Headaches make you cranky. Like my wife Angela gets when I ask her if she wants to see my muscles… This is not good. They also disrupt autonomic nervous system homeostasis, typically elevating the sympathetic autonomic nervous system, which reciprocally inhibits the parasympathetic autonomic nervous system. Chronic sympathetic hyperactivity is almost always involved with any type of headache, including migraine and tension headaches, two of the most common. Overall, the pivotal aspect in resolving headache symptoms is achieving improved autonomic nervous system homeostasis. This is most easily accomplished by removing as much pathologic tissue throughout the body as possible, all of which stimulates sympathetic activity, while concomitantly targeting the parasympathetic autonomic nervous system with low frequency electrical dry needling (Low frequency = 1-5 Hz. I like 1 Hz, as it is closest to typical heartbeat).

Now, many practitioners who specialize in headaches and temporomandibular (TMJ) dysfunction, for example, only treat the shoulders and up. This is a gigantic mistake. This is like assuming you can treat the arms and hands without understanding how to assess the cervical spine or the rest of the body. The mind and body function as a single unit. The entire mind and entire body. Everything, and I mean everything, is intricately interconnected. It is irrational to believe that just because a certain part of the body hurts, like the head, that that specific part of the body is the only problem. This is exceedingly rare.

Related: Check out my video on Dry Needling and Joint Manipulation to Treat and Resolve Headaches and Dizziness

Tissue damage itself, whether it be tight muscles, strained tissues, broken bones, etc., does not hurt. Our brain’s interpretation of the signals coming from those tissues is what hurts. Oftentimes, tissue pathology is present long before the symptoms present themselves. What leads to conscious observation of headache pain, typically, is your autonomic nervous system reaching its unique upper sympathetic limit threshold of tolerance to pathology throughout the body and mind. This can occur from a large problem in a small area, or a lot of small problems distributed throughout the body, or both. So, the pathologic tissue must be addressed. However, it is more important, and a superior method of treatment, to address the autonomic nervous system itself. The autonomic nervous system cannot be maximally regulated toward homeostasis without addressing the entire body. This includes all areas of pathology, along with the parasympathetic-dominant portions of the ANS located throughout the body.

Remember: almost all health impairments involve hyperactivity of the sympathetic autonomic nervous system. Specifically targeting the parasympathetic autonomic nervous system nudges the autonomic nervous system toward homeostasis. This is an overall key to health.

For example, you may have been living with chronic neck muscle and joint tightness for years that never really bothered you, but you just started experiencing headaches following an injury to the foot, or some other area of the body. Pelvic pathology is a primary instigator of headaches, for example. The reason for this being, the 9 pelvic floor muscles are all innervated by S2-S4, a parasympathetic dominant portion of the autonomic nervous system. The more parasympathetically innervated an area is, the more negatively affected it is secondary to sympathetic hyperactivity, as the sympathetic hyperactivity reciprocally inhibits parasympathetic function. Add to that, the more pathologic the tissue, the more the sympathetics are stimulated, and more sympathetic stimulation leads to further degradation of parasympathetic function.

Aside from S2-S4, the other primary locations to target the parasympathetic autonomic nervous system are the upper cervical spine and the ear. The upper cervical spine secondary to proximity to cranial nerves III, V, and X, and the ear secondary to direct innervation by the auricular branch of the vagus nerve, the primary nerve of the parasympathetic autonomic nervous system. This is a principal reason so many people have pelvic, cervical, and sacroiliac joint pain. These areas are primarily parasympathetic, and therefore, are most hindered secondary to sympathetic hyperactivity, anywhere in the body. If the sympathetic-parasympathetic autonomic-seesaw-relationship tilts towards the sympathetic side and gets stuck, the first obvious signs you notice are often found in parasympathetic dominant areas, like the upper cervical and pelvic regions, both primary headache causers.

