WP1-1 Sphenopalatine ganglion stimulation for chronic cluster headache

2019 ◽  
Vol 90 (3) ◽  
pp. e2.3-e2
Author(s):  
S Miller ◽  
S Lagrata ◽  
M Matharu ◽  
L Zrinzo
Keyword(s):  
Cluster Headache ◽  
Acute Effect ◽  
Chronic Cluster Headache ◽  
Headache Frequency ◽  
Sphenopalatine Ganglion ◽  
Open Label ◽  
Vidian Canal ◽  
The Uk ◽  
Fluoroscopy Guidance

ObjectivesTo assess outcome of sphenopalatine ganglion stimulation (SPGS) in chronic cluster headache (CCH) in a UK centre.DesignUncontrolled open-label single centre prospective study.SubjectsNine patients with medically refractory CCH.MethodsParticipants underwent sphenopalatine ganglion stimulator implantation, ipsilateral to CCH symptoms via a gingival incision, with fluoroscopy guidance and dyna-CT confirmation of contact location adjacent to the Vidian canal in the pterygopalatine fossa. One month after surgery, the device was programmed. Patients were instructed to provide stimulation as early as possible after attack onset and at least twice daily. The primary outcome was change in headache frequency as well as adverse events.ResultsMean follow up was 14 months (SD 11.1, range: 3–31) with median reduction in headache frequency at last follow up of 73% (IQR: 67%–88%). At 3 months post op, 4/9 (45%) had at least 50% reduction in frequency of attacks; this increased to 8/9 patients (89%) at last follow up. Two patients became pain free (after 3 and 9 months). Preventative effects were seen in 7/9 and an acute effect in 2/9. One patient suffered numbness over the V2 distribution and did not respond to SPGS. The stimulator was removed 1 year later at the patient’s request. One wound infection settled with oral antibiotics.ConclusionsInitial data from the UK confirms the results from previous studies and compares well with the results of occipital nerve stimulation for CCH.

scholarly journals Pilot study of sphenopalatine injection of onabotulinumtoxinA for the treatment of intractable chronic cluster headache

Cephalalgia ◽  
2015 ◽  
Vol 36 (6) ◽  
pp. 503-509 ◽  
Author(s):  
Daniel Fossum Bratbak ◽  
Ståle Nordgård ◽  
Lars Jacob Stovner ◽  
Mattias Linde ◽  
Mari Folvik ◽  
...  
Keyword(s):  
Pilot Study ◽  
Cluster Headache ◽  
Chronic Cluster Headache ◽  
Post Treatment ◽  
Attack Frequency ◽  
Open Label ◽  
Intention To Treat ◽  
Efficacy Outcome ◽  
Treat Analysis

Objective The main object of this pilot study was to investigate the safety of administering onabotulinumtoxinA (BTA) towards the sphenopalatine ganglion (SPG) in intractable chronic cluster headache. Efficacy data were also collected to provide indication on whether future placebo-controlled studies should be performed. Method In a prospective, open-label, uncontrolled study, we performed a single injection of 25 IU ( n = 5) or 50 IU BTA ( n = 5) towards the SPG in 10 patients with intractable chronic cluster headache with a follow-up of 24 weeks. The primary outcome was adverse events (AEs) and the main efficacy outcome was attack frequency in weeks 3 and 4 post-treatment. Results A total of 11 AEs were registered. There was one severe adverse event (SAE): posterior epistaxis. The number of cluster headache attacks (main efficacy outcome) was statistically significantly reduced in the intention-to-treat analysis from 18 ± 12 per week in baseline to 11 ± 14 ( p = 0.038) in weeks 3 and 4, and five out of 10 patients had at least 50% reduction of attack frequency compared to baseline. The cluster attack frequency was significantly reduced for five out of six months post-treatment. Conclusion Randomised, placebo-controlled studies are warranted to establish the potential of this possible novel treatment of cluster headache.

scholarly journals Occipital Nerve Stimulation with the Bion® Microstimulator for the Treatment of Medically Refractory Chronic Cluster Headache

