Dry Needling in the Management of Chronic Tension Type Headache Associated with Levator Scapulae Syndrome: A Case Report

Background/purpose: Chronic tension-type headaches (CTTH) have a lifetime prevalence of 42% and account for more lost workdays than migraine headaches.Dry needling is being increasingly used by physical therapists in the management of CTTH; however, to date, the supporting evidence is limited.Case Description: The purpose of this case report was to describe how three sessions of dry needling (DN) targeting myofascial trigger points in the levator scapulae muscle and its distal enthesis was used to treat a 63-year-old male patient who presented with work-related CTTH associated with levator scapulae syndrome (LSS).Outcome: The patient was treated for five visits over the course of two months.At discharge and 6-month follow-up, the patient reported full resolution of symptoms.Self-report outcomes included the numeric pain rating scale and the neck disability index.Discussion: The use of DN to the levator scapulae muscle and its distal enthesis may be a valuable addition to a multi-modal plan of care in the treatment of work-related chronic tension-type headaches associated with LSS. Level of Evidence: Level IV Dry Needling in the Management of Chronic Tension Type Headache Associated withLevator Scapulae Syndrome: A Case Report BACKGROUND Headache ranks among the top ten most disabling conditions worldwide. 1 Tension type headache is the most frequent primary headache and is characterized by bilateral, non-throbbing, mild to moderate pain of the head and neck that is not exacerbated by routine physical activity. 2According to the International Headache Society (IHS), there are 2 distinct types of tension type headache.Episodic tension type headaches (subclassified as infrequent or frequent) occur between 1-14 days per month.Less common, chronic tension-type headaches (CTTH) are present on greater than or equal to 15 days per month. 2 Population-based studies