Conflict of Interest: None
Sphenopalatine Ganglion Radiofrequency Ablation for the Management of Chronic Cluster Headache
Article first published online: 9 SEP 2008
© 2008 the Authors. Journal compilation © 2008 American Headache Society
Headache: The Journal of Head and Face Pain
Volume 49, Issue 4, pages 571–577, April 2009
How to Cite
Narouze, S., Kapural, L., Casanova, J. and Mekhail, N. (2009), Sphenopalatine Ganglion Radiofrequency Ablation for the Management of Chronic Cluster Headache. Headache: The Journal of Head and Face Pain, 49: 571–577. doi: 10.1111/j.1526-4610.2008.01226.x
- Issue published online: 25 MAR 2009
- Article first published online: 9 SEP 2008
- Accepted for publication June 16, 2008.
- cluster headache;
- sphenopalatine ganglion;
- radiofrequency ablation;
Objectives.— Chronic cluster headache patients are often resistant to pharmacological management. Percutaneous radiofrequency ablation (RFA) of the sphenopalatine ganglion (SPG) was shown before to improve episodic cluster headache but not chronic cluster headache. We were interested to examine the effect of such intervention in patients with intractable chronic cluster headache who failed pharmacological management.
Methods.— Fifteen patients with chronic cluster headache, who experienced temporary pain relief following SPG block, underwent percutaneous RFA via the infrazygomatic approach under fluoroscopic guidance. Collected data include demographic variables, onset and duration of the headache, mean attack intensity (MAI), mean attack frequency (MAF), and pain disability index (PDI) before and up to 18 months after procedure.
Results.— At 1-, 3-, 6-, 12-, 18-month follow-up, the MAI was 2.6, 3.2, 3.2, 3.4, 4.2, respectively (P < .0001, P < .0001, P < .0001, P < .0005, P < .003, respectively). The PDI improved from 55 (baseline) to 17.2 and 25.6 at 6 and 12 months respectively (P < .001). The MAF improved from 17 attacks/week to 5.4, 6.4, 7.8, 8.6, 8.3 at 1-, 3-, 6-, 12-, 18-month follow-up visits (P < .0001, P < .0001, P < .0001, P < .002, P < .004, respectively).
Conclusion.— Our data showed that percutaneous RFA of the SPG is an effective modality of treatment for patients with intractable chronic cluster headaches. Precise needle placement with the use of real-time fluoroscopy and electrical stimulation prior to attempting radiofrequency lesioning may reduce the incidence of adverse events.