Electrical Stimulation of Sphenopalatine Ganglion for Acute Treatment of Cluster Headaches

Authors

  • Mehdi Ansarinia MD,

    1. From the Headache Specialists, Las Vegas, NV, USA (M. Ansarinia); Department of Neurosurgery and Center for Neuromodulation, The Ohio State University, Columbus, OH, USA (A. Rezai and J. Stump); Cleveland Clinic Centers for Headache and Pain and Neurological Restoration and Department of Neurology, Cleveland, OH, USA (S.J. Tepper); Cleveland Clinic Innovations, Product Development Manager, Center for Neurological Restoration, Cleveland, OH, USA (C.P. Steiner); Cleveland Clinic Center for Pain Anesthesia, Cleveland, OH, USA (M. Stanton-Hicks); Cleveland Clinic Center for Neurological Restoration and Department of Neurosurgery, Cleveland, OH, USA (A. Machado); Cleveland Clinic Center for Pain Anesthesia, Cleveland, OH, USA (S. Narouze).
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  • Ali Rezai MD,

    1. From the Headache Specialists, Las Vegas, NV, USA (M. Ansarinia); Department of Neurosurgery and Center for Neuromodulation, The Ohio State University, Columbus, OH, USA (A. Rezai and J. Stump); Cleveland Clinic Centers for Headache and Pain and Neurological Restoration and Department of Neurology, Cleveland, OH, USA (S.J. Tepper); Cleveland Clinic Innovations, Product Development Manager, Center for Neurological Restoration, Cleveland, OH, USA (C.P. Steiner); Cleveland Clinic Center for Pain Anesthesia, Cleveland, OH, USA (M. Stanton-Hicks); Cleveland Clinic Center for Neurological Restoration and Department of Neurosurgery, Cleveland, OH, USA (A. Machado); Cleveland Clinic Center for Pain Anesthesia, Cleveland, OH, USA (S. Narouze).
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  • Stewart J. Tepper MD,

    1. From the Headache Specialists, Las Vegas, NV, USA (M. Ansarinia); Department of Neurosurgery and Center for Neuromodulation, The Ohio State University, Columbus, OH, USA (A. Rezai and J. Stump); Cleveland Clinic Centers for Headache and Pain and Neurological Restoration and Department of Neurology, Cleveland, OH, USA (S.J. Tepper); Cleveland Clinic Innovations, Product Development Manager, Center for Neurological Restoration, Cleveland, OH, USA (C.P. Steiner); Cleveland Clinic Center for Pain Anesthesia, Cleveland, OH, USA (M. Stanton-Hicks); Cleveland Clinic Center for Neurological Restoration and Department of Neurosurgery, Cleveland, OH, USA (A. Machado); Cleveland Clinic Center for Pain Anesthesia, Cleveland, OH, USA (S. Narouze).
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  • Charles P. Steiner BS,

    1. From the Headache Specialists, Las Vegas, NV, USA (M. Ansarinia); Department of Neurosurgery and Center for Neuromodulation, The Ohio State University, Columbus, OH, USA (A. Rezai and J. Stump); Cleveland Clinic Centers for Headache and Pain and Neurological Restoration and Department of Neurology, Cleveland, OH, USA (S.J. Tepper); Cleveland Clinic Innovations, Product Development Manager, Center for Neurological Restoration, Cleveland, OH, USA (C.P. Steiner); Cleveland Clinic Center for Pain Anesthesia, Cleveland, OH, USA (M. Stanton-Hicks); Cleveland Clinic Center for Neurological Restoration and Department of Neurosurgery, Cleveland, OH, USA (A. Machado); Cleveland Clinic Center for Pain Anesthesia, Cleveland, OH, USA (S. Narouze).
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  • Jenna Stump MS,

    1. From the Headache Specialists, Las Vegas, NV, USA (M. Ansarinia); Department of Neurosurgery and Center for Neuromodulation, The Ohio State University, Columbus, OH, USA (A. Rezai and J. Stump); Cleveland Clinic Centers for Headache and Pain and Neurological Restoration and Department of Neurology, Cleveland, OH, USA (S.J. Tepper); Cleveland Clinic Innovations, Product Development Manager, Center for Neurological Restoration, Cleveland, OH, USA (C.P. Steiner); Cleveland Clinic Center for Pain Anesthesia, Cleveland, OH, USA (M. Stanton-Hicks); Cleveland Clinic Center for Neurological Restoration and Department of Neurosurgery, Cleveland, OH, USA (A. Machado); Cleveland Clinic Center for Pain Anesthesia, Cleveland, OH, USA (S. Narouze).
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  • Michael Stanton-Hicks MD,

