee was obtained from the Rey Juan Carlos University Ethics Committee with the number 2706201911419.…”

“…Despite these associations between intrinsic muscle, fascia and footprint status, no investigations have been conducted on the effects of dry needling on any intrinsic muscle and static footprint variables. It is possible that after dry needling, changes in plantar pressures may occur due to the greater elongation capacity of the muscle, as described after therapy [ 23 ]. Variations in the surface and pressures of the static footprint are important, as it is known that higher levels of plantar pressures are associated with pathologies such as metatarsalgia [ 24 ] and ulcers [ 25 ] in a secondary way, so it is necessary to know if adverse events of these types after dry needling are found.…”

Interaction between Pain, Disability, Mechanosensitivity and Cranio-Cervical Angle in Subjects with Cervicogenic Headache: A Cross-Sectional Study

“…The term cervicogenic headache (CGH) refers to a headache caused by a dysfunction in the cervical spine and its osseous, disc and/or soft tissue components, which is usually accompanied by cervical pain [ 1 ] and one-sided pain referred to the head [ 2 ]. Cervical pain has been proposed as a possible trigger for headache [ 3 ] because of the convergence in the trigeminal nucleus caudalis [ 4 ].…”

Sensor Technologies to Manage the Physiological Traits of Chronic Pain: A Review

“…By definition, chronic pain lasts over 3-6 months [7] and is not solved with treatment [8]. Its origin may be nociceptive or neuropathic [7,9], and it can be triggered by various causes (chronic musculoskeletal pain [10,11], chronic low back pain [12], fibromyalgia [13], tension-type headache [14], osteoarthritis [15], whiplash [16], heart and respiratory systems [7,17], endometriosis [18], etc.). Once developed, it may become resistant to standard treatments, greatly affecting patient quality of life [4].…”