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Acute Treatment of Intractable Migraine With Sphenopalatine Ganglion Electrical Stimulation

Authors

  • Stewart J. Tepper MD,

    1. From the Centers for Headache and Pain and Neurological Restoration and Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA (S.J. Tepper); Centers for Neurological Innovations and Department of Eurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA (A. Rezai); Center for Pain Anesthesia, Anesthesia Institute, Cleveland Clinic, Cleveland, OH, USA (S. Narouze); Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA (C. Steiner); Southern Nevada Pain Specialists, Las Vegas, NV, USA (P. Mohajer); Headache Specialists, Las Vegas, NV, USA (M. Ansarinia).
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  • Ali Rezai MD,

    1. From the Centers for Headache and Pain and Neurological Restoration and Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA (S.J. Tepper); Centers for Neurological Innovations and Department of Eurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA (A. Rezai); Center for Pain Anesthesia, Anesthesia Institute, Cleveland Clinic, Cleveland, OH, USA (S. Narouze); Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA (C. Steiner); Southern Nevada Pain Specialists, Las Vegas, NV, USA (P. Mohajer); Headache Specialists, Las Vegas, NV, USA (M. Ansarinia).
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  • Samer Narouze MD,

    1. From the Centers for Headache and Pain and Neurological Restoration and Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA (S.J. Tepper); Centers for Neurological Innovations and Department of Eurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA (A. Rezai); Center for Pain Anesthesia, Anesthesia Institute, Cleveland Clinic, Cleveland, OH, USA (S. Narouze); Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA (C. Steiner); Southern Nevada Pain Specialists, Las Vegas, NV, USA (P. Mohajer); Headache Specialists, Las Vegas, NV, USA (M. Ansarinia).
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  • Charles Steiner BS,

    1. From the Centers for Headache and Pain and Neurological Restoration and Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA (S.J. Tepper); Centers for Neurological Innovations and Department of Eurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA (A. Rezai); Center for Pain Anesthesia, Anesthesia Institute, Cleveland Clinic, Cleveland, OH, USA (S. Narouze); Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA (C. Steiner); Southern Nevada Pain Specialists, Las Vegas, NV, USA (P. Mohajer); Headache Specialists, Las Vegas, NV, USA (M. Ansarinia).
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  • Pouya Mohajer MD,

    1. From the Centers for Headache and Pain and Neurological Restoration and Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA (S.J. Tepper); Centers for Neurological Innovations and Department of Eurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA (A. Rezai); Center for Pain Anesthesia, Anesthesia Institute, Cleveland Clinic, Cleveland, OH, USA (S. Narouze); Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA (C. Steiner); Southern Nevada Pain Specialists, Las Vegas, NV, USA (P. Mohajer); Headache Specialists, Las Vegas, NV, USA (M. Ansarinia).
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  • Mehdi Ansarinia MD

    1. From the Centers for Headache and Pain and Neurological Restoration and Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA (S.J. Tepper); Centers for Neurological Innovations and Department of Eurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA (A. Rezai); Center for Pain Anesthesia, Anesthesia Institute, Cleveland Clinic, Cleveland, OH, USA (S. Narouze); Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA (C. Steiner); Southern Nevada Pain Specialists, Las Vegas, NV, USA (P. Mohajer); Headache Specialists, Las Vegas, NV, USA (M. Ansarinia).
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  • Financial support: This study was performed with a grant from Autonomic Technologies, Inc.

  • Conflict of Interest:
    Dr Tepper wishes to disclose consulting, scientific advisory board and speaker activites for: ATI, Coherex, Endo, GSK, MAP, Merck, NMT, Nupathe, OrthoMcNeil, Valeant, Vernalis. He received research support from: ATI, GSK, MerckDr Rezai received small honaria from Medtronic Neurological. Dr Rezai also received financial support for research activities from Medtronic Neurological. ATI provided a grant for the current study. Dr Narouze received consulting fees from Philips, SonoSite. ATI provided a grant for the current study. Dr Steiner: ATI provided a grant for the current study. Dr Mohajer wishes to disclose consulting, scientific advisory board and speaker activities for: Boston Scientific and Pfizer. Dr Mohajer confirms: ATI provided a grant for the current study. Dr Ansarinia wishes to disclose the following speaking engagements: Merck, Ortho-McNeil; and the following consulting engagements: Cleveland Clinic and ATI. Dr Ansarinia has received license fee payments from: Cleveland Clinic; and Contractual rights for stocks from: ATI. Investigator and held stock in ATI. Dr Ansarinia's research expenses paid for by ATI, AGA and Advanced Bionics.

S.J. Tepper, Center for Headache and Pain, Cleveland Clinic, 9500 Euclid Ave. T33, Cleveland, OH 44195, USA.

Abstract

Background.— We report preliminary results of a novel acute treatment for intractable migraine. The sphenopalatine ganglion (SPG) has sensorimotor and autonomic components and is involved in migraine pathophysiology.

Methods.— In 11 patients with medically refractory migraine, the sphenopalatine fossa was accessed with a 20-gauge needle using the standard infrazygomatic transcoronoid approach under fluoroscopy. Patients underwent temporary unilateral electric stimulation of the SPG with a Medtronic 3057 test stimulation lead after induction of full-blown migraine. Both sham and active stimulations with different settings were carried out for ≤60 minutes, and then the lead was removed.

Results.— In 11 evaluations, 2 patients were pain-free within 3 minutes of stimulation. Three had pain reduction; 5 had no response; 1 was not stimulated. Five patients had no pain relief. Stimulation settings: mean amplitude of 1.2V, mean pulse rate of 67 Hz, mean pulse width of 462 µs. Lack of headache relief appeared linked to suboptimal lead placement, poor physiologic sensory response to localization stimulation, and diagnosis of medication overuse headache.

Conclusion.— This study suggests a possible role for SPG stimulation in the treatment of refractory migraine headaches.

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