PICO
Patient/Population
- Patients with cervicogenic headache
- Participants from 13 clinics in 10 different geographical states
(n=142)
Intervention
- Thrust spinal manipulation and electrical dry needling
Comparison
- Nonthrust spinal mobilization and exercise
Outcomes
- Headache intensity
- Headache frequency
- Headache duration
- Disability
- Medication intake
Translatability: (3/3) Easy 
Comments: Patients receiving thrust spinal manipulation and dry needling showed significant improvements in headache parameters compared to the nonthrust spinal mobilization and exercise group.
Limitations: Mid-term follow-up assessment only; generalizability of results to other manual therapy and dry needling protocols not certain; Lack of a dry needling placebo group; potential influence of therapist and patient treatment preferences on results
Appraisals:
Risk of Bias – Low (by: Jung, A., Carvalho, G. F., Szikszay, T. M., Pawlowsky, V., Gabler, T., & Luedtke, K. (2024). Physical Therapist Interventions to Reduce Headache Intensity, Frequency, and Duration in Patients With Cervicogenic Headache: A Systematic Review and Network Meta-Analysis. Physical therapy, 104(2), pzad154. https://doi.org/10.1093/ptj/pzad154 )
BTB
Intervention – 1
- Thrust Spinal Manipulation
Dose
- High-velocity, low-amplitude thrust manipulation
Periodicity
- Up to 8 treatment sessions over 4 weeks.
Local/Technic:
- Directed primarily to the upper cervical (C1-2) and upper thoracic (T1-2) articulations.
Supplementary materials: JPG 1; JPG 2; Appendix 1
Intervention – 2
- Electrical dry needling
Dose
- 20 minutes of a biphasic continuous waveform of low frequency (2 Hz), moderate pulse duration (250 µs), and intensity described by the patient as “mild to moderate”.
Periodicity
- Up to 8 treatment sessions over 4 weeks.
Local/Technic:
- A semi-standardized protocol of 8 to 12 needles was used, inserted at occipital-cervical, distal hand, and oculofrontotemporal points based on trigger points or patient-reported pain. Depth ranged from 10 mm to 30 mm based on point selection and patient’s anatomy.
- Optional placement of up to four needles in the upper thoracic paraspinal region.
- Needles manipulated bidirectionally to elicit sensations like aching, tingling, pressure, heaviness, or warmth.
Supplementary materials: Appendix 1; Fig.1
Citation: Dunning, J., Butts, R., Zacharko, N., Fandry, K., Young, I., Wheeler, K., Day, J., & Fernández-de-Las-Peñas, C. (2021). Spinal manipulation and perineural electrical dry needling in patients with cervicogenic headache: a multicenter randomized clinical trial. The spine journal : official journal of the North American Spine Society,21(2), 284–295. https://doi.org/10.1016/j.spinee.2020.10.008