Sphenopalatine ganglion block for refractory COVID-19 headache: a descriptive case series

Machado, Felipe Chiodini; Neto, Gilson Carone; Carone, Rebeca Santiago Duarte

doi:10.1016/j.bjane.2021.04.024

Cited by 6 publications

(5 citation statements)

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“…However, it is unclear whether the headache was acute or persistent, or for how long the patients were followed up. 50 …”

Section: Managementmentioning

confidence: 99%

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Headache associated with COVID‐19: Epidemiology, characteristics, pathophysiology, and management

Rocha-Filho

2022

Headache

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Objective: To review data regarding the epidemiology, pathophysiology, characteristics, and management of COVID-19-associated headache. The persistence of headache after the acute phase of COVID-19 was also reviewed. Background:Headache is a frequent symptom of COVID-19, and understanding its management is important for health-care professionals involved in treating the disease.Method: This is a narrative review. A literature review was conducted in the PubMed database with the following terms: "headache" and "COVID-19." All articles written in English that were considered relevant were included.Results: Half of the patients who have COVID-19 present with headache, which occurs more frequently in younger patients; in those with previous primary headache or with previous migraine; and in those who have concomitantly presented with anosmia, ageusia, and myalgia. The headache usually begins early in the symptomatic phase, is bilateral, moderate to severe, and has a similar pattern to tension-type headache. All studies found the migraine pattern and the tension-type headache pattern to be frequent patterns. The possible pathophysiological mechanisms include direct viral injury, the inflammatory process, hypoxemia, coagulopathy, and endothelial involvement. Common analgesics and nonsteroidal anti-inflammatory drugs are the most commonly used drugs for headache in the acute phase of COVID-19. The headache may persist beyond the acute phase, and in such cases, there is an improvement over time. However, not all patients' headaches improve. It seems to be a greater proportion of patients whose headache improves in the first 3 months after the acute phase of the disease than after this period. COVID-19 may trigger new daily persistent headache. Conclusions:Headache is a clinically significant symptom of COVID-19. Although its characteristics in the acute phase of the disease are already well known, there is a need for studies on its management and persistence.

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“…However, it is unclear whether the headache was acute or persistent, or for how long the patients were followed up. 50 …”

Section: Managementmentioning

confidence: 99%

“…A case series described six patients whose headache improved after sphenopalatine ganglion block. However, it is unclear whether the headache was acute or persistent, or for how long the patients were followed up 50 …”

Section: Managementmentioning

confidence: 99%

Headache associated with COVID‐19: Epidemiology, characteristics, pathophysiology, and management

Rocha-Filho

2022

Headache

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“…In einer Fallserie von 6 Patient:innen mit Kopfschmerzen im Verlauf einer Infektion konnten diese durch eine nasal verabreichte Blockade des Ganglion sphenopalatinum (SPG) mit Lokalanästhetika signifikant gebessert werden [ 22 ]. Ähnlich wird in einer retrospektiven Serie in 27 Patient:innen (12 Frauen, 15 Männer) mit Post-COVID-Kopfschmerzen von einer signifikanten Besserung nach einer Blockade des Nervus occipitalis major berichtet [ 17 ].…”

Section: Diskussionunclassified

COVID-19-Impfung-assoziierte anhaltende Kopfschmerzen: Wie einordnen?

