Background and aims
Myofascial Trigger Points (MTrPs) treatment of the head and neck muscles can reduce frequency, intensity, and duration of attack in patients with tension-type headache (TTH) and migraine. Recently we proposed a new approach of trigger point therapy, performing precise muscle dry needling (DN) under ultrasound (US) guidance. 
The aim was to evaluate efficacy of deep DN of myofascial trigger points (MTrPs) in neck and shoulder muscles to treat chronic headaches.
Methods
We included 24 patients (15 females, 38±6 years old) with intensive chronic persistent or recurrent one- or two-sided pain in temporal and/or occipital areas. Treatment approach by Bubnov [https://doi.org/10.1186/1878-5085-3-13] was applied that included ultrasound identification of MTrPs with following DN under US guidance using steel 28G needles to elicit local muscle response (LTR, `needle grasp`). Visual analogue scale data (VAS0-10) were measured before and after the interventions. 
Results
Main active MTrPs were diagnosed in rectus and obliquus capitis inferior muscles, the additional (latent) MTrPs were defined and effectively needled in the ipsilateral shoulder rotator muscles. In one session 1-3 needles were inserted, 1-2 sessions applied to each patient. Retention of needles corelated with LTR and clinical effects. In seventeen patients pain decreased by a VAS of 90% (p<0.01) pain relief wassustainable during one month after procedure; seven patient received another session after 2-3 weeks after first session. Preliminary data shows decreasing levels of migraine type attacks in 6 patients.
Conclusions
MTrPs DN under ultrasound guidance is effective to treat headaches, evoced by myofascial disorders. 
Further profound studies needed to establish unified Dx and Tx protocol.
See more at: 
•	https://nydnrehab.com/
•	Bubnov RV: The use of trigger point “dry” needling under ultrasound guidance for the treatment of myofascial pain (technological innovation and literature review). Lik Sprava 2010, 5-6:56-64.
•	Bubnov RV: Evidence-based pain management: is the concept of integrative medicine applicable? EPMA J 2012, 3(1):13.

DRY NEEDLING UNDER ULTRASOUND GUIDANCE TRIGGER POINTS IN NECK AND SHOULDER EFFECTIVE OR DIFFERENT TYPES OF HEADACHE