Chiropractic spinal manipulative therapy versus myofascial dry needling of the sternocleidomastoid muscle and a combination thereof on cervicogenic headaches

M.Tech.OBJECTIVE: An association between cervicogenic headache, cervical joint dysfunction and the presence of myofascial trigger points in the sternocleidomastoid muscle exists. This study is aimed at determining the most effective Chiropractic treatment protocol in the management of cervicogenic headache by comparing the objective and subjective measurements gained in delivering Chiropractic spinal manipulative therapy to the upper cervical spine, myofascial dry needling therapy to myofascial trigger points in the sternocleidomastoid muscle and/or a combination of both therapies. DESIGN: Forty-eight participants suffering from cervicogenic headache were allocated into one of three groups of equal male to female ratio. Each patient was examined and cleared for participation in a clinical trial in which Diversified Chiropractic techniques and/or myofascial dry needling therapy were delivered. Group 1 received Chiropractic spinal manipulative therapy to the upper cervical spine. Group 2 received myofascial dry needling therapy to myofascial trigger points in the sternocleidomastoid muscle. Group 3 received a combination of the mentioned therapies. DURATION AND MEASUREMENTS: Participants were consulted seven times in a four week period. They were treated twice per week for three weeks and a final, follow-up assessment was performed at the start of the fourth week. Subjective and objective measurements were taken and recorded on the first, fourth and seventh consultations. Subjective measurements were taken via the Vernon-Mior Neck Pain and Disability Questionnaire, Triple Visual Analogue Scale and the Headache Disability Index. Objective measurements included cervical spine ranges of motion which were measured using the Cervical Range of Motion Instrument (CROM). The data was statistically analysed using the Shapiro-Wilk, Kruskal-Wallis, Mann-Whitney, Friedman and Wilcoxon Signed Ranks tests. RESULTS: Clinically and statistically significant improvements in all three groups were noted over the course of the study, with regards to perception of pain, disability and cervical spine range of motion. Statistically significant changes in ranges of motion were demonstrated in Group 1 for flexion, extension, lateral flexion (right and left) and right rotation; in Group 2 for right lateral flexion and left rotation and in Group 3 for all cervical ranges of motion. The comparison between the groups (intergroup analysis) showed no statistically significant changes except for right lateral flexion at the first consultation (pre-treatment). CONCLUSION: The results show that Chiropractic spinal manipulative therapy and dry needling are both effective treatment protocols in decreasing pain and dysfunction and increasing cervical range of motion in patients suffering from cervicogenic headache. This was demonstrated clinically, and to a lesser degree, statistically. The results carry a possible suggestion that although the different treatment options are effective individually, no treatment option proves to be statistically superior