Cluster Headache is considered one of the worst pains known to man. SPG Blocks are extremely effective at turning off the pain of cluster headaches and other autonomic cephalgia. It has also been extremely effective in treatment chronic migraine, chronic daily headache and new persistent headaches.
This new paper (abstract below) is looking at the use of implanted neuromdulation device to provide stimulation to the ganglion inside the pterygopalatine fossa.
Self-Administration of SPG Blocks is extremely effective and supported by literature but is only infrequently taught to patients. I routinely teach patients to self-administer the blocks with trans-nasal cotton tipped cannulas in my Chicago area office.
The stimulation was effective in 67% of patients in alleviating acute pain. 39% of patients id not respond to neuromodulation. It would be interesting to study both responders and non-responders of neuromdulation to see if it is possible to predict effectiveness prior to invasive treatment. This could be done with trans-nasal application initially to screen patients if a positive correlation is achieved.
The study found that “Long-term results (24 months; 33 patients) confirmed the efficacy of SPG stimulation as an abortive treatment for CH attacks”. as well as reducing frequency of attacks in 35% of patients.
Cluster Headaches have been describes as “Individuals often describe the pain like having a “red hot poker” penetrating one eye.” I described my personal headaches (gone for 38 years) as a “Red hot poker coming in my right ear, searing thru my brain and exploding out my left eye” In the early 1980’s triptans were not available and I would take large amounts of Fiorinal #3 to take the edge off the pain. I found complete relief through treatment of a TMJ disorder with Neuromuscular Dentistry. The basis for neuromuscular dentistry trigeminally innervated muscles with an Ultra-Low Frequency TENS (ULF-TENS) called a Myomonitor. Learn more about the Neuromuscular Approach to treating and eliminating headaches at www.IHateHeadaches.org. and www.ThinkBetterLife.com
The Myomonitor provides bilateral stimulation by the use of three skin electrodes, one at the back of the neck and bilateral placement over the coronoid notch. The stimulation not only effects the somatosensory nerves of the trigeminal and facial nerves but also stimulates the Sphenopalatine Ganglion (SPG) where it sits on the maxillary division of the trigeminal nerve n the pterygopalatine fossa.
The Myomonitor has a fifty year safety record and requires no invasive procedures compared to the implanted device in this study
which showed “The safety of SPG microstimulator implantation procedure was evaluated in a cohort of 99 patients; facial sensory disturbances were observed in 67% of the patients (46% of them being transient), transient allodynia in 3%, and infection in 5%. SPG stimulation appears as a promising innovative, efficient, and safe therapeutic solution for patients suffering from severe CH.”
The Myomonitor is glaringly missing from the literature because stimulation of the Sphenopalatine Ganglion is not its primary purpose but rather a fortunate secondary effect. The Myomonitor in use with diagnostic neuromuscular dental orthotics may be one of the safest and most effective treatments available for a wide variety of headaches and migraines.
Myotronics/Noromed who makes the Myomonitor makes a small portable home unit called the BNS 40 That is extremely safe and effective for patient home use and requires only skin electrodes.
Cluster Headaches have been called the “Suicide Headache” due to their extreme severity. My headaches may not have met the criteria for cluster headaches which are usually one sided”. The article describes the as “CH is characterized by recurrent attacks of very severe unilateral pain, usually located in and around the orbit. During an attack, ipsilateral cranial autonomic symptoms (lacrimation, conjunctival injection, nasal congestion or rhinorrhea, ptosis, edema of the eyelid or the face, sweating of the forehead or the face, miosis) accompany the pain, and behavior is characterized by a marked sense of agitation and necessity to move. Attacks generally last 15 minutes to 3 hours and occur from once every day to eight times daily, sometimes with a striking circadian rhythmicity, with some patients reporting a predictability of onset during the day or, more frequently, during the night, waking from sleep. The term CH is related to the tendency of attacks to cluster together into bouts that last several weeks or months.”
This article give an excellent description of possible pathophysiology as: “The SPG is believed to play a pivotal role in cranial autonomic symptoms associated with pain and might be involved in headache pain. Recent hypothesis suggests that, during CH attacks, there is an activation of the parasympathetic superior salivatory nucleus and SPG parasympathetic fibers, inducing neuropeptides release (especially calcitonin gene-related peptide) and vasodilatation of the cerebral and dural blood vessels, which activate meningeal nociceptive fibers projecting to the trigeminal ganglion and nuclei. These processes induce referred pain in the periorbital region. Thus, blockage of the SPG, by any means, might theoretically interfere with this pathological process and treat CH attack.” It does tend to underplay the effectiveness of Sphenopalatine Ganglion with anesthetics. Blocks.
Byrd in his landmark 1930 paper “Sphenopalatine Phenomea” looked at over 10,000 sphenopalatine ganglion blocks in 2000 patients and complications were extrely rare and very minor. Byrd describes a testing method that could be applied to the sphenopalatine ganglion prior to injection, I think a similar test is warranted prior to implantation.
Full text of this article available.
J Pain Res. 2018 Feb 16;11:375-381. doi: 10.2147/JPR.S129641. eCollection 2018.
Managing cluster headache with sphenopalatine ganglion stimulation: a review.
Fontaine D1,2, Santucci S1,2, Lanteri-Minet M2,3,4.
Cluster headache (CH) is a primary headache and considered as one of the worst pains known to man. The sphenopalatine ganglion (SPG) plays a pivotal role in cranial autonomic symptoms associated with pain. Lesioning procedures involving the SPG and experimental acute SPG stimulation have shown some degree of efficacy with regard to CH. A neuromodulation device, chronically implanted in the pterygopalatine fossa, has been specifically designed for acute on-demand SPG stimulation. In a pilot placebo-controlled study in 28 patients suffering from refractory chronic CH, alleviation of pain was achieved in 67.1% of full stimulation-treated attacks compared to 7% of sham stimulation-treated attacks (p<0.0001). Long-term results (24 months; 33 patients) confirmed the efficacy of SPG stimulation as an abortive treatment for CH attacks. Moreover, 35% of the patients observed a >50% reduction in attack frequency, suggesting that repeated use of SPG stimulation might act as a CH-preventive treatment. Globally, 61% of the patients were acute responders, frequency responders, or both, and 39% did not respond to SPG stimulation. The safety of SPG microstimulator implantation procedure was evaluated in a cohort of 99 patients; facial sensory disturbances were observed in 67% of the patients (46% of them being transient), transient allodynia in 3%, and infection in 5%. SPG stimulation appears as a promising innovative, efficient, and safe therapeutic solution for patients suffering from severe CH. It has shown its efficacy in aborting CH attacks compared to placebo stimulation, suggesting that it is particularly adapted for CH patients who are not sufficiently improved by abortive treatments such as sumatriptan and oxygen. However, further studies comparing SPG stimulation with standard abortive and/or preventive CH treatments will be necessary to define more precisely its place within the management of severe chronic and/or episodic CH.
cluster headache; neuromodulation; primary headache; sphenopalatine ganglion; stimulation
PMID: 29497328 PMCID: PMC5819579 DOI: 10.2147/JPR.S129641