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Monday, November 21, 2011

Intractable Cluster Headache: Sphenopalatine Ganglion Blocks May be Treatment of Choice.

Cluster headaches is a primary neurovascular headache and is associated with autonomic symptoms. A sphenopalatineablation with radiofrequency is suggested in the following abstract. I disagree. If patients get relief from a sphenopalatine block of their cluster hedaches they will probably find intranasal prophylactic SPB blocks are also effective. An old study on SPG ablation at Mayo was discontinued due to adverse outcomes.

Correction of underlying trigeminal aberations through a neuromuscular orthotic and SPG blocks is a safer and more conservative alternative to SPG ablation.

I would only consider ablation as a very last line of treatment.

Curr Pain Headache Rep. 2010 Apr;14(2):160-3.

Role of sphenopalatine ganglion neuroablation in the management of cluster headache.


Pain Management Department, Anesthesiology Institute, Cleveland Clinic, OH 44195, USA. narouzs@ccf.org


Cluster headache is a primary neurovascular headache. It is a strictly unilateral head pain that is associated with cranial autonomic symptoms and usually follows circadian and circannual patterns. Chronic cluster headache, which accounts for about 10% to 15% of patients with cluster headache, lacks the circadian pattern and is often resistant to pharmacological management. The sphenopalatineganglion (SPG), located in the pterygopalatine fossa, is involved in the pathophysiology of cluster headache and has been a target for blocks and other surgical approaches. Percutaneous radiofrequency ablation of the SPG was shown to have encouraging results in those patients with intractable cluster headaches.

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posted by Dr Shapira at 7:09 PM

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