A sonographic comparison of the effect of dry needling and ischemic compression on the active trigger point of the sternocleidomastoid muscle associated with cervicogenic headache: A randomized trial

J Back Musculoskelet Rehabil. 2020;33(5):749-759. doi: 10.3233/BMR-171077.


Background: Cervicogenic headache (CeH) is among the common types of headache which has an undesirable influence on the quality of life. The myofascial trigger point (MTrP) within the sternocleidomastoid (SCM) muscle is one of the most important causes of CeH.

Objective: The purpose of this study was to compare the effect of dry needling (DN) and ischemic compression (IC) on the headache symptoms as well as MTrP-related features in subjects with CeH originating from MTrPs of the SCM muscle using a sonographic method.

Methods: A total of 29 female subjects aged 35.34 ± 12.19 on average with a clinical diagnosis of CeH originating from MTrP in the SCM muscle were randomly divided into the DN, IC, and control groups. Both DN and IC groups received 4 treatment sessions. Headache intensity, duration, frequency, MTrP elastic modulus, MTrP area, and pressure pain threshold (PPT) were assessed 2 weeks before and after treatments.

Results: In both DN and IC groups, a significant improvement was found in the headache intensity, duration, frequency, PPT, and MTrP area (P< 0.05). No significant differences were observed between DN and IC (P> 0.05). Pearson correlation revealed a significant correlation between headache intensity and the MTrP elastic modulus (P< 0.05).

Conclusions: Both interventions could reduce headache symptoms, PPT, and MTrP area. Neither intervention was found to be superior to the other in short-term follow-up. IC may be preferred since it has fewer unwanted side effects compared to DN. Based on the data, it may be concluded that some MTrP biomechanical features such as stiffness may influence the produced headache symptoms.

Keywords: Cervicogenic headache; myofascial trigger point; physiotherapy; stiffness; ultrasonography.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Dry Needling*
  • Female
  • Headache
  • Humans
  • Middle Aged
  • Myofascial Pain Syndromes / therapy
  • Neck Muscles / diagnostic imaging*
  • Pain Measurement
  • Pain Threshold
  • Post-Traumatic Headache / diagnostic imaging
  • Post-Traumatic Headache / therapy*
  • Quality of Life
  • Trigger Points*
  • Ultrasonography
  • Young Adult