Spinal Manipulation and Dry Needling Versus Conventional Physical Therapy in Patients With Cervicogenic Headache

Alabama Physical Therapy & Acupuncture

Status: Completed

Conditions: Cervicogenic Headaches

Treatments: Other: Exercise,Non-thrust Mobilization; Other: Dry Needling,Thrust Manipulation

Study type: Interventional

Funder types: Other

Identifiers

NCT02373605

AAMT0001

Details and patient eligibility

About

The purpose of this research is to compare two different approaches for treating patients with cervicogenic headaches: non-thrust mobilization and exercise versus thrust manipulation and dry needling. Physical therapists commonly use all of these techniques to treat cervicogenic headaches. This study is attempting to find out if one treatment strategy is more effective than the other.

Full description

Patients with cervicogenic headaches will be randomized to receive 1-2 treatment sessions per week for 4 weeks (up to 8 sessions total) of either: (1) Dry Needling and HVLA thrust manipulation group, or the (2) Exercise and non-thrust mobilization group

Enrollment: 142 patients

Sex: All

Ages: 18 to 65 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

1. Diagnosis of cervicogenic headache as defined by Cervicogenic Headache International Study Group criteria
2. Headache frequency of at least one per week for a minimum of 3 months
3. Minimum pain score (NPRS) of 2/10 and minimum disability score (NDI) of 10/50

Exclusion criteria

1. Presence of any of the following atherosclerotic risk factors: hypertension, diabetes, heart disease, stroke, transient ischemic attack, peripheral vascular disease, smoking, hypercholesterolemia or hyperlipidemia

2. Red flags noted in the patient's Neck Medical Screening Questionnaire (i.e. tumors, fracture, metabolic diseases, RA, osteoporosis, history of prolonged steroid use, etc.

3. History of whiplash injury within the last 6 weeks

4. Diagnosis of cervical stenosis

5. Bilateral upper extremity symptoms

6. Evidence of CNS involvement, to include hyperreflexia, sensory disturbances in the hand, intrinsic muscle wasting of the hands, unsteadiness during walking, nystagmus, loss of visual acuity, impaired sensation of the face, altered taste, presence of pathological reflexes (i.e. positive Hoffman's and/or Babinski reflexes).

7. Two or more positive neurologic signs consistent with nerve root compression, including any 2 of the following:

   1. Muscle weakness involving a major muscle group of the upper extremity.
   2. Diminished UE deep tendon reflex of the biceps, brachioradialis, triceps or superficial flexors
   3. Diminished or absent sensation to pinprick in any UE dermatome.

8. Prior surgery to neck of thoracic spine

9. Involvement in litigation or worker's compensation regarding their neck pain and/or headaches

10. PT or chiropractic care treatment for neck pain or headaches in the 3 months prior to baseline exam.

11. Any condition that might contraindicate spinal manipulative therapy.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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142 participants in 2 patient groups

Dry Needling,Thrust Manipulation

Experimental group

Treatment:

Other: Dry Needling,Thrust Manipulation

Exercise,Non-thrust Mobilization

Active Comparator group

Treatment:

Other: Exercise,Non-thrust Mobilization