Transnasal Sphenopalatine Ganglion Block for the Preventive Treatment of Chronic Daily Headache in Adolescents

Chronic headaches are a major source of morbidity in the pediatric population, affecting physical function, school attendance, social capacity, mood, and sleep. In adults, repetitive sphenopalatine ganglion (SPG) blockade has been studied as a preventive treatment for chronic migraines. This case series aims to evaluate the SPG block for the preventive treatment of chronic daily headache (CDH) in adolescents. We prospectively evaluated 17 adolescents (14 females, 14 ± 1 year) with CDH not responding to cognitive behavioral therapy (CBT), physiotherapy, and standard medications. Each patient received 10 SPG blocks (two blocks/week) using the Tx360® device. At the end of treatment, 10 patients (59%) reported a Patient’s Global Impression of Change (PGIC) score ≥ 67%, and 3 months after the end of treatment, nine patients (53%) sustained a PGIC ≥ 67%. There was also a statistically significant reduction in the depression subscale of the Revised Children’s Anxiety and Depression Scale (RCADS) at the end of treatment and 3 months post-treatment compared with baseline. The procedure was well tolerated with no adverse effects. In our study, the use of repeat SPG blockade was associated with sustained benefits on the PGIC and the depression subscale of the RCADS when used as preventive headache treatment in adolescents with refractory CDH.

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The Efficacy of Sphenopalatine Ganglion Block and Radiofrequency Denervation in the Treatment of Cluster Headache: A Case Series

Anesthesiology and Pain Medicine ◽

10.5812/aapm.104466 ◽

2020 ◽

Vol 10 (6) ◽

Author(s):

Dorsa Amighi ◽

Hossein Majedi ◽

Abbas Tafakhori ◽

Amirhossein Orandi

Keyword(s):

Pain Relief ◽

Cluster Headache ◽

Pain Intensity ◽

Case Series ◽

Pain Clinic ◽

Interventional Treatment ◽

Sphenopalatine Ganglion ◽

Ganglion Block ◽

Radiofrequency Denervation ◽

Sphenopalatine Ganglion Block

Background: Cluster headache is a variant of primary neurovascular headaches. some patients with cluster headache are not responsive to medical treatment and may benefit from interventional modalities, including sphenopalatine ganglion block and denervation. Objectives: Our purpose was to evaluate the efficacy of sphenopalatine ganglion block/denervation in the treatment of cluster headache. Methods: In this study, we performed the sphenopalatine ganglion block for patients with cluster headaches, intractable to medical therapy, who were referred to our pain clinic between 2014 and 2018. We registered the following information for all patients: demographic data, pain relief, and pain intensity. First, we conducted a prognostic C-arm-guided sphenopalatine ganglion block. If there was at least 50% pain relief within the first 5 h, then we denervated the ganglion by radiofrequency ablation. The main outcome of the study (dependent variable) was pain relief. We followed the patients for 6 months. Results: Among 23 enrolled patients, 19 consented to interventional treatment. Fifteen out of 19 patients (79%) had an acceptable response to the prognostic block. Ultimately, 11 patients underwent ganglion denervation, and 4 patients did not consent for ganglion ablation. Pain relief at intervals of 48 h, and 1, 3, and 6 months after ganglion denervation was 77, 59, 50, and 31 percent, respectively. Conclusions: Sphenopalatine ganglion conventional radiofrequency denervation can effectively decrease the pain intensity of the patients with cluster headache for at least several months.

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Prevalence and Associated Factors for Episodic and Chronic Daily Headache in the Colombian Population

Cephalalgia ◽

10.1111/j.1468-2982.2007.01499.x ◽

2008 ◽

Vol 28 (3) ◽

pp. 216-225 ◽

Cited By ~ 20

Author(s):

M Rueda-Sánchez ◽

LA Diaz-Martinez

Keyword(s):

Risk Factors ◽

Chronic Daily Headache ◽

Multinomial Logistic Regression ◽

Depression Scale ◽

Female Gender ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Factors Associated ◽

Episodic Headache ◽

Daily Headache

There are multiple risk factors for chronic daily headache (CDH), but they are usually assessed in an isolated form without an adequate control for confounders. CDH is considered a variant of episodic headache, but studies have not gathered enough evidence to evaluate simultaneously CDH and episodic in the same population. We set out to establish simultaneously the factors associated with chronic daily or episodic headache in a population setting, using a cross-sectional survey in a random sample of 1505 adult urban inhabitants (Bucaramanga, Colombia). The survey asked questions about headache, family and personal history of disease, and consumption or abuse of caffeine, alcohol, hypnotics and analgesics. The association among independent variables and CDH or episodic headache was made with multinomial logistic regression. Female gender, arterial hypertension or cranial trauma history, and a high score in the depression scale are associated with episodic headache and CDH. Parents with CDH, the complaint of multiple arousals during sleep and use of hypnotics are associated with CDH, but not with episodic headache. Age < 36 years, alcoholism and snoring are factors associated only with episodic headache. Chronic daily headache and episodic headache have several common risk factors, but there are other factors not shared by both conditions.

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