Journal of Pain Management & Medicine

Abstract

Neurostimulation for Cluster Headaches of the Sphenopalatine Ganglion (SPG)-Literature Review

Mariana Mafra Junqueira*, Pedro Miño Vianna, Andreia Fortini Guimaraes, Raphael Callado de Cerqueira Campos, Bernardo Alvarez Rivello, Carla Mara Sant’ana, Maria Eduarda Nobre, Bruno Lima Pessoa, Miguel Soares Tepedino and Miguel Soares Tepedino

The current literature of the Sphenopalatine Ganglion (SPG) neurostimulation for cluster headache or other trigeminal autonomic cephalalgia is reviewed in this narrative paper. The authors published their experience with surgical transnasal approach with SPG ganglion as a target. SPG is a target in interventional pain medicine for headaches and orofacial pain and several approaches have been described. Cluster headache is a primary headache disorder, and it is classified as a Trigeminal Autonomic Cephalalgia (TAC). It is strictly unilateral, characterized for short excruciating pain attacks with autonomic symptoms. It has a huge impact in patient quality of life and functionality. Patient treatment and relief are challenges for physicians. Poor quality of life and disability are part of life in chronic cluster headache. Small group of patients are non-responders to pharmacological treatment or experience bothersome side effects, and they might be candidates for SPG neurostimulation. Neurostimulation is an alternative for patients with refractory chronic headache and new approaches and techniques have been published recently. Key words used for research were sphenopalatine ganglion, cluster headache, headache, neurostimulation, migraine. Pub Med, Embase, Cochrane Central Register of the Controlled Trials (Central) databases and clinicaltrials.gov were reviewed for the studies. There is no Cochrane systematic review for sphenopalatine ganglion neurostimulation and 21 clinical trials in the last 10 years (Jan 2023-June 2023). Diagnosis and treatment of cluster headache, neurostimulation, sphenopalatine ganglion anatomy and pathophysiology were also reviewed to write this paper. Neurostimulation is not new, however more studies are needed in the field of headache. Cluster headache brings high disability and low quality of life to the patient. Ablative procedures allow short term relief and more disable side effects, such as paresthesia. New studies evaluating disability, quality of life, medications intake, number of attacks and with long term follow up are needed. New devices are emerging and should be studied for headaches, especially for chronic cluster headache. The evidence of neurostimulation for cluster headache treatment is still low and treatment should be personalized.

Published Date: 2023-08-21; Received Date: 2023-07-19