The effects of treating myofascial trigger points of neck using the techniques of dry needling and soft tissue release on the clinical feature of patients with migraine headache
The effects of treating myofascial trigger points of neck using the techniques of dry needling and soft tissue release on the clinical feature of patients with migraine headache
Design
n this study, 60 migraine patients with entry requirements who are referred to the Neurology Clinic of Shiraz Medical Sciences Hospital are selected. The participants are randomly divided into three groups of control, needle and soft tissue release.
Settings and conduct
Migraine patients who come to the neurology clinic of Shiraz Medical Sciences Hospital are evaluated for the presence of trigger points in upper trapezius , suboccipital, and sternocleidomastoid muscles . The presence of trigger points is confirmed if there is a touch sensitive point in the muscles that causes the referral pain to be touched and also triggers a jump sign in the individual. In the presence of trigger points in suboccipital muscles, upper trapezius and sternocleidomastoid muscles, volunteers are included in the study and are assigned to three groups of control, dry needle and soft tissue release, based on simple block random allocation method. Blind study is done in the following cases:
The two-blind study will be conducted in such a way that people are assigned to groups and patients are evaluated by people who are unaware of the patient grouping status. Treatment is provided by a specialist physiotherapist and evaluated by a collaborator.
Participants/Inclusion and exclusion criteria
Inclusion:1. A neurologist selects the study subjects based on IHS criteria for diagnosis of migraine.
2.The patients with migraine are examined to find any active trigger points in UT, SCM, sub-occipital muscles
3.The flexion–rotation test
Exclusion:1.a history of cervical disc herniation, unusual migraine
2.subjects who are pregnant or breastfeeding and those who having TRP therapy within the past month before the study.
3.The patients, who underwent DN, have no contraindication for needling such as local infection, pregnancy with threatened abortion, taking anticoagulants
Intervention groups
Dry needling group(DN):
Dry needle technique is used on the trigger point (TRP) in the UT, SCM and suboccipital muscles.
The needle is applied for three sessions at intervals of 48 hours between sessions. It should be noted that the needle cuff hits the trigger point of one of the following: creating a localized twitch response or creating a sense of distribution .
Soft Tissue Release (STR) group:
The treatment protocol for the STR included 5 steps.
1. Unilateral lateral stretch
2. Bilateral-lateral stretch
3. Long axis longitudinal stretch
4. Suboccipital muscle deep pressure
5. Separation origin and insertion
Patients in the STR group receive each technique with repeated 5 times, hold 20 seconds, once a day for 6 days according in 2 weeks.
Control group:
Patients don’t receive any intervention in this group. Measurement of variables is done at the beginning of the entry to the study and similar to the two intervention groups, measurements of variables are performed in the second evaluation session. Of course, to consider ethical issues after the end of the plan, treatment is done in patients.
Main outcome variables
1. Pain intensity
2. Pressure pain threshold
3.Muscle thickness
4.Disability Index
5.Cervical range of motions measurement
6-Headache parameters
General information
Reason for update
Acronym
DNSTR
IRCT registration information
IRCT registration number:IRCT20171219037956N1
Registration date:2018-02-11, 1396/11/22
Registration timing:retrospective
Last update:2018-02-11, 1396/11/22
Update count:1
Registration date
2018-02-11, 1396/11/22
Registrant information
Name
tahere rezaeian
Name of organization / entity
Country
Iran (Islamic Republic of)
Phone
+98 21 2218 0039
Email address
ta.rezaeian@uswr.ac.ir
Recruitment status
Recruitment complete
Funding source
Expected recruitment start date
2017-09-23, 1396/07/01
Expected recruitment end date
2018-01-21, 1396/11/01
Actual recruitment start date
empty
Actual recruitment end date
empty
Trial completion date
empty
Scientific title
The effects of treating myofascial trigger points of neck using the techniques of dry needling and soft tissue release on the clinical feature of patients with migraine headache
Public title
Effects of dry needling and soft tissue release in treatment of migraine patients
Purpose
Treatment
Inclusion/Exclusion criteria
Inclusion criteria:
1. A neurologist selected the study subjects based on IHS criteria for diagnosis of migraine.
2. The patients in this study were between the ages of 25 and 55 years old
The patients with migraine were examined to find any active trigger points in UT, SCM, sub-occipital muscles . The presence of active trigger points was confirmed if “1- There was an area of focal muscle tenderness that was activated by palpation and that, when activated, referred pain replicating the patient’s headache complaint. 2- There was a jump sign that was the characteristic behavioral response to pressure on a trigger point” .
One diagnostic test in particular, the flexion–rotation test, is said to determine C1-2 dysfunction .Patient was supine position. With the subject relaxed and the cervical spine is fully flexed with the occiput resting against the examiners. The head is then rotated to the left and the right. If firm resistance is percieved, pain provoked and range is limited before the expected end range .The normal range is reported at 44-45 degrees, therefore, the test is positive when the range of motion is more than 10 degrees from the normal range.Studies have shown that migraine has a small effect on the range of motion during this test, but this test shows the presence or absence of cervicogenic headache and this test can use for Differential Diagnosis between migraine headache and cervicogenic headache.The positive test indicates a cervicogenic headache
Exclusion criteria:
history of cervical disc herniation, unusual migraine, heart failure, pulmonary failure, kidney failure, liver failure, circulation failure, diabetes mellitus
patients who were using opioid prophylaxis, anti -depressant, anti-anxiety drugs
subjects who were pregnant or breastfeeding and
Those who having trigger point therapy within the past month before the study
The patients, who underwent DN, had no contraindication for needling such as local infection, pregnancy with threatened abortion, taking anticoagulants
Age
From 25 years old to 55 years old
Gender
Both
Phase
2-3
Groups that have been masked
Participant
Care provider
Investigator
Outcome assessor
Sample size
Target sample size:
60
More than 1 sample in each individual
Number of samples in each individual:
20
20 subjects per group
Randomization (investigator's opinion)
Randomized
Randomization description
Block Randomization
Blinding (investigator's opinion)
Double blinded
Blinding description
Double-blind study will be done,in this way, the allocation of people to the groups and the assessment of patients are done by people who are unaware of the status of the grouping of patients.Treatment is provided by a specialist physiotherapist and evaluated by a collaborator.
Placebo
Not used
Assignment
Parallel
Other design features
Secondary Ids
empty
Ethics committees
1
Ethics committee
Name of ethics committee
Ethics Committee of the University of Social Welfare and Rehabilitation Sciences