Abstract
Purpose of Review
To provide an integrated overview of the current state of knowledge of neuromodulation for the sphenopalatine ganglion (SPG) by reviewing relevant and significant literature.
Recent Findings
There are several case reports and clinical trials evaluating neuromodulation for the SPG. We identified two blinded, randomized clinical trials for patients with chronic cluster headache. The randomized trials and additional studies demonstrated the long-term safety, efficacy, and cost-effectiveness of neuromodulation for the SPG.
Summary
Recent studies in Europe and the USA suggest that SPG neuromodulation is a novel modality with clinical importance for treating acute cluster headaches and reducing the frequency of attacks.
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Data Availability
All data is presented in this manuscript; any additional data is available upon reasonable request.
References
Ho KWD, Przkora R, Kumar S. Sphenopalatine ganglion: block, radiofrequency ablation and neurostimulation - a systematic review. J Headache Pain. 2017;18(1):118.
Robbins MS, Robertson CE, Kaplan E, Ailani J, Charleston L, Kuruvilla D, et al. The sphenopalatine ganglion: anatomy, pathophysiology, and therapeutic targeting in headache. Headache J Head Face Pain. 2016;56(2):240–58.
Hainer BL, Matheson EM. Approach to acute headache in adults. Am Fam Physician. 2013;87(10):682–7.
Goadsby PJ. Pathophysiology of cluster headache: a trigeminal autonomic cephalgia. Lancet Neurol. 2002;1(4):251–7.
Tepper SJ, Caparso A. Sphenopalatine ganglion (SPG): stimulation mechanism, safety, and efficacy. Headache. 2017;57(Suppl 1):14–28.
Sluder G. The role of the sphenopalatine ganglion in nasal headaches. NY State J Med. 1908.
Topazweb. Sphenopalatine ganglion medical illustration. https://www.giverr.com/topazweb. Accessed and purchased 10 Nov 2022.
Jürgens TP, May A. Role of sphenopalatine ganglion stimulation in cluster headache. Curr Pain Headache Rep. 2014;18(7):433.
Devoghel JC. Cluster headache and sphenopalatine block. Acta Anaesthesiol Belg. 1981;32(1):101–7.
Hardebo JE, Elner A. Nerves and vessels in the pterygopalatine fossa and symptoms of cluster headache. Headache. 1987;27(10):528–32.
Piagkou M, Demesticha T, Troupis T, Vlasis K, Skandalakis P, Makri A, et al. The pterygopalatine ganglion and its role in various pain syndromes: from anatomy to clinical practice: PPG and its role in pain syndromes. Pain Pract. 2012;12(5):399–412.
INS. How has neuromodulation been developed and used? [Internet]. international neuromodulation society. [cited 2022 Oct 27]. Available from: https://www.neuromodulation.com/learn-more.
Fontaine D, Lazorthes Y, Mertens P, Blond S, Géraud G, Fabre N, et al. Safety and efficacy of deep brain stimulation in refractory cluster headache: a randomized placebo-controlled double-blind trial followed by a 1-year open extension. J Headache Pain. 2010;11(1):23–31.
Silberstein SD, Dodick DW, Saper J, Huh B, Slavin KV, Sharan A, et al. Safety and efficacy of peripheral nerve stimulation of the occipital nerves for the management of chronic migraine: results from a randomized, multicenter, double-blinded, controlled study. Cephalalgia Int J Headache. 2012;32(16):1165–79.
Oshinsky ML, Murphy AL, Hekierski H, Cooper M, Simon BJ. Noninvasive vagus nerve stimulation as treatment for trigeminal allodynia. Pain. 2014;155(5):1037–42.
Wolter T, Kiemen A, Kaube H. High cervical spinal cord stimulation for chronic cluster headache. Cephalalgia Int J Headache. 2011;31(11):1170–80.
Transcranial Direct Current Stimulation (tDCS) of the visual cortex: a proof-of-concept study based on interictal electrophysiological abnormalities in migraine | The Journal of Headache and Pain | Full Text [Internet]. [cited 2022 Oct 28]. Available from: https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/1129-2377-14-23.
Barker AT, Shields K. Transcranial magnetic stimulation: basic principles and clinical applications in migraine. Headache. 2017;57(3):517–24.
Magis D, Sava S, d’Elia TS, Baschi R, Schoenen J. Safety and patients’ satisfaction of transcutaneous Supraorbital NeuroStimulation (tSNS) with the Cefaly® device in headache treatment: a survey of 2,313 headache sufferers in the general population. J Headache Pain. 2013;14(1):95.
