Is dry needling effective compared to placebo needling effect in easing pain and disability among adults with migraine headache?

• Study setting: Teaching Hospital, Anuradhapura. • Randomization: 1:1 randomization using sealed envelopes. • Treatment group: Dry needling for active trigger points in suboccipital, and cervical musculature will be performed by a Certified Dry Needling Physiotherapist. Treatment will be continued for 3 days per week with 48 hours gap in between. Dry Needling is defined by the American Physical Therapy Association (APTA) as a skilled intervention that uses a thin filiform needle to penetrate the skin and stimulate underlying myofascial trigger points, muscular and connective tissue for the management of neuromuscular pain and movement impairments.

• Control group: Sham needling will be performed by the same therapist where active trigger points are not identified. In sham intervention, patients will be treated with muscle pressed with tube housing of the needle, but the needle will never be inserted into the skin. Sham Needling will be done four times superficially where trigger points are not identified in the same frequency and same duration as the intervention group.

• Both groups will receive neck specific muscle strengthening program as part of standard of care. *.Headache diary: will be measured in both treatment and control groups at the baseline, 1 week after the commencement and at the end of 4 weeks. • Both patients and assessors are blinded to the treatments, and patients are unaware of whether they have received active or sham dry needling

• Adult patients with migraine headache * Minimum age 18 and maximum age 50 years • Diagnosis should be confirmed by a consultant neurologist based on the International Classification of Headache Disorders (ICHD-3). • Patients should have at least one active trigger point in their suboccipital and cervical musculature.

• Patient with a history of neck trauma, cervical radiculopathy • Patients with previous surgery on the neck or shoulder area • Patients with abnormal bleeding tendencies, a severely compromised immune system, vascular disease • Frail patients, • Patients with epilepsy • Patient allergic to metals or latex • Patients with altered psychological status, • Patient with prosthetic implants, and implantable electrical devices. • Patients with a history of physiotherapy intervention in the neck and shoulder region in the previous six months • Pregnancy • Patients with needle phobia • Patients who are on anticoagulant therapy • Patients with thrombocytopenia and those with lymphedema in a specific area or limb.