Quantitative Sensory Testing May Predict Response to Sphenopalatine Ganglion Pulsed Radiofrequency Treatment in Cluster Headaches: A Case Series

Abstract

Pulsed radiofrequency treatment has been described as a nonablative alternative to radiofrequency thermocoagulation for the management of certain chronic pain syndromes. We present our first three patients with long-standing cluster headaches who were treated with pulsed radiofrequency to the sphenopalatine ganglion. All three patients have had cluster headaches for more than 10 years' duration and experienced minimal relief with conservative treatment. An excellent midterm effect was achieved in two of the three patients and a partial effect in one. No neurological side effects or complications were reported. Quantitative sensory testing consisting of allodynia testing, pressure-pain thresholds, electrical pain thresholds, and conditioned pain modulation (CPM) response testing were used to monitor their sensory processing changes before and after the procedure. From this case series, it might be that cluster headache patients with an impaired CPM response with or without signs of allodynia will respond less favorably to interventional treatment. Further studies are required to validate this hypothesis.

Conditioned Pain Modulation Predicts Exercise-Induced Hypoalgesia in Healthy Adults

“…Two such studies have reported an association of CPM with pain reduction using transcutaneous electrical nerve stimulation in individuals with fibromyalgia 4 and pulsed radio frequency current in individuals with cluster headaches. 2 Specific to exercise, there are likely multiple mechanisms responsible for EIH, 3,8,13 and CPM could provide an additive effect as the exercise becomes painful. For example, pain is seen to increase steadily during prolonged submaximal isometric contractions.…”

Sphenopalatine Ganglion Block in the Management of Chronic Headaches

“…Two patients were symptom free up to 4 months, while the third patient experienced partial pain relief only. While the results of this study yielded mixed reviews, it demonstrated for the first time that PRF could be an acceptable alternative for patients non-responsive to conservative therapies [25]. The results of this case study have been replicated, with minimum treatment-related adverse events or complications, in other slightly larger studies [26,27].…”

“…Chua et al performed the first documented case series of PRF to the SPG. There were three patients with a history of cluster headaches in this study [25]. Two patients were symptom free up to 4 months, while the third patient experienced partial pain relief only.…”

Long‐term Outcomes of Computerized Tomography–Guided Sphenopalatine Ganglion–Targeted Pulsed Radiofrequency for Refractory Cluster Headache

“…Subsequently, studies have reported the efficacy of SPG‐PRF therapy for patients with CH. The available limited literature suggests that PRF of the SPG is a quick, effective, and safe approach for treating refractory CHs . In our previous study, we found that computerized tomography (CT)‐guided PRF of the SPG had an efficacy rate of 85% for treating ECHs.…”