Ramsey RR, Ryan JL, Hershey AD, Powers SW, Aylward BS, Hommel KA. Treatment adherence in patients with headache: a systematic review. Headache. 2014;54(5):795–816.
Ibarra E. Neuromodulación del ganglio esfenopalatino para aliviar los síntomas de la cefalea en racimos: reporte de un caso. Dolor. 2007;12–8.
Tepper SJ, Rezai A, Narouze S, Steiner C, Mohajer P, Ansarinia M. Acute treatment of intractable migraine with sphenopalatine ganglion electrical stimulation. Headache. 2009;49(7):983–9.
Ansarinia M, Rezai A, Tepper SJ, Steiner CP, Stump J, Stanton-Hicks M, et al. Electrical stimulation of sphenopalatine ganglion for acute treatment of cluster headaches. Headache. 2010;50(7):1164–74.
Schoenen J, Jensen RH, Lantéri-Minet M, Láinez MJ, Gaul C, Goodman AM, et al. Stimulation of the sphenopalatine ganglion (SPG) for cluster headache treatment. Pathway CH-1: a randomized, sham-controlled study. Cephalalgia. 2013;33(10):816–30.
Jürgens TP, Barloese M, May A, Láinez JM, Schoenen J, Gaul C, et al. Long-term effectiveness of sphenopalatine ganglion stimulation for cluster headache. Cephalalgia. 2017;37(5):423–34.
Barloese MCJ, Jürgens TP, May A, Lainez JM, Schoenen J, Gaul C, et al. Cluster headache attack remission with sphenopalatine ganglion stimulation: experiences in chronic cluster headache patients through 24 months. J Headache Pain. 2016;17(1):67.
Barloese M, Petersen A, Stude P, Jürgens T, Jensen RH, May A. Sphenopalatine ganglion stimulation for cluster headache, results from a large, open-label European registry. J Headache Pain. 2018;19(1):6.
Goadsby PJ, Sahai-Srivastava S, Kezirian EJ, Calhoun AH, Matthews DC, McAllister PJ, et al. Safety and efficacy of sphenopalatine ganglion stimulation for chronic cluster headache: a double-blind, randomised controlled trial. Lancet Neurol. 2019;18(12):1081–90.
Pietzsch JB, Garner A, Gaul C, May A. Cost-effectiveness of stimulation of the sphenopalatine ganglion (SPG) for the treatment of chronic cluster headache: a model-based analysis based on the Pathway CH-1 study. J Headache Pain. 2015;16(1):48.
Pietzsch JB, Weber SA, Lund N, Gaul C. Changes in medication cost observed in chronic cluster headache patients treated with sphenopalatine ganglion (SPG) stimulation: analysis based on 1-year data from the Pathway R-1 Registry. Cephalalgia Int J Headache. 2018;38(8):1455–62.
Khan S, Schoenen J, Ashina M. Sphenopalatine ganglion neuromodulation in migraine: what is the rationale? Cephalalgia Int J Headache. 2014;34(5):382–91.
Fontaine D, Santucci S, Lanteri-Minet M. Managing cluster headache with sphenopalatine ganglion stimulation: a review. J Pain Res. 2018;16(11):375–81.
Jessup C. Autonomic technologies gains expanded indication of CE mark for Pulsante SPG Microstimulator System. Available at: https://www.fdanews.com/articles/180842-autonomic-technologies-gains-expanded-indication-of-ce-mark-for-pulsante-spg-microstimulator-system. (Accessed 23 Nov 2022).
May A. The need for continued care after sponsor closure. Lancet Neurol. 2020;19(3):205.
Goadsby PJ, Rezai AR, Dodick DW. The need for continued care after sponsor closure – Authors’ reply. Lancet Neurol. 2020;19(3):205–6.
https://www.prnewswire.com/news-releases/unity-ha-awarded-breakthrough-device-designation-for-implantable-neurostimulation-technology-to-treat-cluster-headache-pain-301298964.html. Accessed 2 Dec 2022. https://www.businesswire.com/news/home/20210818005115/en/Unity-HA-Adds-Jon-J.-Snyder-as-CEO-Announces-Name-Change-to-Realeve%E2%84%A2#:~:text=The%20company%20also%20announced%20the. Accessed 2 Dec 2022.
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Lim, T., Anderson, S., Stocum, R. et al. Neuromodulation for the Sphenopalatine Ganglion—a Narrative Review. Curr Pain Headache Rep 27, 645–651 (2023). https://doi.org/10.1007/s11916-023-01132-3
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DOI: https://doi.org/10.1007/s11916-023-01132-3