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Xin B, Xie K, Luo G, Yao M. Long-Term Follow-Up Safety and Effectiveness of CT-Guided Radiofrequency Thermocoagulation of Sphenopalatine Ganglion in Refractory Headache Treatment. Pain Ther 2022; 11:1011-1023. [PMID: 35793048 PMCID: PMC9314503 DOI: 10.1007/s40122-022-00401-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 05/26/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the effectiveness and safety of computed tomography (CT)-guided radiofrequency thermocoagulation (RFTA) of the sphenopalatine ganglion (SPG) for patients with refractory headache. METHODS A total of 14 patients with refractory migraine and 10 patients with cluster headache (CH) who underwent CT-guided SPG RF between May 2019 and August 2021 at the Jiaxing First Hospital, located in Jiaxing City, Zhejiang Province, China, were included and analyzed in this retrospective cohort study. Pain score, sleep quality scores, and treatment effects were observed before operation as well as 1 day and 1, 3, 6, 12, and 24 months after surgery. Also, the incidence of facial numbness at different timepoints after operation was evaluated. RESULTS The frequency and duration of attacks decreased after treatment in patients with migraine, and the shortening of the cluster period and the prolongation of the remission period after treatment in patients with CH indicated that the treatment was effective. The numeric rating scale (NRS) ranged from 0 to 10, where 0 meant no pain and 10 meant the worst imaginable pain. The NRS of patients at 1 day and 1, 3, 6, 12, and 24 months after surgery was significantly lower than before operation (P < 0.05). The treatment of patients with migraine and CH was effective. The overall incidence of numbness in patients with migraine and the total incidence of numbness in patients with CH was recorded. The total incidence of numbness decreased gradually, but no significant difference was detected in the incidence of numbness between the two groups (P > 0.05). No serious adverse reactions, such as orthostatic hypertension, intracranial infection, and visual disturbance, occurred in the patients after operation. CONCLUSION CT-guided RFTA of the SPG significantly relieves headache symptoms in patients with refractory migraine and CH. It has the advantages of rapid onset, long duration, and a safe and reliable treatment process, making it worthy of clinical application.
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Affiliation(s)
- Bingyue Xin
- The Second Affiliated Hospital & Yuying Children’s Hospital of Wenzhou Medical University/The Second School of Medicine, Wenzhou Medical University, No. 109 West Xueyuan Road, Wenzhou City, Zhejiang China ,Department of Anesthesiology and Pain Research Center, The First Hospital of Jiaxing or The Affiliated Hospital of Jiaxing University, No. 1882 South Zhonghuan Road, Jiaxing City, Zhejiang China
| | - Keyue Xie
- The Second Clinical Medical College, Zhejiang Chinese Medicine University, No. 548 Binwen Road, Hangzhou City, Zhejiang China ,Department of Anesthesiology and Pain Research Center, The First Hospital of Jiaxing or The Affiliated Hospital of Jiaxing University, No. 1882 South Zhonghuan Road, Jiaxing City, Zhejiang China
| | - Ge Luo
- Department of Anesthesiology and Pain Research Center, The First Hospital of Jiaxing or The Affiliated Hospital of Jiaxing University, No. 1882 South Zhonghuan Road, Jiaxing City, Zhejiang China
| | - Ming Yao
- The Second Affiliated Hospital & Yuying Children’s Hospital of Wenzhou Medical University/The Second School of Medicine, Wenzhou Medical University, No. 109 West Xueyuan Road, Wenzhou City, Zhejiang China ,Department of Anesthesiology and Pain Research Center, The First Hospital of Jiaxing or The Affiliated Hospital of Jiaxing University, No. 1882 South Zhonghuan Road, Jiaxing City, Zhejiang China
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Schindler EAD, Cooper V, Quine DB, Fenton BT, Wright DA, Weil MJ, Sico JJ. "You will eat shoe polish if you think it would help"-Familiar and lesser-known themes identified from mixed-methods analysis of a cluster headache survey. Headache 2021; 61:318-328. [PMID: 33502769 DOI: 10.1111/head.14063] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 12/12/2020] [Accepted: 12/21/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To characterize patient-reported ideas and concerns about cluster headache, treatment options, and management strategies. BACKGROUND Cluster headache patients experience severe pain and often suffer additional consequences from their disease. Patients have identified methods to cope with and combat cluster headache that are not widely known. METHODS Secondary analysis was performed using deidentified data from the online Clusterbusters Medication Use survey, wherein 10 questions allowed for freely written comments. Using mixed-methods techniques, neurologists with expertise in headache medicine identified themes from these comments. Subgroup analysis sought to identify variables associated with specific themes. RESULTS Among 2274 free-text responses from 493 adult participants, 23 themes were identified. Themes commonly discussed in the literature included such topics as "nothing worked" (24.7%, 122/493), "side effects" (12.8%, 63/493), and difficulties with "access/cost" (2.4%, 12/493). Less widely recognized themes included the use of "illicit substances" (35.5%, 175/493) and "vitamins/supplements" (12.2%, 60/493) in disease management. Lesser-known themes included "coffee" (5.3%, 26/493) and "exercise/physical activity" (4.7%, 23/493). Using strict significance criteria, no subgroup was associated with any theme. Several poignant quotes highlighted patient thoughts and experiences. CONCLUSIONS This mixed-methods analysis identified challenges endured by cluster headache patients, as well as a variety of patient-directed disease management approaches. The volunteered information spotlights pharmacological, physiological, and psychological aspects of cluster headache that warrant further exploratory and interventional investigation.