2011 ◽  
Vol 5;14 (5;9) ◽  
pp. 435-440
Author(s):  
Terrence L. Trentman
Keyword(s):  
Cluster Headache ◽  
Nerve Stimulation ◽  
Chart Review ◽  
Chronic Cluster Headache ◽  
Headache Frequency ◽  
Occipital Nerve Stimulation ◽  
Long Term Outcome ◽  
Occipital Nerve ◽  
Small Patient Population

Background: Chronic cluster headache is a severely disabling neurological disorder. Evidence from open-label case series suggest that occipital nerve stimulation may be effective for the treatment of chronic cluster headache. Objective: To evaluate the effectiveness of a microstimulator for chronic cluster headache. Study Design: Prospective, observational feasibility study plus medical record review. Settings: Academic medical center. Methods: Four patients with medically refractory chronic cluster headache underwent implantation of a unilateral bion microstimulator. In-person follow-up was conducted for 12 months after implantation, and a prospective follow-up chart review was carried out to assess long term outcome. Results: Three of the participants returned their headache diaries for evaluation. The mean duration of chronic cluster headache was 14.3 years (range 3 to 29 years). Pain was predominantly or exclusively retroocular/periocular. One participant demonstrated a positive response (> 50% reduction in cluster headache frequency) at 3 months postimplant, while there were 2 responders at 6 months. At least one of the participants continued to show > 60% reduction in headache frequency at 12 months. A chart review showed that at 58-67 months post-implant, all 3 participants reported continued use and benefit from stimulation. No side-shift in attacks was noted in any participant. Adverse events were limited to 2 participants with neck pain and/or cramping with stimulation at high amplitudes; one required revision for a faulty battery. Limitations: Small patient population without control group. Not blinded or randomized. Conclusion: Unilateral occipital nerve stimulation, using a minimally invasive microstimulator, may be effective for the treatment of medically refractory chronic cluster headache. This benefit may occur immediately after implantation, remain sustained up to 5 years after implantation, and occur despite the anterior location of the pain. Prospective, randomized controlled trials of occipital nerve stimulation in chronic cluster headache should proceed. Key words: chronic headache, bion, peripheral nerve stimulation, cluster headache, migraine, occipital

scholarly journals Long-term effectiveness of sphenopalatine ganglion stimulation for cluster headache

Cephalalgia ◽  
2016 ◽  
Vol 37 (5) ◽  
pp. 423-434 ◽  
Author(s):  
Tim P Jürgens ◽  
Mads Barloese ◽  
Arne May ◽  
Jose Miguel Láinez ◽  
Jean Schoenen ◽  
...  
Keyword(s):  
Cluster Headache ◽  
Response To Therapy ◽  
Sphenopalatine Ganglion ◽  
Attack Frequency ◽  
Open Label ◽  
Acute Therapy ◽  
Medical Treatments ◽  
Term Data

Objectives The sphenopalatine ganglion (SPG) plays a pivotal role in cluster headache (CH) pathophysiology as the major efferent parasympathetic relay. We evaluated the long-term effectiveness of SPG stimulation in medically refractory, chronic CH patients. Methods Thirty-three patients were enrolled in an open-label follow-up study of the original Pathway CH-1 study, and participated through 24 months post-insertion of a microstimulator. Response to therapy was defined as acute effectiveness in ≥ 50% of attacks or a ≥ 50% reduction in attack frequency versus baseline. Results In total, 5956 attacks (180.5 ± 344.8, range 2–1581 per patient) were evaluated. At 24 months, 45% ( n = 15) of patients were acute responders. Among acute responders, a total of 4340 attacks had been treated, and in 78% of these, effective therapy was achieved using only SPG stimulation (relief from moderate or greater pain or freedom from mild pain or greater). A frequency response was observed in 33% ( n = 11) of patients with a mean reduction of attack frequency of 83% versus baseline. In total, 61% (20/33) of all patients were either acute or frequency responders or both. The majority maintained their therapeutic response through the 24-month evaluation. Conclusions In the population of disabled, medically refractory chronic CH patients treated in this study, SPG stimulation is an effective acute therapy in 45% of patients, offering sustained effectiveness over 24 months of observation. In addition, a maintained, clinically relevant reduction of attack frequency was observed in a third of patients. These long-term data provide support for the use of SPG stimulation for disabled patients and should be considered after medical treatments fail, are not tolerated or are inconvenient for the patients.

