A Safe and Holistic Treatment for Cervicogenic Headaches: Perineural Electric Dry Needling combined with Spinal Manipulation

Cervicogenic headaches, a type of headache originating from the neck, can significantly impact one’s quality of life. For those seeking effective relief, a combination of perineural electric dry needling and spinal manipulation is a potent, promising, and lasting approach. This was recently demonstrated in a large scale randomized controlled trial observing the effects of this approach on pain, disability, and headache frequency, duration, and intensity. In this blog, we’ll delve into the key concepts behind these therapies and explore how their integration can provide comprehensive treatment for cervicogenic headaches.

Understanding Cervicogenic Headaches:

Cervicogenic headaches are characterized by various issues within the neck region (which you may or may not be aware of) that can cause pain in the head and neck and radiate to other regions of the scalp, jaw, ear, eye, or forehead. Cervicogenic headaches can seem complex due to the nerve pathways that are involved. Common origin of these issues may include anything from a past whiplash or concussion event, to prolonged postures such as desk and computer work. These circumstances can negatively impact the oxygenation and mobility of various structures within the head and neck including joint structures, ligaments, muscles and tendons, nerves, and fascia. Traditional treatments often include medication, conventional physical therapy, and lifestyle modifications. However, the promise of a combination of perineural electric dry needling and spinal manipulation introduces a holistic and targeted strategy for addressing the root causes of these headaches with less risk than taking an over the counter pain medication. 

Perineural Electric Dry Needling:

Perineural electric dry needling is a technique that involves the insertion of thin needles at specific points of an affected area (usually an area that was previously strained or injured, such as from a car accident years ago). Depending on the condition or diagnosis, there are established semi-standardized protocols which are recommended for faster and more complete healing. Each protocol typically involves needles to be left in place and gently stimulated by a specific electric setting known to reduce pain and inflammation and promote blood flow. Unlike the more common type of dry needling (trigger point), evidence-based needling is a is designed to obtain the full therapeutic effects with a fraction of the discomfort and soreness. Evidence-based perineural needling is known to modulate pain signals, promote the release of endorphins, and significantly improve blood flow to the area for up to several days following treatment. In the context of cervicogenic headaches, perineural electric dry needling aims to help re-structure and re-vascularize (form new blood vessels) in previously injured or strained tissues, reduce pain and tension, alleviate nerve irritation, and normalize the pH level in the affected region.

Spinal Manipulation:

Spinal manipulation, often performed by osteopractors, involves the precise application of a low amplitude force (low amplitude = minimal amount of motion) at a high speed addressing pathological fixations of the joints and tissues of the spine. These techniques should be very comfortable for patients. Based on recent large-scale studies, specific techniques that bias the upper neck joints as well as the upper back joints seem to be the most valuable targets when treating migraines and cervicogenic headaches. This manual therapy is designed to inhibit abnormal pain signaling, reduce reflexive spasming, and – like the evidence-based needling, stimulate the release of endogenous opioids. 

The Synergy of Combined Treatment:

When perineural electric dry needling and spinal manipulation are used together, they create a synergistic effect that addresses multiple aspects of cervicogenic headaches. Perineural electric dry needling stimulates problematic tissue to return to a normal state (homeostasis) by stimulating blood flow and new cell formation and alleviating muscle tension and nerve irritation. Spinal manipulation, in turn, can enhance the effectiveness of perineural electric dry needling by optimizing joint mobility and alignment.

Patient Experience and Safety:

It’s crucial to note that these therapies are generally well-tolerated, with a lower risk for adverse effects than even taking an over-the-counter such as ibuprofen. The combination of various types of treatment are tailored to each patient’s specific needs. Patients often report reduced pain, headache frequency, intensity, and duration after undergoing this integrated approach within a consistent plan of care. As with any medical intervention, it’s essential to consult with a qualified healthcare professional, such as a physical therapist specialized in the treatment of headaches, or an osteopractor, to determine the most suitable treatment plan for each individual. 


The combination of perineural electric dry needling and spinal manipulation offers a promising avenue for individuals seeking relief from cervicogenic headaches. By addressing factors such as blood flow, inflammation, and the state of various joints and tissues, this holistic approach aims to restore balance to the craniocervical region, providing a comprehensive solution for those who experience the gripping pain of cervicogenic headaches. If you suffer from cervicogenic headaches, consider discussing these treatment options with your healthcare provider to determine if this integrated approach is right for you.

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