Effectiveness of Dry Needling of the Sternocleidomastoid in Patients With Cervicogenic Headaches

The purpose of this study is to determine whether individuals with cervicogenic headache
respond favorably to a program of manual therapy in combination with dry needling of the
major muscle between chest bone and the head (sternocleidomastoid muscle) compared to manual
therapy directed to the upper body quadrant alone.

The researchers will conduct a randomized clinical trial to assess the effectiveness of a
manual therapy and dry needling approach (group 1) vs. manual therapy only. (group 2)

Inclusion Criteria:

1. Age between 18-65 years old

2. Primary complaint of cervicogenic headache

3. Restricted cervical Range of motion

4. Neck Disability Index > 20 points

Exclusion Criteria:

1. Red flags identified during the patients physical therapy initial evaluation (i.e.
tumor, fracture, metabolic diseases, RA, osteoporosis, prolonged history of steroid
use, symptoms of vertebrobasilary insufficiency, pregnancy, cervical spinal stenosis,
bilateral upper extremity symptoms etc.

2. Use of blood thinners

3. History of whiplash injury within the past six weeks

4. Evidence of central nervous system 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, the presence of pathological reflexes (i.e. positive Hoffman's and/or Babinski
reflexes), etc.

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

1. Muscle weakness involving a major muscle group of the upper extremity

2. Diminished upper extremity muscle stretch reflex (biceps brachii,
brachioradialis, or triceps)

3. Diminished or absent sensation to pinprick in any upper extremity dermatome

6. Prior surgery to the neck or thoracic spine

7. Chiropractic, Physical Therapy, or Acupuncture treatment for their neck pain in the
last 6-months

8. Workers compensation or pending legal action regarding their headaches

9. Insufficient English language skills to complete all questionnaires

10. Inability to comply with treatment and follow-up schedule