Dry Needling Versus Dry Cupping on Pain and Disability in Cervicogenic Headache Patients
NCT ID: NCT06689371
Last Updated: 2024-11-14
Study Results
Results pending
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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Recruitment Status
NOT_YET_RECRUITING
Clinical Phase
NA
Total Enrollment
45 participants
Study Classification
INTERVENTIONAL
Study Start Date
2024-11-13
Study Completion Date
2025-02-01
Brief Summary
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This study aims to compare the added effects of dry needling and dry cupping to conventional physical therapy on headache pain intensity, headache frequency, headache duration, upper cervical range of motion, and disability levels in patients with cervicogenic headache.
It will be assumed that:
* All patients will follow all the given instructions strictly during the study duration, regarding the assessment and the treatment procedure.
* All participants will be evaluated under the same environmental conditions.
It will be assumed that:
* All patients will follow all the given instructions strictly during the study duration, regarding the assessment and the treatment procedure.
* All participants will be evaluated under the same environmental conditions.
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Detailed Description
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Neck pain is a highly popular musculoskeletal complain and the second most common musculoskeletal condition affecting people in their adolescence after low back pain. It is a common condition affecting general populations with high economic burden for neck pain including raised treatment costs, reduced productivity, and job-related problems. Headache is one of the most common disorders associated with neck pain with a potential for major disability.
Migraine, tension-type headache (TTH), and cervicogenic headache (CGH) are common types of headaches that negatively affect the quality of life, work activities, and family life. It has a direct or indirect economic burden on society.
Cervicogenic headache (CH) is a secondary headache caused by a disorder of the cervical spine and its disc or bony and/or periarticular components. In this type, pain originates from the back of neck and radiates towards the front of the head and eye on the same side. CGH can last from a few hours to days. The prevalence rate of CGH was estimated to be from 0.4% to 2.5% in the adult population and appears to affect women more than men.
The physiological mechanism of pain in CGH headache is the convergence of upper cervical spinal nerves (C1, C2, and C3) afferents and trigeminal afferents in the trigeminocervical nucleus caudalis. This convergence allows the bidirectional referral of painful sensations between the neck and trigeminal sensory receptive fields of the face and head.
Another cause of CGH is myofascial trigger points in the muscles. These trigger points, which are innervated by C1 to C3 (specifically in the suboccipital, semispinalis capitis, splenius cervices, trapezius, and sternocleidomastoid), can cause referral pain in various parts of the head.
Systematic review concluded that patients with CGH have significantly decreased cervical ROM and muscle function. Those patients have deep neck flexor weakness and tightness of the Sternocleidomastoid (SCM), trapezius and other muscles in the scapular region.
Management of CGH can involve a wide variety of therapeutic techniques, including medication, anesthetic and corticosteroid blocks, pulsed radiofrequency, cognitive therapy, relaxation therapy and physical therapy. Physical therapy interventions are recommended as nonpharmacological approaches for the treatment of CGH patients. These interventions include spinal manipulation, mobilization, manual therapy, dry needling, and therapeutic exercise.
Dry needling (DN) is an intervention method commonly used by physiotherapists for treatment of muscle pain associated with Trigger points (TrPsA). Acupuncture needles are placed directly into Muscle Trigger points (MTrPs) during this minimally invasive treatment. The benefits of DN include immediate relief in local, referred, and widespread pain and a restoration of range of motion and muscle activation patterns.
A previous study reported that the DN into the MTrPs of the suboccipital and upper trapezius muscles decreased headache index (HI), MTrP tenderness, increased functional rating index, and the range of motions in patients with CGH.
Cupping therapy (CT) is a physical traditional Chinese medicine (TCM) practiced by ancient Chinese, Egyptians, and Greeks and currently used by therapists and acupuncturists in the treatment of a wide range of medical conditions and played a vital role in human health. This alternative therapy involves creating a vacuum inside a cup positioned over the surface of the skin, using the local negative pressure to improve blood flow.
It has been used to treat various medical conditions, such as musculoskeletal injuries, dermatologic conditions, and chemical imbalances within the body. The most common use is reducing musculoskeletal or myofascial pain. It has been used to treat fibromyalgia, rheumatoid arthritis, neck and shoulder pain, and low back pain.
Cupping produces localized hyperemia to the applied area, The dilation of capillaries improves microcirculation which decreases muscle tone and promotes healing via metabolic changes.
Cupping therapy was the most preferred treatment method after herbal treatments in headache patients. Acupuncture and wet cupping method has a beneficial effect on pain intensity and cervical ROM in cervical headache patients when compared to shame acupuncture.
Moreover, a systematic review concluded that the evidence for dry needling and cupping is not greater than placebo in treatment of myofascial pain.
There is no study compare between effect of dry needling and dry cupping on cervicogenic headache patients.