One of the current hypotheses on one of the origins of headaches and dizziness, often closely mimicking benign paroxysmal positional vertigo (BPPV) symptoms, is dysfunction of the trigeminocervical nucleus and the trigeminocervical complex in the upper cervical spine and brain. Both key players in the autonomic nervous system. The trigeminocervical nucleus sits in the dorsal horn of the spinal column around C2. The afferent nerves of the suboccipital muscles cross over this nucleus. With enough abnormal afferent electrical signals crossing over the trigeminocervical nucleus, originating in the cervical musculature and terminating in the brain, this nucleus is thought to short-circuit, resulting in various dizziness and headache-related symptoms. Needling combined with joint manipulation is the fastest way I know of to resolve these symptoms.

Per studies, about 17% of American women experience migraines and 6% of men. The current US population is about 330 million people. Again, assuming a 50/50 male/female split, that means about 28 million females and 10 million males, 38 million total. That is just migraines. Tension-type headaches are even more common. According to research, about 38%, 125 million people, of the United States population experience tension-type headaches. So, about half the United States population suffers from just 2 impairments; migraine headaches (38 million) and tension-type headaches (125 million). The majority of those people are easily and effectively treated with the thoughtful combination of dry needling and joint manipulation. They are suffering needlessly.

I propose most headaches involve prolonged periosteal inflammation in the cervical and suboccipital regions, resulting in sympathetic hyperactivity, vasoconstriction, hypoxia, chemically induced pain amplification, and more nasty stuff. This is commonly secondary to muscle shortening and excessive tension at the osteotendinous junctions in the cervical spine and cranium. Directly treating the periosteum is impossible without the use of needles. This is one of the many reasons dry needling is the most powerful autonomic regulating tool physical therapists utilize. It is therapeutic and educational to advance the needle until you encounter periosteum. This gives the practitioner direct information about the quality and health of tissue from skin to bone. If you encounter soft, squishy periosteum, it is pathologic and needs treatment.

Without needles, direct treatment of anything but the skin is impossible. This especially includes the periosteum, the deepest treatable tissue PT’s have access to. When the sympathetics have surpassed their upper limit of functional regulatory ability, the autonomic nervous system loses its ability to recover normal physiology on its own. So, something must be done to stimulate change, and the human body and mind just so happen to respond to a sharp piece of metal being inserted into pathologic tissue by amplifying autonomic nervous system homeostasis to allow the mind and body to properly deal with the annoyance. The awesome ability of the mind and body to heal themselves and each other is widely misunderstood and underappreciated in medicine. Or completely ignored. Unfortunately, the entire medical complex is ruled by 1 simple question. How much money can be made? This question immediately puts anything that can safely treat, or help treat, almost all medical impairments for pennies a treatment, on the blacklist. It’s sad, petty, and pathetic.

Most chronic, recurrent impairments like headaches, plantar fasciitis, temporomandibular dysfunction, epicondylitis, etc., involve significant periosteal inflammation at the tendon attachments. Unlike muscle bellies, tendons, ligaments and periosteum have a more intimate connection with the autonomic nervous system. Targeting these structures elicits a stronger homeostatic effect on the autonomic nervous system, overall, than targeting muscle bellies. We do not understand precisely why this is, but targeting periosteum in the clinic leads to superior patient outcomes. As far as muscle tendons go, I believe a major reason needling them has such a homeostatic effect is, in part, secondary to the concentration of muscle spindles and golgi tendon organs. We know these are key regulators of normal muscle physiology. We know dry needling tenoperiosteal junctions, especially with low frequency microcurrent, has a regulatory, anti-inflammatory, and healing effect. It makes sense that the spindles and golgi tendon organs are at least partially responsible for said change. Whatever the reason, we know needling inflamed periosteum leads to healing. We can see this healing with imaging and you can feel the quality of the periosteum improve throughout treatment sessions with direct periosteal needle palpation. Healthy periosteum is hard. It feels like hitting a piece of steel. The softer it is, the more inflamed it is.

Remember, don’t get too focused on the cervical spine, although it is frequently a primary causative factor in headache occurrence. It is always important to treat people with the overall goal of maximally improving autonomic nervous system homeostasis. This involves removing as much pathologic tissue from as much of the body as possible. Every little piece of pathologic tissue, including tight tissue that may or may not stimulate conscious awareness, annoys the autonomic nervous system. The more annoyed the autonomics are, the less ability they retain to maintain health. So, every piece of pathologic tissue treated reduces annoyance. Less annoyance = less problems. If the overall goal of treatment is to regulate the autonomics as much as possible, this leads you to treat the body and mind as a whole, rather than individual parts.

