Advertisement

Cluster headache: crosspoint between otologists and neurologists—treatment of the sphenopalatine ganglion and systematic review

  • Cecilia Rosso
  • Giovanni FelisatiEmail author
  • Antonio Bulfamante
  • Carlotta Pipolo
Review Article
  • 1 Downloads

Abstract

Among cephalgias, cluster headache (CH) is the rarest and the most disabling, explaining the appellation of “suicide headache.” Up to 20% of chronic CH reveals to be resistant to pharmacological treatments, in which case interventional procedures should be considered. Many reports evaluated invasive approaches and a wide strand of research is dedicated to the sphenopalatine ganglion. Our paper will now be focused on providing an overview on modern applications on the sphenopalatine ganglion (SPG), their outcomes, and their feasibility in terms of risks and benefits. The group reviewed the international literature systematically for procedures targeting the sphenopalatine ganglion and its branches for episodic and chronic CH, including block, stimulation, radiofrequency, stereotactic radiosurgery, and vidian neurectomy. Seventeen articles fixed our inclusion criteria. Comparing the outcomes that have been analyzed, it is possible to notice how the most successful procedure for the treatment of refractory chronic and episodic CH is the SPG block, which reaches respectively 76.5% and 87% of efficacy. Radiofrequency has a wide range of outcomes, from 33 to 70.3% in CCH. Stimulation of SPG only achieved up to 55% of outcomes in significant reduction in attack frequency in CCH and 71% in ECH. Radiosurgery and vidian neurectomy on SPG have also been analyzed. Generally, ECH patients show better response to standard medical therapies; nevertheless, even this more manageable condition may sometimes benefit from interventional therapies mostly reserved for CCH. First results seem promising and considering the low frequency of side effects or complications, we should think of expanding the indications of the procedures also to those conditions. Outcomes certainly suggest that further studies are necessary in order to understand which method is the most effective and with less side effects. Placebo-controlled studies would be pivotal, and tight collaboration between neurologists and otorhinolaryngologists should also be central in order to give correct indications, which allow us to expect procedures on the SPG to be an effective and mostly safe method to control either refractory ECH or CCH.

Keywords

Cluster headache Sphenopalatine ganglion Endoscopic transnasal approach Refractory headache Cephalgia 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

This article does not contain any study with human subjects performed by any of the authors.

