Summary
Dr. Taves and Dr. Storsbach from The Headache Doctor podcast discuss how they use dry needling as an adjunct treatment for headache and migraine patients. They explain that dry needling involves inserting sterile monofilament needles into trigger points to relieve muscle tension, improve range of motion, and reduce pain. The technique emerged in the 1980s when researchers discovered that the needle itself, not the injected liquid, was responsible for pain relief. The doctors describe two main approaches: trigger point dry needling for patients with chronic muscle tension in the upper trapezius and levator scapula that refers pain to the head, and a desensitization protocol using 13 needle sites connected to electrical current for patients with generalized head and neck pain. They emphasize that dry needling is never a standalone treatment but works best alongside hands-on joint mobilization of C1 and C2 vertebrae. They also discuss safety considerations including the extremely low risk of pneumothorax, potential for mild soreness lasting 24-48 hours, and the importance of patient comfort since anxiety can counteract the treatment's benefits.
Key Points
- Dry needling originated in the 1980s when researchers found the needle itself, not injected solutions, provided pain relief
- Two main approaches: trigger point needling for muscle tension, and a 13-point desensitization protocol with electrical stimulation for sensitized patients
- Upper trapezius and levator scapula trigger points commonly refer pain into the head, making dry needling effective for tension headaches
- Suboccipital muscle tension can compress the occipital nerve, contributing to headaches and even visual aura symptoms
- Dry needling should never be used in isolation; it's most effective as an adjunct to hands-on joint mobilization of C1 and C2
- Electrical current through needles provides a dull vibration signal that can drown out sharper pain sensations via gate control mechanisms
- Approximately 50% of headache and migraine patients in their clinic receive dry needling as part of their treatment plan
- Potential side effects include 24-48 hours of soreness, rare bruising, and extremely rare pneumothorax risk
Key Moments
How dry needling got its name
The doctors explain that dry needling got its name because researchers originally tried injecting liquids like lidocaine into trigger points, but realized over time it was the needle itself causing the improvement, not the liquid.
"they tried always injecting a liquid, maybe lidocaine or some kind of solution into the trigger point to see if that would be helpful. But they actually realized over time it was the needle itself causing the improvement, not the liquid. So now it's called dry needling. Yeah. And so when we go through physical therapy school,"
Dry needling with electrical current for headache desensitization
Dr. Taves describes a 13-point needle protocol with electrical current for sensitized headache patients, where the dull vibration signal from the TENS unit drowns out sharper pain sensations through gate control mechanisms.
"There's actually like 13 different sites that I'll use. And I'll put the needles in these different sites that correspond to muscles and I'll hook it up to an electrical current. And what that current does is it allows the brain to get a different signal."
Suboccipital needling can improve headaches and visual aura
Needling the suboccipital region at the base of the skull can be effective for headache tension and may even improve visual aura symptoms by relieving compression on the occipital nerve.
"Because needles can be really effective in there and also, again, improve with headache, tension, and even sometimes that like aura visual stuff can be coming from those really tight muscles compressing on the occipital nerve back there. And so I think that can even improve with this type of treatment."
About half of headache patients receive dry needling
Dry needling is used with roughly 50% of headache and migraine patients as an adjunct treatment, but it's never standalone. The foundation of headache treatment remains hands-on joint mobilization of C1 and C2 vertebrae.
"Dry needling is, yeah, it's going to be an adjunct. It's going to be something that we can add into a patient's plan of care because one, maybe they have an increased amount of tension or tone through like their upper traps or their levator scapula."
