DRY NEEDLING TRIGGER POINTS
IN RECTUS AND OBLIQUUS CAPITIS INFERIOR MUSCLES
UNDER ULTRASOUND GUIDANCE IS EFFECTIVE FOR CHRONIC HEADACHE
R. Bubnov1, L. Kalika2.
1Clinical Hospital "Feofaniya", Ultasound; Institute of Microbiology and Virology, NAS of Ukraine , Kyiv, Ukraine
2New York Dynamic Neuromuscular Rehabilitation & Physical Therapy,
https://nydnrehab.com/, New York, USA.
This study included 24 patients (15 females, avarage age was
38±6 years old). All patients suffered from intensive chronic
persistent or recurrent one- or two-sided pain in temporal and/or
occipital areas; sometimes radiation to neck, arm. The treatment
approach by R. Bubnov (PMID:23088743) [2,3] was applied that
included ultrasound identification of MTrPs with following dry
needling under US guidance using steel 28G needles to elicit the
local twitch response (LTR). Visual analogue scale data (VAS0-10)
were measured before, immediately after and 24 hours after the
intervention. A decrease in pain as measured by a VAS of 50% or
more one week after treatment was considered as success.
1.Clinical definition zone of possible trigger point—pain
syndrome with typical referred pain pattern registration.
2.Trigger point palpation. Palpation of a hypersensitive bundle
or nodule of the muscle fiber of harder than normal
consistency. Localization of a trigger point is based on the
sense of feel, assisted by patient expressions of pain, and by
visual and palpable observations of local twitch response 
3.Using precise physical tests, extensive neuromuscular
ultrasound using M-mode to evaluate muscle thickness, CSA
and motion , different patterns of decreasing motility,
contractility (muscle contracted / rested thickness) in involved
4.When the affected muscle is detected, ultrasonography
examination is performed for myofascial trigger point
visualization using gray-scale, Doppler, and sonoelastography
5.After the visual identification of the trigger point, dry needling
was performed—acupuncture needles were inserted into MTrP
to elicit the LTR effect. The needle was held in the tissue until
complete disappearance of the LTR which could be considered
similar to the phenomenon of the ‘needle grasp,’ which has
been attributed to the muscle fibers contracting around the
needle, and was held tightly in place to increase the resistance
to further move the inserted needle [2-4].
6.Ultrasound control after procedure [2-4].
7.Visual analog scale (VAS) scores (0–10) were recorded
throughout the study period before, immediately after, and 24 h
after the procedure.
Dry needling trigger points in suboccipital muscles under
ultrasound guidance is effective to treat headaches,
evoced by myofascial disorders. Further profound studies
needed to establish unified Dx and Tx protocol.
1.Falsiroli Maistrello L, et al. (2018) Effectiveness of Trigger Point Manual Treatment on the Frequency, Intensity, and Duration of Attacks in
Primary Headaches: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front. Neurol. 9:254.
2.Bubnov R. V. The use of trigger point dry needling under ultrasound guidance for the treatment of myofascial pain (technological innovation
and literature review). Lik Sprava. 2010 Jul-Sep;(5-6):56-64.
3.Bubnov RV. Evidence-based pain management: is the concept of integrative medicine applicable? EPMA J. 2012;3(1):13. doi: 10.1186/1878-
4.Bubnov R. Trigger Points Dry Needling Under Ultrasound Guidance for Low Back Pain Therapy. Comparative Study. Annals of the Rheumatic
Diseases 2015;74:624. http://dx.doi.org/10.1136/annrheumdis-2015-eular.2323
5.R. V. Bubnov, L. Kalika, L. Babenko MULTILEVEL EVALUATION OF MOTION AND POSTURE PATTERNS IN LOWER EXTREMITY AND
SPINE USING DYNAMIC ULTRASOUND Annals of the Rheumatic Diseases 77(Suppl 2):1699. DOI: 10.1136/annrheumdis-2018-eular.3949
Myofascial pain is widespread, can be reliable cause of large number of headaches.
Suboccipital triangle has high complexity of vasularity and innervation network with
sympathetic signaling. Myofascial Trigger Points (MTrPs) treatment of the head and
neck muscles was reported to to be useful to reduce frequency, intensity, and
duration of attack in patients with tension-type headache (TTH) and migraine,
however evidence is very low yet . We proposed a new approach of trigger point
therapy, performing precise muscle dry needling under ultrasound (US) guidance [2-
4], that proved efficacy for treatment numeral pain localizations and widespread pain.
The aim was to evaluate efficacy of deep dry needling of myofascial trigger points
(MTrPs) in suboccipital muscles (rectus and obliquus capitis inferior muscles) treat
Conclusion Dry needling trigger points in suboccipital muscles under ultrasound
guidance is effective to treat headaches, evoced by myofascial disorders. Further
profound studies needed to establish unified Dx and Tx protocol.
Keywords: migraine disorders, tension-type headache, cluster headache; Myofascial
Trigger Points; Ultrasound
Main active MTrPs were diagnosed in rectus and obliquus
capitis inferior muscles, the additional (latent) MTrPs were
defined and effectively needled in muscles of the
ipsilateral shoulder rotator cuff. In one session 1-3
needles were inserted, 1-2 sessions appilied to each
patient. Retention of needles depended of muscle LTR
duration. Seventeen patients showed decrease in pain as
measured by a VAS of 90%, the difference was significant
in this group (p<0.01) and pain relief outcome after one
month observation; seven patient received another
session after 2-3 weeks after first procedure.
CASE - tension-type headache, associated with shoulder
Functional US testing - left shoulder impingement:
movement restriction - abduction at 90 degrees (after
manipulation =180 degrees).
MTrPs were detected in the shoulder rotators muscles, head,
neck oblique muscles – see figures below;
immediate effect after needling.
Approach [2-5] Trigger point in rectus capitis m. (trigger point
close to vertebral artery)
Trigger point in suprspinatus m.