References

  1. 1.
    Rozen TD, Fishman RS (2012) Cluster headache in the United States of America: demographics, clinical characteristics, triggers, suicidality, and personal burden. Headache J Head Face Pain 52(1):99–113CrossRefGoogle Scholar
  2. 2.
    Fischera M, Marziniak M, Gralow I, Evers S (2008) The incidence and prevalence of cluster headache: a meta-analysis of population-based studies. Cephalalgia 28(6):614–618CrossRefGoogle Scholar
  3. 3.
    Fanciullacci M, Alessandri M (2018) Le cefalee primarie nella pratica clinica. Google LibriGoogle Scholar
  4. 4.
    Farri A, Enrico A, Farri F (2012) Headaches of otolaryngological interest: current status while awaiting revision of classification. Practical considerations and expectations. Acta Otorhinolaryngol Ital 32(2):77–86Google Scholar
  5. 5.
    Gooriah R, Buture A, Ahmed F (2015) Evidence-based treatments for cluster headache. Ther Clin Risk Manag 11:1687–1696CrossRefGoogle Scholar
  6. 6.
    Cepero R, Miller RH, Bressler KL (1987) Long-term results of sphenopalatine ganglioneurectomy for facial pain. Am J Otolaryngol 8(3):171–174CrossRefGoogle Scholar
  7. 7.
    Sebastian S, Schweitzer D, Tan L, Broadley SA (2013) Role of trigeminal microvascular decompression in the treatment of SUNCT and SUNA. Curr Pain Headache Rep 17(5):332CrossRefGoogle Scholar
  8. 8.
    Magis D, Gérard P, Schoenen J (2016) Invasive occipital nerve stimulation for refractory chronic cluster headache: what evolution at long-term? Strengths and weaknesses of the method. J Headache Pain 17:8CrossRefGoogle Scholar
  9. 9.
    Gaul C, Roguski J, Dresler T, Abbas H, Totzeck A, Görlinger K, Diener HC, Weber R (2017) Efficacy and safety of a single occipital nerve blockade in episodic and chronic cluster headache: a prospective observational study. Cephalalgia 37(9):873–880CrossRefGoogle Scholar
  10. 10.
    Kinfe TM, Schuss P, Vatter H (2015) Occipital nerve block prior to occipital nerve stimulation for refractory chronic migraine and chronic cluster headache: myth or prediction? Cephalalgia 35(4):359–362CrossRefGoogle Scholar
  11. 11.
    Gaul C, Diener HC, Silver N, Magis D, Reuter U, Andersson A, Liebler EJ, Straube A, on behalf of the PREVA Study Group (2016) Non-invasive vagus nerve stimulation for PREVention and Acute treatment of chronic cluster headache (PREVA): a randomised controlled study. Cephalalgia 36(6):534–546CrossRefGoogle Scholar
  12. 12.
    Saibene AM et al (2017) The role of laryngeal electromyography in vagus nerve stimulation-related vocal fold dysmotility. Eur Arch Oto-Rhino-Laryngol 274(3):1585–1589CrossRefGoogle Scholar
  13. 13.
    Felisati G, Saibene AM, Canevini MP (2015) In reference to Treatment of epilepsy by stimulation of the vagus nerve from head-and-neck surgical point of view. Laryngoscope 125(9):E326–E326CrossRefGoogle Scholar
  14. 14.
    Ji T, Yang Z, Liu Q, Liao J, Yin F, Chen Y, Zou L, Li B, Gao Y, Shu X, Huang S, Gao F, Liang J, Lin SF, Peng J, Song S, Wang J, Che C, Sun W, Tian M, Yang L, Hua Y, Hao Y, Cai L, Li L, Jiang Y (2019) Vagus nerve stimulation for pediatric patients with intractable epilepsy between 3 and 6 years of age: study protocol for a double-blind, randomized control trial. Trials 20(1):44CrossRefGoogle Scholar
  15. 15.
    Leone M, Franzini A, Bussone G (2001) Stereotactic stimulation of posterior hypothalamic gray matter in a patient with intractable cluster headache. N Engl J Med 345(19):1428–1429CrossRefGoogle Scholar
  16. 16.
    Akram H, Miller S, Lagrata S, Hariz M, Ashburner J, Behrens T, Matharu M, Zrinzo L (2017) Optimal deep brain stimulation site and target connectivity for chronic cluster headache. Neurology 89(20):2083–2091CrossRefGoogle Scholar
  17. 17.
    Leone M, Franzini A, Cecchini AP, Bussone G (2012) Efficacy of hypothalamic stimulation for chronic drug-resistant cluster headache. Cephalalgia 32(4):267–268CrossRefGoogle Scholar
  18. 18.
    Felisati G, Lozza P, Maccari A, Scotti A, Leone M, Bussone G (2005) The role of the ear, nose and throat specialist in diagnosing headaches. Neurol Sci 26(S2):s83–s86CrossRefGoogle Scholar
  19. 19.
    Leone M et al (2005) Deep brain stimulation and cluster headache. Neurol Sci 26(S2):s138–s138CrossRefGoogle Scholar
  20. 20.
    Vyas DB, Ho AL, Dadey DY, Pendharkar AV, Sussman ES, Cowan R, Halpern CH (2018) Deep brain stimulation for chronic cluster headache: a review. Neuromodulation Technol Neural InterfaceGoogle Scholar
  21. 21.
    Hoffmann J, May A (2018) Diagnosis, pathophysiology, and management of cluster headache. Lancet Neurol 17(1):75–83CrossRefGoogle Scholar
  22. 22.
    DOCK G (1929) Sluder’s nasal ganglion syndrome and its relation to internal medicine. J Am Med Assoc 93(10):750CrossRefGoogle Scholar
  23. 23.
    Felisati G, Arnone F, Lozza P, Leone M, Curone M, Bussone G (2006) Sphenopalatine endoscopic ganglion block: a revision of a traditional technique for cluster headache. Laryngoscope 116(8):1447–1450CrossRefGoogle Scholar
  24. 24.
    Pipolo C, Bussone G, Leone M, Lozza P, Felisati G (2010) Sphenopalatine endoscopic ganglion block in cluster headache: a reevaluation of the procedure after 5 years. Neurol Sci 31(SUPPL.1):S197–S199CrossRefGoogle Scholar
  25. 25.
    Levin M (2010) Nerve blocks in the treatment of headache. Neurotherapeutics 7(2):197–203CrossRefGoogle Scholar
  26. 26.