It is of utmost importance to include manipulative treatment into your dry needling treatment plan if you want to improve your health to the highest potential. I like to manipulate following needling, as I find it easier to manipulate, the manipulation is more comfortable, and more effective. One of the reasons the trigeminocervical nucleus gets so abused is its location in the cervical spine. Again, it sits in the dorsal horn right around C2. C1/2 is the most mobile joint in our spine, by far. It accounts for about 50% of all cervical rotation. If we assume “normal” cervical rotation is 90 degrees, 50%, or 45 out of the 90 degrees, originate at C1/2. The other 45 degrees are split between C2 and T1. If C1/2 gets stuck in a deviated position, which is exceedingly common, the trigeminocervical nucleus and adjacent structures receive abnormal tension, abnormal electroactivity, hypoxia, and more bad stuff. Dysfunction of the trigeminocervical complex and nucleus can lead to a variety of nasty impairments, including dizziness, brain fog, balance problems, and headaches, to name a few.

Since the C1/2 segment is the most mobile joint in the spine, and the trigeminocervical nucleus sits around C2, any deviation anywhere in the spine is going to create amplified pathology of C2. The body naturally attempts to compensate for dysfunction and disposition. If the lumbar or thoracic spine stop moving normally, the easiest place for the spine to normalize position is by altering the joints that can move the most. C2 has a lot of tendons attaching to it, including 2 of 4 true suboccipital muscles. If it gets displaced, the tendons and muscles get grumpy and tight, further displacing C1/2, increasing aggravation of the trigeminocervical nucleus. This leads to a vicious negative feedback loop driving many impairments, mental and physical, including headaches.

Thanks for reading. Let me know if anyone has any questions about anything or if you would like to sign up for a course to learn how to treat headaches and other common impairments. Thanks.

Jason

References

• https://jamanetwork.com/journals/jama/fullarticle/187196
• https://headachejournal.onlinelibrary.wiley.com/doi/full/10.1111/head.12878
• Escaloni, J., Butts, R. and Dunning, J., 2018. The use of dry needling as a diagnostic tool and clinical treatment for cervicogenic dizziness: A narrative review & case series. Journal of bodywork and movement therapies, 22(4), pp.947-955.
• Murillo, C., Treleaven, J., Cagnie, B., Peral, J., Falla, D. and Lluch, E., 2021. Effects of dry needling of the obliquus capitis inferior on sensorimotor control and cervical mobility in people with neck pain: A double-blind, randomized sham-controlled trial. Brazilian journal of physical therapy, 25(6), pp.826-836.
• Pourahmadi, M., Dommerholt, J., Fernández-de-Las-Peñas, C., Koes, B.W., Mohseni-Bandpei, M.A., Mansournia, M.A., Delavari, S., Keshtkar, A. and Bahramian, M., 2021. Dry Needling for the treatment of tension-type, Cervicogenic, or migraine headaches: a systematic review and meta-analysis. Physical therapy, 101(5), p.pzab068.
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• Gildir, S., Tüzün, E.H., Eroğlu, G. and Eker, L., 2019. A randomized trial of trigger point dry needling versus sham needling for chronic tension-type headache. Medicine, 98(8).
• Lonzar, G., Abuín-Porras, V., Del-Blanco-Muñiz, J.A., González-de-la-Flor, Á., García-Pérez-de-Sevilla, G. and Domínguez-Balmaseda, D., 2023. Efficacy of invasive techniques in physical therapy for migraine treatment and prevention: a systematic review of randomized controlled trials. Revista da Associação Médica Brasileira.
• Gildir, S., Tüzün, E.H., Eroğlu, G. and Eker, L., 2019. A randomized trial of trigger point dry needling versus sham needling for chronic tension-type headache. Medicine, 98(8).
• Kamonseki, D.H., Lopes, E.P., van der Meer, H.A. and Calixtre, L.B., 2022. Effectiveness of manual therapy in patients with tension-type headache. A systematic review and meta-analysis. Disability and Rehabilitation, 44(10), pp.1780-1789.
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