Continuous Sphenopalatine Ganglion Block for Refractory Hemicrania Continua

2021 ◽  
Author(s):  
Carlos E Restrepo-Garces
Keyword(s):  
Primary Headache ◽  
Hemicrania Continua ◽  
Trigeminal Autonomic Cephalalgias ◽  
Sphenopalatine Ganglion ◽  
Headache Disorders ◽  
Ganglion Block ◽  
Pharmacological Management ◽  
Primary Headache Disorders ◽  
Significant Challenge ◽  
Sphenopalatine Ganglion Block

Trigeminal autonomic cephalalgias (TAC) pose a significant challenge for pain physicians. Despite being part of the primary headache disorders, they are uncommon in the general population. Although the literature commonly describes pharmacological management, in refractory patients, interventional pain modalities may be necessary .

Concomitant occurrence of different trigeminal autonomic cephalalgias: A case series and review of the literature

Cephalalgia ◽  
2013 ◽  
Vol 34 (3) ◽  
pp. 231-235 ◽  
Author(s):  
Andreas Totzeck ◽  
Hans-Christoph Diener ◽  
Charly Gaul
Keyword(s):  
Cluster Headache ◽  
Clinical Presentation ◽  
Case Series ◽  
Primary Headache ◽  
Hemicrania Continua ◽  
Paroxysmal Hemicrania ◽  
Trigeminal Autonomic Cephalalgias ◽  
Headache Disorders ◽  
Primary Headache Disorders

Introduction The trigeminal autonomic cephalalgias (TACs) subsume four primary headache disorders. Hemicrania continua is increasingly regarded as an additional TAC. In rare cases patients may present with two different TACs or a TAC and hemicrania continua. Cases We report four patients with two different TACs or one TAC and hemicrania continua. Two patients presented with cluster headache and paroxysmal hemicrania, one patient with cluster headache and hemicrania continua, and one patient suffered from cluster headache and SUNCT. Discussion While the International Classification of Headache Disorders (ICHD-II) proposes specific diagnostic criteria, the variability of clinical presentation may make clear diagnosis difficult. All patients fulfilled the ICHD-II criteria. The manifestation of two different TACs or hemicrania continua in one patient is uncommon but possible and should be taken into account especially when chronic headache patients present with changing headache symptoms.

scholarly journals Sphenopalatine ganglion block in primary headaches

2019 ◽  
Vol 10 (6) ◽  
pp. 503-509
Author(s):  
John G. Burkett ◽  
Matthew S. Robbins ◽  
Carrie E. Robertson ◽  
Mihriye Mete ◽  
Nicolas P. Saikali ◽  
...  
Keyword(s):  
Practice Patterns ◽  
Headache Disorder ◽  
Ease Of Use ◽  
Primary Headaches ◽  
Sphenopalatine Ganglion ◽  
Headache Disorders ◽  
Ganglion Block ◽  
Treatment Protocols ◽  
Sphenopalatine Ganglion Block ◽  
Question Survey

BackgroundThe sphenopalatine ganglion (SPG), in the pterygopalatine fossa, is a known current and historical target for therapeutic intervention in headache disorders because of its role in cranial autonomics and vasodilation. There remains an overall lack of well-established SPG treatment protocols, particularly with the advent of newer commercial devices.MethodsA 22 multiple-choice question survey was created to evaluate clinical practice patterns with SPG block and sent to members of the American Headache Society (AHS). Questions focused on determining indications, preferred applicators, medications applied, perceived efficacy, tolerability, and reimbursement.ResultsOne hundred seventy-two of 1,346 (12.8%) AHS members participated. Ninety-three respondents (56.3%) had performed SPG blocks on 50 or fewer patients. The SphenoCath (42.4%) and the Tx360 (41.8%) were the most common methods of application. Ease of use was the top reason for provider preference in applicator type. SPG blocks were mostly used as an as-needed one-time procedure. When a scheduled protocol was used, twice weekly for 6 weeks was most common. Chronic migraine was the most commonly treated headache disorder and rated the most likely to respond to SPG block. Experienced clinicians found SPG more helpful as a stand-alone treatment and tended to report that acute relief was not predictive of enduring response.ConclusionsThe variety of responses strongly suggests that clinicians would benefit from formalized protocols for SPG blocks. More experienced clinicians may have developed individualized protocols that they feel are more effective. The lack of evidence-based protocols contribute to clinicians not performing SPG blocks more frequently.

