Clinical course of patients with episodic cluster headache treated with corticosteroids inproximity to the sphenopalatine ganglion: A preliminary study of 23 patients

Abstract

Objective: A study is made of the clinical course of patients with episodic cluster headache following the injection of corticosteroids in the proximity of the sphenopalatine ganglion of the affected side. Study Design: A retrospective observation study was made corresponding to the period between 2006 and 2010. Patients with episodic cluster headache received corticosteroid infiltrations in the vicinity of the sphenopalatine ganglion. Data were collected to assess the clinical course, quantifying pain intensity and quality of life. A total of 23 patients (11 women and 12 men) with a mean age of 50.4 years (range 25-65) were included. Forty percent of the patients had undergone dental extractions in the quadrant affected by the pain, before the development of episodic cluster headache, and 37.8% underwent extractions in the same quadrant after appearance of the headache. Results: Most of the patients suffered 1-3 attacks a day, with a duration of pain of between 31-90 minutes. The mean pain intensity score during the attacks at the time of the first visit was 8.8 (range 6-10), versus 5.4 (range 3-9) one week after the first corticosteroid injection. On the first visit, 86.9% of the patients reported unbearable pain, versus 21.7% after one week, and a single patient after one month. Conclusions: The evolution of episodic cluster headache is unpredictable and variable, though corticosteroid administration clearly reduces the attacks and their duration. Key words:Episodic cluster headache, vascular pain, sphenopalatine ganglion, corticosteroid infiltration.

Unsuccessful Pulsed Radiofrequency of the Sphenopalatine Ganglion in Patients with Chronic Cluster Headache and Subsequent Successful Thermocoagulation

“…Fifth, we cannot conclude if the success of the last procedure was due to the CRF of the SPG, the corticosteroid injection within the pterygopalatine fossa, or a combination of both treatments. For example, Sanders and Zuurmond achieved good results after CRF without performing corticosteroid injection in the SPG, whereas Peñarrocha‐Diago also reported favorable results following SPG corticosteroid injection alone . Other authors, as we did in this article, carry out both treatments during the same procedure .…”

“…Other authors, as we did in this article, carry out both treatments during the same procedure . However, anesthetic blockade, plus corticosteroid injection, seems to produce only temporary improvement . Sixth, we must comment that the only patient who achieved some improvement in autonomic manifestations also experienced at least some pain relief following PRF‐SPG.…”

“…Even though the physiopathology of CH is still unknown, the hypothalamus is thought to be the generator of this disease because of its circadian and circannual periodicity and the activation of the posterior hypothalamus found in neuroimaging studies that were undertaken during the attacks. Furthermore, activation of the parasympathetic outflow from the superior salivary nucleus via the SPG is supposed, explaining the autonomic manifestations of CH and the likely role of the SPG at least in this aspect of the disease . Indeed, it was shown that low frequency (5 Hz) SPG stimulation could induce cluster‐like attacks with autonomic features.…”

“…Cluster headache (CH) is a trigeminal autonomic cephalalgia, a condition that is characterized by severe unilateral headache and cranial parasympathetic manifestations . Approximately 10% to 15% of patients develop chronic cluster headache (CCH) .…”

“…In these cases, as well as those in which the side effects of the medications are intolerable a sphenopalatine ganglion (SPG) block may be indicated. Although several methods for blockade are proposed in the literature, we previously used continuous radiofrequency (CRF) of the SPG in patients with medically refractory CCH . However, there may be some complications following this procedure, such as hyperpathia or deafferentation pain in the territory of the maxillary branch of the trigeminal nerve; permanent or transient hypesthesia; hypersensitivity or dysesthesia in the palate; maxilla;, gums; cheek or posterior pharynx; in addition to dryness of the eye and reflex bradycardia during radiofrequency lesioning .…”