Effects of Spinal Manipulation and Dry Needling on Headache and Migraine: A Systematic Review of Randomized Controlled Trials

<b>Background/Objectives</b>: Cervical pain is defined as pain in the neck that may or may not radiate to one or both upper extremities and lasts at least one day. Headaches are within the spectrum of neck pain, defined as any painful sensation perceived in the head that can extend to the neck. They are classified as primary (migraines and tension headaches) or secondary (cervicogenic headaches) depending on their clinical presentation and associated symptoms. The objective of this review is to compare the effects of dry needling with and without spinal manipulative techniques versus the application of other physical therapy modalities. <b>Methods</b>: A systematic review was conducted searching articles compatible with the objectives of this study in PubMed, ScienceDirect, and Scopus databases using the search terms spinal manipulation, cervical manipulation, dry needling, headache, headaches, and migraine over the last five years and combined with the Boolean operators AND and OR. After screening, all studies underwent methodological quality assessments using the PEDro scale and qualitative synthesis for study design, patients' characteristics, interventions, comparators, outcomes assessed and main results data. <b>Results</b>: Thirteen randomized clinical trials were selected. The quality of the studies is varied, with PEDro scale values ranging from six to eight. Dry needling and cervical manipulations have proven to be effective tools, compared to other interventions, in reducing pain and improving functionality in patients with headaches. <b>Conclusions</b>: Dry needling techniques and manipulations have shown significant effects on parameters related to pain, sensitivity, functionality, and general health in patients with headaches. However, future studies are necessary to more deeply analyze the long-term effects of both techniques.