    1. From the Headache Specialists, Las Vegas, NV, USA (M. Ansarinia); Department of Neurosurgery and Center for Neuromodulation, The Ohio State University, Columbus, OH, USA (A. Rezai and J. Stump); Cleveland Clinic Centers for Headache and Pain and Neurological Restoration and Department of Neurology, Cleveland, OH, USA (S.J. Tepper); Cleveland Clinic Innovations, Product Development Manager, Center for Neurological Restoration, Cleveland, OH, USA (C.P. Steiner); Cleveland Clinic Center for Pain Anesthesia, Cleveland, OH, USA (M. Stanton-Hicks); Cleveland Clinic Center for Neurological Restoration and Department of Neurosurgery, Cleveland, OH, USA (A. Machado); Cleveland Clinic Center for Pain Anesthesia, Cleveland, OH, USA (S. Narouze).
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  • Andre Machado MD,

    1. From the Headache Specialists, Las Vegas, NV, USA (M. Ansarinia); Department of Neurosurgery and Center for Neuromodulation, The Ohio State University, Columbus, OH, USA (A. Rezai and J. Stump); Cleveland Clinic Centers for Headache and Pain and Neurological Restoration and Department of Neurology, Cleveland, OH, USA (S.J. Tepper); Cleveland Clinic Innovations, Product Development Manager, Center for Neurological Restoration, Cleveland, OH, USA (C.P. Steiner); Cleveland Clinic Center for Pain Anesthesia, Cleveland, OH, USA (M. Stanton-Hicks); Cleveland Clinic Center for Neurological Restoration and Department of Neurosurgery, Cleveland, OH, USA (A. Machado); Cleveland Clinic Center for Pain Anesthesia, Cleveland, OH, USA (S. Narouze).
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  • Samer Narouze MD

    1. From the Headache Specialists, Las Vegas, NV, USA (M. Ansarinia); Department of Neurosurgery and Center for Neuromodulation, The Ohio State University, Columbus, OH, USA (A. Rezai and J. Stump); Cleveland Clinic Centers for Headache and Pain and Neurological Restoration and Department of Neurology, Cleveland, OH, USA (S.J. Tepper); Cleveland Clinic Innovations, Product Development Manager, Center for Neurological Restoration, Cleveland, OH, USA (C.P. Steiner); Cleveland Clinic Center for Pain Anesthesia, Cleveland, OH, USA (M. Stanton-Hicks); Cleveland Clinic Center for Neurological Restoration and Department of Neurosurgery, Cleveland, OH, USA (A. Machado); Cleveland Clinic Center for Pain Anesthesia, Cleveland, OH, USA (S. Narouze).
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  • Conflict of Interest: None.

M. Ansarinia, 3101 South Maryland Parkway, Suite 211, Las Vegas, NV 89109, USA.

Abstract

(Headache 2010;50:1164-1174)

Introduction.— Cluster headaches (CH) are primary headaches marked by repeated short-lasting attacks of severe, unilateral head pain and associated autonomic symptoms. Despite aggressive management with medications, oxygen therapy, nerve blocks, as well as various lesioning and neurostimulation therapies, a number of patients are incapacitated and suffering. The sphenopalatine ganglion (SPG) has been implicated in the pathophysiology of CH and has been a target for blocks, lesioning, and other surgical approaches. For this reason, it was selected as a target for an acute neurostimulation study.

Methods.— Six patients with refractory chronic CH were treated with short-term (up to 1 hour) electrical stimulation of the SPG during an acute CH. Headaches were spontaneously present at the time of stimulation or were triggered with agents known to trigger clusters headache in each patient. A standard percutaneous infrazygomatic approach was used to place a needle at the ipsilateral SPG in the pterygopalatine fossa under fluoroscopic guidance. Electrical stimulation was performed using a temporary stimulating electrode. Stimulation was performed at various settings during maximal headache intensity.

Results.— Five patients had CH during the initial evaluation. Three returned 3 months later for a second evaluation. There were 18 acute and distinct CH attacks with clinically maximal visual analog scale (VAS) intensity of 8 (out of 10) and above. SPG stimulation resulted in complete resolution of the headache in 11 attacks, partial resolution (>50% VAS reduction) in 3, and minimal to no relief in 4 attacks. Associated autonomic features of CH were resolved in each responder. Pain relief was noted within several minutes of stimulation.

Conclusion.— Sphenopalatine ganglion stimulation can be effective in relieving acute severe CH pain and associated autonomic features. Chronic long-term outcome studies are needed to determine the utility of SPG stimulation for management and prevention of CH.

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