Effectiveness of a multimodal rehabilitation program incorporating manual therapy, electrically stimulated auricular needling, and stabilization exercises in individuals with cervicogenic headache and temporomandibular disorders: a randomized control

Cervicogenic headache (CEH) and temporomandibular disorders (TMD) frequently coexist due to shared neuromusculoskeletal and nociceptive mechanisms, often resulting in persistent pain, functional limitation, and reduced quality of life. Multimodal rehabilitation approaches addressing cervical and temporomandibular dysfunction have demonstrated promising clinical benefits; however, high-quality randomized controlled trials evaluating integrated rehabilitation strategies remain limited. To evaluate the short-term effectiveness of a multimodal rehabilitation program incorporating manual therapy, auricular electrical stimulation using filiform needles, and stabilization exercises compared with conventional physiotherapy in reducing pain, disability, and functional impairment in individuals with coexisting cervicogenic headache and temporomandibular disorders. In this assessor-blinded randomized controlled trial, 150 participants with CEH and coexisting myogenous TMD were randomly allocated to an experimental group (manual therapy combined with auricular electrical stimulation using filiform needles and stabilization exercises; n = 75) or a control group (conventional physiotherapy; n = 75). Interventions were delivered over four weeks. Participants were actively monitored for adverse events following each treatment session. Primary outcomes included pain intensity (Numeric Pain Rating Scale) and headache-related disability (Headache Disability Index). Secondary outcomes included pressure pain threshold, maximum mouth opening, jaw functional limitation, oral health–related quality of life, and neck disability. Outcomes were assessed at baseline and immediately post-intervention. Between-group comparisons were performed using analysis of covariance, adjusting for baseline values. Compared with the control group, the experimental group demonstrated significantly greater improvements in pain intensity, headache-related disability, pressure pain threshold, maximum mouth opening, neck disability, and jaw-related functional outcomes (all p < 0.001). All between-group comparisons remained statistically significant following Bonferroni correction (adjusted significance threshold p < 0.007). The observed between-group improvements exceeded the MCID thresholds for all outcome measures (Table 5). No adverse events were reported. A multimodal intervention incorporating manual therapy and electrical needling applied to the auricular region produced superior short-term improvements in pain, disability, mandibular mobility, and quality of life compared with conventional physiotherapy in individuals with CEH and TMD. These findings suggest that incorporating auricular needling with electrical stimulation into a multimodal rehabilitation program may provide greater short-term improvements in pain, headache-related disability, jaw function, cervical mobility, and oral health-related quality of life than conventional physiotherapy alone following a 4-week intervention. Long-term effectiveness requires confirmation through future randomized controlled trials. CTRI/2019/05/019401 on 28/05/2019. (Search Result, Clinical Trials Registry - India (CTRI)).