Migraine and Headache in Children

2017 ◽  
Author(s):  
Jessica Klein ◽  
Christopher Oakley
Keyword(s):  
Quality Of Life ◽  
Clinical Presentation ◽  
Primary Headache ◽  
Diagnostic Workup ◽  
Trigeminal Autonomic Cephalalgias ◽  
Headache Disorders ◽  
Children With Cancer ◽  
Primary Headache Disorders ◽  
Pediatric Neurologist

Headache is the number one reason for referral to a pediatric neurologist, and these children report a quality of life similar to children with cancer and arthritis; therefore this concern warrants particular attention to accurately diagnose, evaluate, and treat. Of the primary headache disorders, tension is the most common, whereas migraine is often the most disabling. Other examples of childhood headaches include migraine precursors, cluster, trigeminal autonomic cephalalgias, and neuralgias. The aim of this chapter is to define migraine and other primary headache disorders of childhood, discuss the neurobiology of headache, and review clinical presentation, diagnostic workup, and treatment.

Primary Headache Disorders: Trigeminal Autonomic Cephalalgias, Headaches With Specific Triggers, and Other Primary Headache Disorders

2021 ◽  
pp. 884-891
Author(s):  
Juliana H. VanderPluym ◽  
Rashmi B. Halker Singh
Keyword(s):  
Primary Headache ◽  
Tension Type Headache ◽  
Clinical Feature ◽  
Trigeminal Autonomic Cephalalgias ◽  
Headache Disorders ◽  
Primary Headache Disorders ◽  
Daily Headache ◽  
The Common ◽  
Type Headache ◽  
Careful History

Primary headache disorders are those in which the predominant clinical feature is headache that is not caused by or attributed to another disorder. This chapter reviews the common primary headache disorders of migraine, tension-type headache, and chronic daily headache. The present chapter reviews less common primary headache disorders, such as trigeminal autonomic cephalalgias and headaches with certain triggers. A careful history, physical examination, and additional testing are often necessary to rule out a secondary cause.

TM2-5 Percutaneous electrical nerve stimulation (PENS) therapy for refractory primary headache disorders: a pilot study

2019 ◽  
Vol 90 (3) ◽  
pp. e14.1-e14
Author(s):  
MW Weatherall ◽  
D Nandi
Keyword(s):  
Cluster Headache ◽  
Treatment Options ◽  
Primary Headache ◽  
Cervicogenic Headache ◽  
Chronic Cluster Headache ◽  
Hemicrania Continua ◽  
Single Shot ◽  
Headache Disorders ◽  
Trigeminal Neuropathy ◽  
Primary Headache Disorders

ObjectivesPrimary headache disorders are common, but many patients are refractory to medical treatment. PENS therapy involves the stimulation of one or more individual nerves or dermatomes using needle probes. We assessed whether a ‘single shot with single probe’ strategy would benefit patients with refractory headache disorders, including chronic migraine (CM), and chronic cluster headache (CCH).DesignService evaluation of 36 patients treated with PENS therapy between September 2012 and June 2016. Follow-up data was available for 33 patients.Subjects16 patients with CM, nine with CCH, and one with hemicrania continua. Secondary headaches comprised occipital neuralgia, cervicogenic headache, and trigeminal neuropathy.MethodsPENS was given using Algotec® disposable 21 gauge PENS therapy probes (8 cm) to the occipital nerve ipsilateral to the pain (or bilaterally in cases of bilateral pain). Stimulation was delivered at 2 Hz/100 Hz, at 3 cycles/second, between 1.2–2.5 V depending on patient tolerability, for 25–28 min.Results6/9 patients with CCH improved significantly after the first session. In all patients with CCH, PENS therapy was well tolerated, with no significant adverse events reported. One patient with CCH reverted to episodic cluster. Only four patients with CM experienced any benefit.ConclusionsPENS therapy shows potential as a relatively non-invasive, low-risk, and inexpensive component of the treatment options for refractory primary headache disorders, particularly chronic cluster headache.

Sphenopalatine ganglion block for the treatment of acute headache: An old treatment revisited

2021 ◽  
Author(s):  
Meredith Busman ◽  
Tiffany Fleeger ◽  
Erin Leach ◽  
Natalie Payne ◽  
Andrew Nguyen ◽  
...  
Keyword(s):  
Sphenopalatine Ganglion ◽  
Ganglion Block ◽  
Sphenopalatine Ganglion Block ◽  
Acute Headache
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