Straube

Ruscheweyh

Klonowski

2023

Schmerz

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Einleitung Im Rahmen einer akuten COVID-19-Infektion (Coronavirus SARS-CoV‑2 Infektion) treten in 10–60 % der Patient:innen Kopfschmerzen auf, die Tage und in einem kleineren Teil (ca. 10 %) der Patient:innen Wochen oder länger anhalten können. Weniger bekannt ist aber, dass auch nach einer COVID-19-Impfung anhaltende Kopfschmerzen auftreten können. Methode Retrospektive Beschreibung der Kopfschmerzen und des Verlaufs in einer Fallserie von 32 ambulanten Patienten mit anhaltenden Kopfschmerzen, die sich in zeitlichem Zusammenhang mit einer COVID-19-Impfung verstärkt haben oder neu aufgetreten sind. Ergebnis In der Mehrzahl der Patient:innen kam es zur Verstärkung eines vorbestehenden Migränekopfschmerzes. Bei 2 Patient:innen traten seltene sekundäre Kopfschmerzsyndrome wie intrakranielle Hypertension oder Donnerschlagkopfschmerz auf. Die Kopfschmerzen manifestierten sich in über 50 % der Patient:innen innerhalb der ersten 48 h nach Impfung. Über 50 % der Patient:innen sprachen auf eine Akuttherapie mit einem Triptan an. Schlussfolgerung Über den pathophysiologischen Zusammenhang zwischen Impfung und anhaltenden Kopfschmerzen bestehen noch keine klaren Vorstellungen. Die kurze Latenz, die partielle Wirksamkeit von Kortison und erste Befunde, die eine Erhöhung von verschiedenen Entzündungsmarkern im Verlauf der Kopfschmerzen bei COVID-Infektion zeigen, weisen auf eine mögliche Beteiligung des angeborenen Immunsystems und hier des Inflammasoms hin. Des Weiteren weist das Ansprechen auf eine Triptangabe bei einem Teil der Patienten auf eine Aktivierung des trigeminovaskulären Systems hin.

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“…To regulate sympathetic overactivity, stellate ganglion blocks have been considered [ 48 , 50 ]. However, the rationale for blocking the sphenopalatine ganglion for non‐specific headache is not clear [ 51 , 52 ]. Myalgia is common in other viral disease, mediated by interleukin‐6 (IL‐6), upregulated in muscle and joint tissues [ 7 ].…”

Section: Mechanisms and Treatment Considerations Of Covid ...mentioning

confidence: 99%

The COVID‐19 pandemic and its consequences for chronic pain: a narrative review

et al. 2022

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Summary The COVID‐19 pandemic transformed everyday life, but the implications were most impactful for vulnerable populations, including patients with chronic pain. Moreover, persistent pain is increasingly recognised as a key manifestation of long COVID. This narrative review explores the consequences of the COVID‐19 pandemic for chronic pain. Publications were identified related to the COVID‐19 pandemic influence on the burden of chronic pain, development of new‐onset pain because of long COVID with proposed mechanisms and COVID‐19 vaccines and pain interventions. Broadly, mechanisms underlying pain due to SARS‐CoV‐2 infection could be caused by ‘systemic inflammatory‐immune mechanisms’, ‘direct neuropathic mechanisms’ or ‘secondary mechanisms due to the viral infection or treatment’. Existing chronic pain populations were variably impacted and social determinants of health appeared to influence the degree of effect. SARS‐CoV‐2 infection increased the absolute numbers of patients with pain and headache. In the acute phase, headache as a presenting symptom predicted a milder course. New‐onset chronic pain was reportedly common and likely involves multiple mechanisms; however, its prevalence decreases over time and symptoms appear to fluctuate. Patients requiring intensive support were particularly susceptible to long COVID symptoms. Some evidence suggests steroid exposure (often used for pain interventions) may affect vaccine efficacy, but there is no evidence of clinical repercussions to date. Although existing chronic pain management could help with symptomatic relief, there is a need to advance research focusing on mechanism‐based treatments within the domain of multidisciplinary care.

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Sphenopalatine ganglion block for refractory COVID-19 headache: a descriptive case series

Cited by 6 publications

References 5 publications

Headache associated with COVID‐19: Epidemiology, characteristics, pathophysiology, and management

Headache associated with COVID‐19: Epidemiology, characteristics, pathophysiology, and management

COVID-19-Impfung-assoziierte anhaltende Kopfschmerzen: Wie einordnen?

The COVID‐19 pandemic and its consequences for chronic pain: a narrative review

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