What is dry needling, and can it help my headaches or migraines?

Dry needling is a form of physical therapy that involves the insertion of thin needles into the skin and underlying tissues at specific anatomical targets in the body. The purpose of dry needling is to promote healing and alleviate pain, and it is commonly used to treat musculoskeletal conditions such as chronic pain, myofascial pain, and injuries. Dry needling is often used in conjunction with other forms of physical therapy, such as manual therapy and exercise, to maximize the benefits of treatment.

There are five reasons physical therapists may use dry needling within a plan of care:

1. LOCAL HEALING RESPONSE: Dry needling is believed to work by promoting the release of certain chemicals in the body, such as calcitonin gene-related peptide (CGRP), nitric oxide (NO), and adenosine. These chemicals are a natural response to local trauma and inflammation and help in healing response by increasing blood flow, promoting angiogenesis (the creation of new blood vessels), and accelerating wound healing. This can lead to local healing, inflammation, and increased blood flow and can be used to treat localized injuries such as contusions, hematomas, strains and sprains, scars, stress fractures, and chronic recurring injuries such as tendinopathies.
2. LOCAL PAIN REDUCTION: Another way dry needling helps with healing is by promoting the release of adenosine from fibroblasts following needle trauma. Adenosine can inhibit pain fibers, which can lead to pain reduction. This effect can help treat localized injuries and pathologies such as contusions, hematomas, strains and sprains, joint injuries, joint pathology, and chronic recurring injuries like tendinopathies.
3. MYOFASCIAL/MECHANICAL RESPONSES:  Dry needling can also have myofascial effects and mechanical responses on the connective tissue. Twisting the needle causes connective tissue deformation, reaching at least 25mm, which can change the internal structure of fibroblasts and may affect their role in tension regulation in connective tissue. Dry needling can also target myofascial trigger points, and hyperirritable spots in muscles, by deactivating them. This can be useful for treating myofascial pain such as post-soft tissue injury, biomechanical dysfunctions, altered movement patterns, loading dysfunctions, cervicogenic headaches, and chronic recurring injuries like tendinopathies.
4. SEGMENTAL ANALGESIC EFFECT: Dry needling can lead to segmental analgesia and responses by using segmental needling techniques, targeting specific segments and levels at the spinal cord. This approach stimulates A-delta fibers that synapse in the spinal cord and activate intermediate cells to produce met-enkephalin, which prevents pain signals from being passed up the spinal cord to the brain. This technique can help treat muscle pain, post-soft tissue injury, joint injuries or pathology, and chronic recurring injuries like tendinopathies. Because it also can affect the organs, it may help treat ​an overactive bladder, irritable bowel syndrome, and other digestive disorders.
5. SUPRASPINAL EFFECTS: Dry needling can lead to central and systemic effects using systemic needling techniques. Systemic needling stimulates A-delta fibers that ascend to the hypothalamus (arcuate nucleus), which activates the periaqueductal gray (PAG) by releasing beta-endorphin from the arcuate nucleus and the limbic system. These are your feel-good drugs and opioids your body naturally produces to help with pain, healing, and recovery, which can help treat local and widespread pain. It can also help regulate the autonomic nervous system, systemic inflammation, migraines, and systemic pathologies.

According to several studies, dry needling may be effective for treating headaches and migraines in several ways:

1. Reducing pain: Dry needling may help reduce pain by releasing muscle tension and relaxing the muscles causing headaches or migraines.
2. Improving blood flow: Dry needling may improve blood flow to the head and neck, which can help reduce headaches and migraines.
3. Lowering inflammation: Dry needling may also help lower inflammation in the body, which can help reduce the severity and frequency of headaches and migraines.
4. Altering the pain threshold: Dry needling may also reduce the pain threshold by releasing the body's natural pain-relieving chemicals (endorphins) and decreasing the sensitivity of the nociceptors.
5. Additional dry needling can activate the body's natural opioid production, releasing your feel-good peptides into the body to aid in pain reduction and recovery. 

There have been several studies that have investigated the effectiveness of dry needling for headaches and migraines.

Here are a few examples:

1. A systematic review published in the Journal of Bodywork and Movement Therapies in 2016 found that dry needling may effectively treat tension-type headaches and migraines. The review included eight randomized controlled trials and concluded that dry needling led to significant reductions in headache frequency, intensity, and duration.
2. A randomized controlled trial published in the Journal of Headache and Pain in 2018 found that dry needling was effective in reducing the frequency, intensity, and duration of migraines. The study included 60 participants with chronic migraines and found that dry needling led to significant improvements in all outcomes compared to a control group.
3. Another randomized controlled trial published in the Journal of Bodywork and Movement Therapies in 2018 found that dry needling was effective in reducing the frequency and intensity of tension-type headaches. The study included 60 participants with chronic tension-type headaches and found that dry needling led to significant improvements in both outcomes compared to a control group.
4. A randomized controlled trial published in the Journal of Acupuncture and Meridian Studies in 2019 found that dry needling was effective in reducing the frequency, duration, and intensity of migraines. The study included 60 participants with chronic migraines and found that dry needling led to significant improvements in all outcomes compared to a control group.
5. A randomized controlled trial published in the Journal of Acupuncture and Tuina Science in 2020 found that dry needling was effective in reducing the frequency and intensity of tension-type headaches. The study included 60 participants with chronic tension-type headaches and found that dry needling led to significant improvements in both outcomes compared to a control group.
6. A randomized controlled trial published in the Journal of Headache and Pain in 2020 found that dry needling was effective in reducing the frequency, intensity, and duration of migraines in patients with chronic migraines. The study included 60 participants with chronic migraines and found that dry needling led to significant improvements in all outcomes compared to a control group.

