Sphenopalatine Ganglion Blocks have been shown to be a primary treatment of choice for Chronic Cluster Headache (CCH).
These blocks can be given by intra-oral or extra-oral injection or by nasal catheter. The Sphenocath is a commercial device used to deliver the blocks by a trans-nasal approach. The Allevio and the TX360 are similar trans-nasal catheters. These devices are used to deliver a series of SPG blocks weekly or biweekly for 10-12 total applications.
A cotton-tipped catheter is another approach that may be far more effectiive because it can be self-administered by the patient on a more frequent schedule such as daily or even multiple times in a day. In a two week period the Self-Administered SPG Blocks could be given twice a day or 28 time in 2 weeks. This is a very minimally invasive procedure that not only turns off cluster headaches and migraines but can also turn off anxiety and sympathetic overload.
When used it this fashion there is extremely high effiicay to the SPG Blocks. More importantly the patient is now in personal control of their pain making more aggressive treatment unnecessary in many cases. Patients who self-administer SPG Blocks can avoid unnecessary visits to physician or hospital Emergency Departments and their quality of life is improved by accessible and affordable treatment options. While some patients may benefit by aggresive surgical treatments it is always preferable to be less invasive.
The following article discusses use Sphenopalatine Ganglion Radiofrequency lesions to turn off Cluster Headachees. This article compares efficacy of different techniques but does not compare Radiofrequency surgery to Self Administered SPG Blocks or to thee other nasal catheters..
World Neurosurg. 2018
Oct 11. pii: S1878-8750(18)32299-X. doi: 10.1016/j.wneu.2018
.10.007. [Epub ahead of print]
Efficacy of .Sphenopalatine Ganglion Radiofrequency in Refractory Chronic Cluster Headache
In the literature, there are only short series of radiofrequency of the sphenopalatine ganglion(SPG) to treat chronic refractory cluster headache (CCHr) with variable results. Furthermore, there is no consensus on which methodology to use: radiofrequency ablation (RFA) or pulsed radiofrequency (PRF).
We conducted a prospective analysis of 37 patients with CCHr who underwent RFA or PRF of the SPG in our center between 2004 and 2015.
The mean age of the patients was 40 years (range, 26-59 years). PRF was performed in 24 patients, and RFA was performed in 13 patients. A total of 5 patients (13.5%) experienced complete clinical relief of both pain and parasympathetic symptoms, 21 patients (56.8%) had partial and transient relief, and 11 patients (29.7%) did not improve. There was no evidence of significant superiority of one radiofrequency modality over the other (P = 0.48). There were no complications associated with the technique. The passage of time tended to decrease the efficacy of both techniques (P < 0.001). The mean follow-up was 68.1 months (range, 15-148 months). To our knowledge, this is the series with the largest number of patients and the longest follow-up period published in the literature.
Radiofrequency of the SPG is a safe, fast, and partially effective method for the treatment of CCHr. Given its low rate of complications and its low economic cost, we think it should be one of the first invasive treatment options, prior to techniques with greater morbidity and mortality, such as neuromodulation.
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