Therefore, this study aims to compare between the effect of dry needling versus dry cupping on pain, Range of Motion (ROM) and level of disabilities in patients of cervicogenic headache.
Migraine, tension-type headache (TTH), and cervicogenic headache (CGH) are common types of headaches that negatively affect the quality of life, work activities, and family life. It has a direct or indirect economic burden on society.
Cervicogenic headache (CH) is a secondary headache caused by a disorder of the cervical spine and its disc or bony and/or periarticular components. In this type, pain originates from the back of neck and radiates towards the front of the head and eye on the same side. CGH can last from a few hours to days. The prevalence rate of CGH was estimated to be from 0.4% to 2.5% in the adult population and appears to affect women more than men.
The physiological mechanism of pain in CGH headache is the convergence of upper cervical spinal nerves (C1, C2, and C3) afferents and trigeminal afferents in the trigeminocervical nucleus caudalis. This convergence allows the bidirectional referral of painful sensations between the neck and trigeminal sensory receptive fields of the face and head.
Another cause of CGH is myofascial trigger points in the muscles. These trigger points, which are innervated by C1 to C3 (specifically in the suboccipital, semispinalis capitis, splenius cervices, trapezius, and sternocleidomastoid), can cause referral pain in various parts of the head.
Systematic review concluded that patients with CGH have significantly decreased cervical ROM and muscle function. Those patients have deep neck flexor weakness and tightness of the Sternocleidomastoid (SCM), trapezius and other muscles in the scapular region.
Management of CGH can involve a wide variety of therapeutic techniques, including medication, anesthetic and corticosteroid blocks, pulsed radiofrequency, cognitive therapy, relaxation therapy and physical therapy. Physical therapy interventions are recommended as nonpharmacological approaches for the treatment of CGH patients. These interventions include spinal manipulation, mobilization, manual therapy, dry needling, and therapeutic exercise.
Dry needling (DN) is an intervention method commonly used by physiotherapists for treatment of muscle pain associated with Trigger points (TrPsA). Acupuncture needles are placed directly into Muscle Trigger points (MTrPs) during this minimally invasive treatment. The benefits of DN include immediate relief in local, referred, and widespread pain and a restoration of range of motion and muscle activation patterns.
A previous study reported that the DN into the MTrPs of the suboccipital and upper trapezius muscles decreased headache index (HI), MTrP tenderness, increased functional rating index, and the range of motions in patients with CGH.
Cupping therapy (CT) is a physical traditional Chinese medicine (TCM) practiced by ancient Chinese, Egyptians, and Greeks and currently used by therapists and acupuncturists in the treatment of a wide range of medical conditions and played a vital role in human health. This alternative therapy involves creating a vacuum inside a cup positioned over the surface of the skin, using the local negative pressure to improve blood flow.
It has been used to treat various medical conditions, such as musculoskeletal injuries, dermatologic conditions, and chemical imbalances within the body. The most common use is reducing musculoskeletal or myofascial pain. It has been used to treat fibromyalgia, rheumatoid arthritis, neck and shoulder pain, and low back pain.
Cupping produces localized hyperemia to the applied area, The dilation of capillaries improves microcirculation which decreases muscle tone and promotes healing via metabolic changes.
Cupping therapy was the most preferred treatment method after herbal treatments in headache patients. Acupuncture and wet cupping method has a beneficial effect on pain intensity and cervical ROM in cervical headache patients when compared to shame acupuncture.
Moreover, a systematic review concluded that the evidence for dry needling and cupping is not greater than placebo in treatment of myofascial pain.
There is no study compare between effect of dry needling and dry cupping on cervicogenic headache patients.
Therefore, this study aims to compare between the effect of dry needling versus dry cupping on pain, Range of Motion (ROM) and level of disabilities in patients of cervicogenic headache.
Conditions
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Dry Needling
Dry Cupping
Cervicogenic Headache
Study Design
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Allocation Method
RANDOMIZED
Intervention Model
PARALLEL
Primary Study Purpose
TREATMENT
Blinding Strategy
DOUBLE
Participants
Investigators
Study Groups
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Group A (Dry needling): The 15 patients will receive three dry needling sessions per week for four
Group Type
EXPERIMENTAL
Group A (Dry Needling)
Intervention Type
OTHER
The patient will receive dry needling on suboccipital, upper trapezius and SCM muscles with conventional therapy 3 sessions per week for 4 weeks.
Group B (Dry cupping): The 15 patients will receive three dry cupping sessions per week for four we
Group Type
EXPERIMENTAL
Group B (Dry cupping)
Intervention Type
OTHER
Patients will receive dry cupping on suboccipital, upper trapezius and SCM muscles weeks with conventional therapy 3 sessions per week for 4 weeks.
Group C (control): The 15 patients will receive standard exercise three sessions per week for four w
Group Type
ACTIVE_COMPARATOR
Group C (control)
Intervention Type
OTHER
will receive standard exercise three sessions per week for four weeks. This standard regimen consists of the same exercises as group A and B.