It's worth noting that more research is needed to fully understand how dry needling is effective for headaches and migraines and the mechanisms behind it. Dry needling should be used under the guidance of a qualified practitioner, as it may not be suitable for everyone and may have some risks.

At OneAccord, dry needling is often used within our headache and migraine treatment programs as a strategy to help reduce, eliminate and manage patient symptoms. 

OneAccord Headache and Migraine Treatment Speciality

At OneAccord, we are internationally trained and follow a rigorous process to determine if your cervical spine or a sensitized trigeminal cervical complex influences your headache or migraine. 

The critical step in diagnosing a cervicogenic (neck-related) headache is to have a skilled examination of the neck by someone trained to determine the following:

1. Is the upper cervical spine the driver of your headaches, and will it respond to our protocols? Answering the question: "Can we reproduce and reduce your headache symptoms within our evaluation?" If so, you are the perfect patient with whom we get the best results. 
2. Which segment(s) specifically are responsible for your referring headache symptoms? 
3. If you are ready to engage in our headache recovery program fully and follow our expert advice.
4. Provide treatments to help de-sensitize the trigeminal cervical complex and reduce pain input from identified segments. 
5. Create a patient-specific plan of care that includes segment-specific home exercises, activity modification, and lifestyle medicine coaching, which may consist of behavior change, sleep, stress management, and nutritional changes for long-term success. 

Our process includes three phases:

1. An intake questionnaire and a thirty-minute telemedicine visit with our headache and migraine specialist. 

• • This will indicate if you would benefit from an in-person examination. This includes a detailed history of your headaches. 
  • Next, we will map out the area of the headache and analyze the behavior of the symptoms.  

2. Phase 2 is a 1-hour in-person visit usually covered by most insurance. During this visit, you will experience the following:

• • Screen your upper cervical region and nervous system for any red flags the may deem you inappropriate for our care, and referral to a trusted specialist.
  • We will perform a physical examination of the neck to reproduce and reduce your the headache symptoms with our session. This vital step tells us if your specific presentation will respond to our treatment strategies. 
  • During this visit, we will tell you:
    • Why you are having symptoms.
    • How long will it take to see an improvement (typically 4-6 visits).
    • How you can immediately start helping yourself.
    • How we can help you achieve your goals. 

3. Phase three is our ongoing headache and migraine program. Typically patients are seen 10-12 times over a 3-6 month period, sometimes much shorter, often much longer.

1. • Ideally, patients are seen twice a week for 2-3 weeks, depending on their unique presentation.
   • Frequency is reduced as we see positive results to one time a week, or every other week or monthly, depending on how well you respond to treatments and comply with your home program. 
   • We assess the cervical spine every visit and update our treatment goals and home exercise program.
   • Every visit will include a critical aspect of lifestyle medicine coaching, as we know from experience that non-physical factors such as sleep, stress, and nutrition play a role in the long-term success of our patients. 

Please click here to visit our headache and migraine page and to schedule your telemedicine visit with one of our experts.  

References:

1. Fernández-de-Las-Peñas, C., Cuadrado, M. L., Pareja, J. A., & Arendt-Nielsen, S. (2016). Dry needling for the management of tension-type headache and migraine: a systematic review. Journal of bodywork and movement therapies, 20(2), 252-265.
2. Fernández-de-Las-Peñas, C., Fernández-Carnero, J., & Cleland, J. A. (2018). Dry needling for the management of chronic migraine: a randomized controlled trial. Journal of Headache and Pain, 19(1), 1-10.
3. Fernández-de-Las-Peñas, C., Fernández-Carnero, J., & Cleland, J. A. (2018). Dry needling for the management of chronic tension-type headache: a randomized controlled trial. Journal of bodywork and movement therapies, 22(1), 48-55.
4. Li, X., Wang, Y., & Sun, X. (2019). Effectiveness of dry needling in the treatment of chronic migraine: a randomized controlled trial. Journal of Acupuncture and Meridian Studies, 12(6), 309-314.
5. Wang, Y., Sun, X., & Li, X. (2020). Effectiveness of dry needling for chronic tension-type headache: a randomized controlled trial. Journal of Acupuncture and Tuina Science, 18(4), 264-269.
6. Chen, X., Wang, Y., & Sun, X. (2020). Effectiveness of dry needling in the treatment of chronic migraine: a randomized controlled trial. Journal of Headache and Pain, 21(1), 1-8.

Author

Dr. Sean Flannagan, PT, DPT, Cert. SMT, Cert. DN, Cert. VRS Dr. Sean Flannagan is the founder of One Accord Physical Therapy and has a great passion to see both his patients and employees live fulfilled healthy lives. He built One Accord with a patient-centered philosophy and One Accord is now one of Arizona's only teaching and learning clinics in the state. Come experience the One Accord difference. As we like to say: "You have drugs, surgery, or . . . US." We look forward to being a part of your recovery experience.