Vidian Neurectomy for Management of Chronic Cluster Headache

Neurosurgery ◽  
2018 ◽  
Vol 84 (5) ◽  
pp. 1059-1064 ◽  
Author(s):  
Shao-Cheng Liu ◽  
Ming-Chang Kao ◽  
Yun-Chen Huang ◽  
Wan-Fu Su
Keyword(s):  
Cluster Headache ◽  
Chronic Cluster Headache ◽  
Preliminary Evaluation ◽  
Sphenopalatine Ganglion ◽  
Attack Frequency ◽  
Pain Disability Index ◽  
Pain Disability ◽  
Vidian Neurectomy ◽  
Headache Onset ◽  
Attack Intensity

Abstract BACKGROUND Management of chronic cluster headache (CCH) remains a challenging endeavor, and the optimal surgical approach for medically refractory CCH remains controversial. OBJECTIVE To conduct a preliminary evaluation of the efficacy and safety of vidian neurectomy (VN) in patients with medically refractory CCH. METHODS Between March 2013 and December 2015, 9 CCH patients, all of whom had failed to respond to conservative therapy, underwent VN with a precise nerve cut and maximal preservation of the sphenopalatine ganglion. Data included demographic variables, cluster headache onset and duration, mean attack frequency, mean attack intensity, and pain disability index measures pre- and through 12-mo postsurgery. RESULTS Seven of the 9 cases (77.8%) showed immediate improvement. Improvement was delayed by 1 mo in 1 patient, after which the surgical effects of pain relief were maintained throughout the follow-up period. One patient (11.1%) did not improve after surgery. One year after VN, patients’ mean attack frequency, mean attack intensity, and pain disability index decreased by 54.5%, 52.9%, and 56.4%, respectively. No patient experienced treatment-related side effects or complications. CONCLUSION VN is an effective treatment method for CCH patients. Precise Vidian nerve identification and maximal preservation of the sphenopalatine ganglion may achieve good surgical outcomes and dramatically improve quality of life among patients, without significant adverse events.

Secondary chronic cluster headache treated by posterior hypothalamic deep brain stimulation: First reported case

Cephalalgia ◽  
2012 ◽  
Vol 33 (2) ◽  
pp. 136-138 ◽  
Author(s):  
Giuseppe Messina ◽  
Michele Rizzi ◽  
Roberto Cordella ◽  
Augusto Caraceni ◽  
Ernesto Zecca ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Cluster Headache ◽  
Brain Stimulation ◽  
Soft Tissues ◽  
Chronic Cluster Headache ◽  
Successful Outcome ◽  
The Right ◽  
Fondazione Irccs ◽  
Deep Brain

Introduction Deep brain stimulation (DBS) of the posterior hypothalamus (pHyp) has been reported as an effective treatment for primary, drug-refractory and chronic cluster headache (CCH). We here describe the use of such a procedure for the treatment of secondary CCH due to a neoplasm affecting the soft tissues of the right hemiface. Methods A 27-year-old man affected by infiltrating angiomyolipoma of the right hemiface who subsequently developed drug refractory homolateral CCH underwent DBS of the right pHyp region at the Fondazione IRCCS Istituto Nazionale Neurologico Carlo Besta. Results After surgery, the patient presented a significant reduction in frequency of pain bouts. However, because of a subsequent infection, the entire system was removed. After re-implantation of the system, successful outcome was observed at 2 years follow-up. Discussion This brief report shows the feasibility of pHyp DBS in secondary drug-refractory CCH syndromes; future reports are needed in order to confirm our positive result.

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