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Thursday, September 23, 2010

Glycerol injections of the Trigeminal Nerve for Cluster Headaches

Orville : I have suffered with episodic cluster migraines for years they usually come every other fall. the only thing that has helped me besides oxygen is zomig but I have to take more than the manufacturer recomends. What are the possible complications associated with Glycerol facial injections

Dr Shapira response: Glycerol injections are usually safe and effective but can have advers effects.

I have quoted a reference below that discusses adverse effects such as refractory pain that becomes non-remitting and possibly worse and unresponsive to treatment.

I would recommend utilizing Sphenopalatine Ganglion Blocks (SPG), an autonomic block that can be done transnasaly with no risk almost no risk. Patients can do SPG blocks at home to turn off or prevent attacks. Oxygen is obviously an excellent therap and can be used alone or with SPG blocks. SPG blocks before bed can often prevent an attack if they occur primarily in the night.

Taking more than rx dose of ZOMIG should be discussed with your physician.

Trigeminal Cistern Glycerol Injections for Facial Pain†
Thomas A. Waltz M.D., Donald J. Dalessio M.D., Kenneth H. Ott M.D., Brian Copeland M.D., Gaye Abbott C.M.A.-C.Article first published online: 22 JUN 2005

Headache: The Journal of Head and Face Pain
Volume 25, Issue 7, pages 354–357, October 1985
Dalessio, D. J., Ott, K. H., Copeland, B. and Abbott, G. (1985), Trigeminal Cistern Glycerol Injections for Facial Pain. Headache: The Journal of Head and Face Pain, 25: 354–357.
Publication History Issue published online: 22 JUN 2005
Article first published online: 22 JUN 2005

The treatment of paroxysmal facial pain is often easily accomplished. At times, however, the converse occurs; the pain becomes more refractory, and unresponsive to therapy. This is especially the case when trigeminal neuralgia, cluster headache, and atypical facial pain become chronic. This report will summarize our experience with injection of glycerol into the region of the trigeminal cistern for intractable facial pain in 71 patients; 58 with trigeminal neuralgia, 5 with chronic cluster headache, and 8 with atypical facial pain.

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posted by Dr Shapira at 12:52 PM

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