Effect of Dry Needling of the M. Obliquus Capitis Inferior on Rotational Mobility and Headache Related Outcome Measures in Patients With Cervicogenic Headache: a Randomized, Controlled Experimental Study
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 入组人数
- 60
- 试验地点
- 2
- 主要终点
- Changes in Atlanto-axial rotational mobility after dry needling or sham needling assessed by the flexion-rotation test.
研究概览
简要总结
An experimental study will be conducted to evaluate the effect of dry needling on the M. Obliquus capitis inferior on rotational mobility and headache realted outcome measures in patients with cervicogenic headache.
详细描述
Headache is a common and disabling condition. Several primary and secondary headache forms have been described, such as migraine, tension-type headache and cervicogenic headache (CH). In patients with CH; we can see a reffered pain pattern to the head, possibly originating from a source in the (upper)cervical spine. It has been described that nociceptive input, originating from the C1-C3 nervous system may be responsible for pain referal to head and neck regions. Recently, the flexion-rotation test (FRT) has been described as one of the most usefel clinical tests in the clinical testing and research of CH. Other literature showed that the rotational movement during the FRT was diminished in patients with CH and these results were correlated to headache intensity. 5,6
To treat this disabling condition, manual therapy is already known to be an effective treatment strategy. However, the additional value of dry needling is still to be discussed. Since the M. Obliquus capitis inferior (M. OCI) finds its origin on the apex of the spinous processus of C2 and inserts on transverse processus of the atlas (C1); this muscle might be anatomically very relevant to influence rotational mobility in the upper cervical spine. Additionally, this muscle is responsible for proprioception and accurate positioning of the head and neck, due to the presence of a large amount of Golgi bodies and muscle spindles in the muscle. Considering the myofascial pain referal pattern of the M. OCI, a referred pain pattern to the temporal region may be present when active triggerpoints are present.
Previous research already showed some preliminary evidence for positive treatment effects by dry needling of the M. OCI in patients with cervicogenic dizziness and headache.
The goal of this study is to evaluate the effect of a single dry needling intervention of the M. OCI on rotational mobility and headache related parameters, in a group of cervicogenic headache patients with a positive flexion-rotation test (articular mobility test on level C1-C2).
In this experimental study, 40 patients with cervicogenic headache will be recruited. Participants are required to have complaints for at least 3 months. Participants are included based on online questionnaires, a clinical examination of neck and shoulder, and the identification of a MTrP in the M. OCI muscle. All participants will receive information and have to sign an informed consent form.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Double (Participant, Outcomes Assessor)
入排标准
- 年龄范围
- 18 Years 至 65 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Diagnosis of cervicogenic headache according to the ICHD-3 criteria:
- •A. Any headache fulfilling criterion C B. Clinical and/or imaging evidence1 of a disorder or lesion within the cervical spine or soft tissues of the neck, known to be able to cause headache2
- •C. Evidence of causation demonstrated by at least two of the following:
- •headache has developed in temporal relation to the onset of the cervical disorder or appearance of the lesion
- •headache has significantly improved or resolved in parallel with improvement in or resolution of the cervical disorder or lesion
- •cervical range of motion is reduced, and headache is made significantly worse by provocative manœuvres
- •headache is abolished following diagnostic blockade of a cervical structure or its nerve supply D. Not better accounted for by another ICHD-3 diagnosis3;4;
- •Age: 18-65 years
- •Headache for at least 1 day/week for at least 3 months
- •Limited mobility of the neck
- •Positive flexion-rotation test (<32 degrees on the left/right side or a difference of 10 degrees or more between left and right side)
- •NRS > 3/10
排除标准
- •Primary headache forms: migraine, TTH
- •Other secondary headaches that do not comply with the ICDH-3 criteria for CH
- •Whiplash or other traumatic incident in the past
- •Pregnancy or given birth in the last year
- •Previous head, neck or shoulder surgery
- •Cervical radiculopathy complaints
- •Fear of needles
- •Receiving other treatments for headache or neck pain (physical therapy/ostheopathy/chiropraxie...) in the previous month
- •All possible contra-indications for dry needling (taking anti-coagulantia; infectional diseases; skin abnormalties in the head/neck-region; epilepsia; allergies for latex, nickel...)
结局指标
主要结局
Changes in Atlanto-axial rotational mobility after dry needling or sham needling assessed by the flexion-rotation test.
时间窗: Baseline, Immediately after needling (DN or SN), immediately after manual therapy, 1 week after the needling intervention.
Changes in Atlanto-axial rotational mobility after dry needling or sham needling will be assessed by the flexion-rotation test at baseline, immediately after needling (DN or SN); immediately after manual therapy and 1 week after treatment. Measurements will be registered with the digital EasyAngle Goniometer (Meloq). The change in Atlanto-axial rotational mobility after dry needling will be compared with the change Atlanto-axial rotational mobility after sham needling. Atlanto-axial rotational mobility be expressed in degrees.
次要结局
- Changes in headache pain intensity(Baseline, immediately after the intervention (needling + manual therapy), 1 week after the needling intervention.)
- Motor control of the cervical spine (craniocervical flexion test)(Baseline, immediately after the intervention (needling + manual therapy), 1 week after the needling intervention.)
- Psychosocial headache related parameters: central sensitization, pain catastrophizing, pain coping and pain related fear.(Baseline, immediately after the intervention (needling + manual therapy), 1 week after the needling intervention.)
- Changes in headache related disability(Baseline, immediately after the intervention (needling + manual therapy), 1 week after the needling intervention.)
- Changes in Global Perceived Effect(immediately after the intervention (needling + manual therapy), 1 week after the needling intervention.)
- Changes in neck related disability(Baseline, immediately after the intervention (needling + manual therapy), 1 week after the needling intervention.)
- Changes in global cervical mobility after dry needling or sham needling.(Baseline, immediately after the intervention (needling + manual therapy), 1 week after the needling intervention.)
- Change in Pain Pressure Thresholds (PPTs)(Baseline, immediately after the intervention (needling + manual therapy), 1 week after the needling intervention.)
- Changes in headache impact.(Baseline, immediately after the intervention (needling + manual therapy), 1 week after the needling intervention.)
- Changes in joint position error(Baseline, immediately after the intervention (needling + manual therapy), 1 week after the needling intervention.)