Headache in children and young people

Dry Needling for the Treatment of Tension-Type, Cervicogenic, or Migraine Headaches: A Systematic Review and Meta-Analysis

OBJECTIVE

Dry needling is a treatment technique used by clinicians to relieve symptoms in patients with tension-type headache (TTH), cervicogenic headache (CGH), or migraine. This systematic review's main objective was to assess the effectiveness of dry needling on headache pain intensity and related disability in patients with TTH, CGH, or migraine.

METHODS

Medline/PubMed, Scopus, Embase, PEDro, Web of Science, Ovid, Allied and Complementary Medicine Database/EBSCO, Cochrane Central Register of Controlled Clinical Trials, Google Scholar, and trial registries were searched until April 1, 2020, along with reference lists of eligible studies and related reviews. Randomized clinical trials or observational studies that compared the effectiveness of dry needling with any other interventions were eligible for inclusion. Three reviewers independently selected studies, extracted data, and assessed risk of bias. Random-effects meta-analyses were performed to produce pooled-effect estimates (Morris dppc2) and their respective CIs.

RESULTS

Of 2715 identified studies, 11 randomized clinical trials were eligible for qualitative synthesis and 9 for meta-analysis. Only 4 trials were of high quality. Very low-quality evidence suggested that dry needling is not statistically better than other interventions for improving headache pain intensity in the short term in patients with TTH (SMD -1.27, 95% CI = -3.56 to 1.03, n = 230), CGH (SMD -0.41, 95% CI = -4.69 to 3.87, n = 104), or mixed headache (TTH and migraine; SMD 0.03; 95% CI = -0.42 to 0.48, n = 90). Dry needling provided significantly greater improvement in related disability in the short term in patients with TTH (SMD -2.28, 95% CI = -2.66 to -1.91, n = 160) and CGH (SMD -0.72, 95% CI = -1.09 to -0.34, n = 144). The synthesis of results showed that dry needling could significantly improve headache frequency, health-related quality of life, trigger point tenderness, and cervical range of motion in TTH and CGH.

CONCLUSIONS

Dry needling produces similar effects to other interventions for short-term headache pain relief, whereas dry needling seems to be better than other therapies for improvement in related disability in the short term.

IMPACT

Although further high-methodological quality studies are warranted to provide a more robust conclusion, our systematic review suggested that for every 1 or 2 patients with TTH treated by dry needling, 1 patient will likely show decreased headache intensity (number needed to treat [NNT] = 2; large effect) and improved related disability (NNT = 1; very large effect). In CGH, for every 3 or 4 patients treated by dry needling, 1 patient will likely exhibit decreased headache intensity (NNT = 4; small effect) and improved related disability (NNT = 3; medium effect).

Changes in Japanese Junior High School Students' Sense of Coherence Before and After the Onset of the COVID-19 Pandemic: A Longitudinal Study of Children and Mothers

We conducted a longitudinal study to clarify the changes in the sense of coherence (SOC); that is, the ability to cope with stress successfully, of 166 Japanese junior high school students and their mothers before and after the onset of the COVID-19 pandemic. First, we analyzed changes in SOC at three time points for all students and divided them into two groups: Group 1 included students with SOC scores that increased or maintained before and after the onset of the pandemic and Group 2 included students with decreased SOC scores after the onset of the pandemic. Second, we conducted a comparative analysis between the two groups. Overall, results indicated that student's SOC scores increased. Additionally, interpersonal stress scores were lower after the onset of the pandemic than before. There were almost no differences in family relationships, financial conditions, or personality tendencies between the two groups. However, Group 2 did not regain their sense of belonging to school. In this group, the frequency of stress experiences in club activities after the onset of the pandemic, troubles with the opposite gender, and inability to catch up with the contents of the subject lecture were high. The accumulation of small stressors may have hindered the maintenance of a sense of school affiliation. Mothers of students in Group 2 either were full-time employees at baseline or had started a new job after the onset of the pandemic. Their children may have been affected by the household's damaged financial budget and changes in mother's working styles. As COVID-19 reduced the number of days students went to school, students' SOC could have reduced had they not felt a sense of presence or belonging due to the lack of participation in club activities, school events, etc. Teachers and mothers should communicate carefully with their students and children, respectively, to develop a sense of belonging.