Transnasal Sphenopalatine Ganglion Block for the Preventive Treatment of Chronic Daily Headache in Adolescents

Abstract

Chronic headaches are a major source of morbidity in the pediatric population, affecting physical function, school attendance, social capacity, mood, and sleep. In adults, repetitive sphenopalatine ganglion (SPG) blockade has been studied as a preventive treatment for chronic migraines. This case series aims to evaluate the SPG block for the preventive treatment of chronic daily headache (CDH) in adolescents. We prospectively evaluated 17 adolescents (14 females, 14 ± 1 year) with CDH not responding to cognitive behavioral therapy (CBT), physiotherapy, and standard medications. Each patient received 10 SPG blocks (two blocks/week) using the Tx360® device. At the end of treatment, 10 patients (59%) reported a Patient’s Global Impression of Change (PGIC) score ≥ 67%, and 3 months after the end of treatment, nine patients (53%) sustained a PGIC ≥ 67%. There was also a statistically significant reduction in the depression subscale of the Revised Children’s Anxiety and Depression Scale (RCADS) at the end of treatment and 3 months post-treatment compared with baseline. The procedure was well tolerated with no adverse effects. In our study, the use of repeat SPG blockade was associated with sustained benefits on the PGIC and the depression subscale of the RCADS when used as preventive headache treatment in adolescents with refractory CDH.

Emerging Pharmacological Treatments for Migraine in the Pediatric Population

“…Although there is some evidence in adults (achieved with various techniques, including intranasal lidocaine) [67], studies on SPG blockade in the pediatric population are still lacking [68]. In general, few reports have been published on peripheral nerve blocks with local anesthetics or devices in children [49].…”

“…In 2017, an abstract reported 133 SPG procedures performed in 85 patients aged 7-18 years as acute treatment for migraine, which decreased headache pain 10 min after the procedure with no complications [69]. Recently, a prospective case series evaluated the SPG block for the prevention of chronic daily headache in 17 adolescents, receiving multiple blocks using a medical device: a benefit on the Patient's Global Impression of Change (PGIC) score after three months of treatment with no adverse events was reported [68]. However, there are no published placebo-controlled studies of SPG blocks in the pediatric population to date.…”