Interventions
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Group A (Dry Needling)
The patient will receive dry needling on suboccipital, upper trapezius and SCM muscles with conventional therapy 3 sessions per week for 4 weeks.
Intervention Type
OTHER
Group B (Dry cupping)
Patients will receive dry cupping on suboccipital, upper trapezius and SCM muscles weeks with conventional therapy 3 sessions per week for 4 weeks.
Intervention Type
OTHER
Group C (control)
will receive standard exercise three sessions per week for four weeks. This standard regimen consists of the same exercises as group A and B.
Intervention Type
OTHER
Eligibility Criteria
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Inclusion Criteria
* The patients will be included in our study if they meet the following criteria:
* Age between 25-45 years old for both genders.
* No physiotherapy intervention for the last three months.
* Intermittent headaches of varying duration and pain level at the rate of one headache per week for greater than 2 months.
* Ipsilateral neck, shoulder, or arm pain.
* Provocation of usual head pain by neck movement, sustained awkward neck positions or external pressure over the upper cervical or occipital region on the symptomatic side.
* Limited neck ROM \> 10 degrees confirmed by a positive Flexion Rotation Test.
* Active trigger points (TrPs) within the suboccipital, upper trapezius or sternocleidomastoid muscles.
The diagnosis of active TrPs will be based on the major criteria proposed by):
* Presence of a palpable taut band in a skeletal muscle
* presence of a hypersensitive point in the taut band
* local twitch response elicited by the snapping palpation of the taut band
* reproduction of the referred pain in response to compression
* patient recognition of the referred pain as a familiar symptom
* Age between 25-45 years old for both genders.
* No physiotherapy intervention for the last three months.
* Intermittent headaches of varying duration and pain level at the rate of one headache per week for greater than 2 months.
* Ipsilateral neck, shoulder, or arm pain.
* Provocation of usual head pain by neck movement, sustained awkward neck positions or external pressure over the upper cervical or occipital region on the symptomatic side.
* Limited neck ROM \> 10 degrees confirmed by a positive Flexion Rotation Test.
* Active trigger points (TrPs) within the suboccipital, upper trapezius or sternocleidomastoid muscles.
The diagnosis of active TrPs will be based on the major criteria proposed by):
* Presence of a palpable taut band in a skeletal muscle
* presence of a hypersensitive point in the taut band
* local twitch response elicited by the snapping palpation of the taut band
* reproduction of the referred pain in response to compression
* patient recognition of the referred pain as a familiar symptom
Exclusion Criteria
* The patients will be excluded if they have:
* Cervical radiculopathy.
* History of neck, shoulder trauma or surgery.
* Physical therapy intervention in the neck and shoulder region in the previous 3 months.
* Vertebrobasilar insufficiency or vestibular dysfunctions.
* Evidence of cognitive deficits.
* Presence of any needle contraindication.
* Presence of any cupping contraindication.
* Cervical radiculopathy.
* History of neck, shoulder trauma or surgery.
* Physical therapy intervention in the neck and shoulder region in the previous 3 months.
* Vertebrobasilar insufficiency or vestibular dysfunctions.
* Evidence of cognitive deficits.
* Presence of any needle contraindication.
* Presence of any cupping contraindication.
Minimum Eligible Age
25 Years
Maximum Eligible Age
45 Years
Eligible Sex
ALL
Accepts Healthy Volunteers
Yes
Sponsors
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Cairo University
OTHER
Sponsor Role
lead
Responsible Party
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Mariam Samara Elsaeed Shahen
Demonstrater
Responsibility Role
PRINCIPAL_INVESTIGATOR
Central Contacts
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References
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Reference Type
BACKGROUND
Young IA PT, DSc, Dunning J PT, DPT, Butts R PT, PhD, Mourad F PT, DPT, Cleland JA PT, PhD. Reliability, construct validity, and responsiveness of the neck disability index and numeric pain rating scale in patients with mechanical neck pain without upper extremity symptoms. Physiother Theory Pract. 2019 Dec;35(12):1328-1335. doi: 10.1080/09593985.2018.1471763. Epub 2018 Jun 1.
Reference Type
BACKGROUND
Ziaeifar M, Arab AM, Karimi N, Nourbakhsh MR. The effect of dry needling on pain, pressure pain threshold and disability in patients with a myofascial trigger point in the upper trapezius muscle. J Bodyw Mov Ther. 2014 Apr;18(2):298-305. doi: 10.1016/j.jbmt.2013.11.004. Epub 2013 Nov 9.
Reference Type
BACKGROUND
Other Identifiers
Review additional registry numbers or institutional identifiers associated with this trial.
R.T.REC/012/005277
Identifier Type: -
Identifier Source: org_study_id
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