    Robbins MSMS et al (2016) The sphenopalatine ganglion: anatomy, pathophysiology, and therapeutic targeting in headache. Headache 56(2):240–258CrossRefGoogle Scholar
  27. 27.
    Carroll I, Hah J, Nicholson D, Coleman S (2011) Local anesthetics and other interventional approaches. In: Neuropatic pain: cause, management and understanding, pp 267–272Google Scholar
  28. 28.
    Zanella S et al (2018) Transnasal sphenopalatine ganglion blockade for acute facial pain: a prospective randomized case-control study. Eur Rev Med Pharmacol Sci 22(1):210–216Google Scholar
  29. 29.
    Magis D, Jensen R, Schoenen J (2012) Neurostimulation therapies for primary headache disorders: present and future. Curr Opin Neurol 25(3):269–276CrossRefGoogle Scholar
  30. 30.
    Narouze SNSN (2010) Role of sphenopalatine ganglion neuroablation in the management of cluster headache. Curr Pain Headache Rep 14(2):160–163CrossRefGoogle Scholar
  31. 31.
    Wei DYDY, Jensen RHRH (2018) Therapeutic approaches for the management of trigeminal autonomic cephalalgias. Neurotherapeutics 15(2):346–360CrossRefGoogle Scholar
  32. 32.
    Peñarrocha-Diago M et al (2012) Clinical course of patients with episodic cluster headache treated with corticosteroids inproximity to the sphenopalatine ganglion: a preliminary study of 23 patients. Med Oral Patol Oral Cir Bucal 17(3):e477–e482CrossRefGoogle Scholar
  33. 33.
    Kastler A, Cadel G, Comte A, Gory G, Piccand V, Tavernier L, Kastler B (2014) Alcohol percutaneous neurolysis of the sphenopalatine ganglion in the management of refractory cranio-facial pain. Neuroradiology 56(7):589–596CrossRefGoogle Scholar
  34. 34.
    Bratbak DFDF et al (2016) Pilot study of sphenopalatine injection of onabotulinumtoxinA for the treatment of intractable chronic cluster headache. Cephalalgia 36(6):503–509CrossRefGoogle Scholar
  35. 35.
    Aschehoug I, Bratbak DFDF, Tronvik EAEA (2018) Long-term outcome of patients with intractable chronic cluster headache treated with injection of onabotulinum toxin a toward the sphenopalatine ganglion - an observational study. Headache 58(10):1519–1529CrossRefGoogle Scholar
  36. 36.
    Devoghel JCC (1981) Cluster headache and sphenopalatine block. Acta Anaesthesiol Belg 32(1):101–107Google Scholar
  37. 37.
    Filippini-De Moor GPG et al (1999) Retrospective analysis of radiofrequency lesions of the sphenopalatine ganglion in the treatment of 19 cluster headache patients. Pain Clin 11(4):285–291Google Scholar
  38. 38.
    Narouze S, Kapural L, Casanova J, Mekhail N (2009) Sphenopalatine ganglion radiofrequency ablation for the management of chronic cluster headache. Headache 49(4):571–577CrossRefGoogle Scholar
  39. 39.
    Fang L, Jingjing L, Ying S, Lan M, Tao W, Nan JJ (2016) Computerized tomography-guided sphenopalatine ganglion pulsed radiofrequency treatment in 16 patients with refractory cluster headaches: twelve- to 30-month follow-up evaluations. Cephalalgia 36(2):106–112CrossRefGoogle Scholar
  40. 40.
    Salgado-Lopez L et al (2018) Efficacy of sphenopalatine ganglion radiofrequency in refractory chronic cluster headache. World NeurosurgGoogle Scholar
  41. 41.
    Ott K, Hodgens DW, Goetsch S (2010) Gamma knife® radiosurgery of the trigeminal nerve and sphenopalatine ganglion for cluster headache, vol. 7CrossRefGoogle Scholar
  42. 42.
    Kano H, Kondziolka D, Mathieu D, Stafford SL, Flannery TJ, Niranjan A, Pollock BE, Kaufmann AM, Flickinger JC, Lunsford LD (2011) Stereotactic radiosurgery for intractable cluster headache: an initial report from the North American Gamma Knife Consortium. J Neurosurg 114(6):1736–1743CrossRefGoogle Scholar
  43. 43.
    Schoenen J, Jensen RH, Lantéri-Minet M, Láinez MJA, Gaul C, Goodman AM, Caparso A, May A (2013) Stimulation of the sphenopalatine ganglion (SPG) for cluster headache treatment. Pathway CH-1: a randomized, sham-controlled study. Cephalalgia 33(10):816–830CrossRefGoogle Scholar
  44. 44.
    Barloese MCJMCJ et al (2016) Cluster headache attack remission with sphenopalatine ganglion stimulation: experiences in chronic cluster headache patients through 24 months. J Headache Pain 17(1):67CrossRefGoogle Scholar
  45. 45.
    Jürgens TP, Barloese M, May A, Láinez JM, Schoenen J, Gaul C, Goodman AM, Caparso A, Jensen RH (2017) Long-term effectiveness of sphenopalatine ganglion stimulation for cluster headache. Cephalalgia 37(5):423–434CrossRefGoogle Scholar
  46. 46.
    Barloese M, Petersen A, Stude P, Jürgens T, Jensen RH, May A (2018) Sphenopalatine ganglion stimulation for cluster headache, results from a large, open-label European registry. J. Headache Pain 19(1):6CrossRefGoogle Scholar
  47. 47.
    Barloese M et al (2016) Pathway registry 12 month interim results - long-term therapeutic effectiveness of sphenopalatine ganglion (SPG) stimulation for cluster headache (CH). CEPHALALGIA 36(1):1396–1397Google Scholar
  48. 48.
    Liu S-C, Kao M-C, Huang Y-C, Su W-F (2018) Vidian neurectomy for management of chronic cluster headache. NeurosurgeryGoogle Scholar

Copyright information

© Fondazione Società Italiana di Neurologia 2019

Authors and Affiliations

  • Cecilia Rosso
    • 1
  • Giovanni Felisati
    • 1
    • 2
    Email author
  • Antonio Bulfamante
    • 1
  • Carlotta Pipolo
    • 2
  1. 1.Otorhinolaryngology Unit, ASST Santi Paolo e CarloUniversity of MilanMilanItaly
  2. 2.Otorhinolaryngology Unit, Department of Health SciencesUniversity of MilanMilanItaly

Personalised recommendations