Dry Needling for Tension-Type Headache: A Scoping Review on Intervention Procedures, Muscle Targets, and Outcomes

This scoping review analyzed seven studies involving 309 participants to examine the characteristics and methodologies of dry needling in the treatment of tension-type headache (TTH). TTH is the most prevalent form of primary headache, affecting between 26% and 38% of the global population, manifesting as bilateral, diffuse pain of mild to moderate intensity in the head or neck. Although its etiology is not completely understood, evidence suggests an association with myofascial trigger points (MTrPs) in cervical and facial muscles. Dry needling has emerged as an effective and safe non-pharmacological therapeutic option for pain relief, involving the insertion of solid filiform needles into the skin to target MTrPs, aiming to disrupt dysfunctional motor endplates and alleviate neuromusculoskeletal pain.

The methodology followed the Arksey and O'Malley framework, using PubMed, Embase, Scopus, and Web of Science databases. Inclusion criteria considered studies that evaluated dry needling interventions in adults with TTH, reporting target muscles, diagnostic criteria, and technical characteristics. Of the included studies, five were randomized clinical trials and two were case reports, demonstrating a solid methodological level with appropriate randomization procedures and well-implemented blinding strategies. The most frequently treated muscles were the temporalis and the trapezius, corroborating previous findings about their relevance in the occurrence of MTrPs related to TTH.

Identification of MTrPs was performed primarily through manual palpation, although diagnostic criteria varied. Some studies used algometers for precise digital palpation (1.5 kg pressure), while others employed flat or pincer palpation. Dry needling interventions differed in technique, with some authors describing the use of alcohol for skin disinfection before puncture. Needle dimensions varied from 0.2 to 0.3 mm in gauge and 0.13 to 0.5 mm in length.

Patient positioning during the intervention varied from supine to prone or seated. The applied techniques were based on the methodology described by Travell and Simons, with some studies emphasizing the optimal needle insertion angle and others describing various techniques based on the specific muscle being treated. The mean number of treatment sessions was three, ranging from one to five sessions. All studies indicated favorable results from dry needling interventions, with improvements in headache symptoms observed in all cases.

One study specifically reported that dry needling was effective not only in reducing the frequency, intensity, and duration of headaches but also in improving health-related quality of life. None of the studies reported significant adverse effects, suggesting that the technique is safe. However, heterogeneity in protocols and diagnostic criteria limits the comparability of the results. The analysis revealed a clear trend in the selection of the temporalis and trapezius muscles, validating the focus adopted in most analyzed studies.

However, wide diversity was observed in the approach to other muscles involved, reflecting different existing theories and methodologies. Limitations of the study include the small number of included studies, significant methodological heterogeneity, lack of comprehensive reporting of key details in many studies, and the diagnostic process for MTrP identification being largely subjective and lacking standardization. The evidence supports the use of dry needling in key muscles such as the temporalis and trapezius for TTH management, although the diversity in methodologies and diagnostic criteria highlights the need for standardization.