From Evidence to Clinical Practice: A Proposed Clinical Framework for Dry Needling in Tension-Type Headache
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Abstract
Background: Dry needling (DN) is frequently used within physiotherapy management of tension-type headache (TTH). Although previous studies suggest potential benefits for headache-related outcomes, considerable heterogeneity persists regarding patient selection, target muscle selection, treatment dosage, and clinical decision-making processes.
Objective: To propose a clinically oriented framework for the application of DN in patients with TTH informed by the available scientific literature and contemporary physiotherapy practice patterns.
Methods: A narrative review and conceptual synthesis were conducted using evidence from studies addressing DN, myofascial pain mechanisms, headache pathophysiology, and physiotherapy management of TTH. Findings from recent investigations examining physiotherapy practice patterns and DN interventions were also considered to support framework development.
Results: Available evidence suggests that DN may represent a useful component of multimodal physiotherapy management for selected patients with TTH. However, substantial variability remains across intervention protocols, target muscle selection, dosage parameters, and clinical implementation strategies. Based on the narrative synthesis of the literature and clinical practice evidence, a six-domain clinical framework is proposed, including patient selection, clinical examination, target muscle selection, intervention parameters, multimodal integration, and reassessment strategies.
Conclusions: The proposed framework is intended as a conceptual tool to support clinical reasoning and promote greater consistency in DN application for TTH. It should not be interpreted as a validated clinical protocol. Future research should evaluate its feasibility, reliability, and clinical utility in prospective studies while further clarifying optimal treatment parameters and patient subgroups most likely to benefit from DN interventions.
Keywords
- tension-type headache
- physical therapy modalities
- rehabilitation
- trigger points
- myofascial pain syndromes
- treatment outcome
- clinical decision-making
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Copyright (c) 2026 Ana Bravo-Vazquez, Cleofas Rodriguez-Blanco, Carlos Bernal Utrera
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