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Affiliation(s)
- Emmanuelle A D Schindler
- Headache Center of Excellence, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA.,Neurology Service, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA.,Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Vanessa Cooper
- Neurology Service, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA.,Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Douglas B Quine
- Headache Center of Excellence, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA.,Pain, Research, Informatics, Medical comorbidities, and Education (PRIME) Center, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
| | - Brenda T Fenton
- Headache Center of Excellence, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA.,Pain, Research, Informatics, Medical comorbidities, and Education (PRIME) Center, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
| | | | | | - Jason J Sico
- Headache Center of Excellence, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA.,Neurology Service, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA.,Department of Neurology, Yale School of Medicine, New Haven, CT, USA.,Pain, Research, Informatics, Medical comorbidities, and Education (PRIME) Center, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
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Interventional Radiofrequency Treatment for the Sympathetic Nervous System: A Review Article. Pain Ther 2021; 10:115-141. [PMID: 33433856 PMCID: PMC8119558 DOI: 10.1007/s40122-020-00227-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 11/24/2020] [Indexed: 12/14/2022] Open
Abstract
Introduction Interventional techniques such as radiofrequency (RF) treatment can be used to interrupt pain signals transmitted through the sympathetic nervous system (SNS). RF treatments including the pulsed (PRF) and continuous (CRF) modalities show enhanced control over lesion size and enhanced ability to confirm accurate positioning compared to other interventional methods. PRF also acts to reduce the area of the lesion. In this article, we characterize the currently available evidence supporting the use and efficacy of RF treatments in sympathetically mediated pain (SMP) conditions. Study Design A comprehensive literature review. Methods A PubMed and Cochrane Library database search was performed for human studies applying RF treatment at sympathetic sites (sphenopalatine ganglion, stellate ganglion, cervical, thoracic, or lumbar sympathetic ganglia, celiac plexus, splanchnic nerves, superior hypogastric plexus, and ganglion impar) between January 1970 to May 2020. Data were extracted, summarized into tables, and qualitatively analyzed. Results PRF and CRF both show promise in relieving SMP conditions, such as complex regional pain syndrome (CRPS), pain in the perineal region, headache and facial pain, and oncologic and non-oncologic abdominal pain, in addition to other types of pain, with minimal complications. Furthermore, in most comparative studies, outcomes using RF treatments exceeded other interventional techniques, such as anesthetic block and chemical neurolysis. Conclusions RF treatments can be effective in carefully selected patients who are refractory to conservative management. However, further randomized controlled studies are needed prior to implementing it into common practice.
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Huang RY, Poree L, Ho KY, Tsai SY, Liu YC, Tan PH, Wen YR. Behavioral Survey of Effects of Pulsed Radiofrequency on Neuropathic and Nociceptive Pain in Rats: Treatment Profile and Device Implantation. Neuromodulation 2020; 24:1458-1466. [PMID: 32558126 DOI: 10.1111/ner.13169] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/15/2020] [Accepted: 04/15/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Pulsed radiofrequency (PRF) stimulation is widely used for intractable pain; however, there is no consensus on treatment protocols and appropriate types of pain. We compared effectiveness of bipolar and unipolar PRF on neuropathic or inflammatory pains, and of targets at the dorsal root ganglion (DRG) and sciatic nerve (SN). We also examined efficacy of repetitive PRF stimulations. This preclinical study could serve as an extensive survey before human trials. MATERIALS Spare nerve injury (SNI)-induced neuropathic pain and complete Freund's adjuvant (CFA) injection-induced inflammatory pain were used. Behavioral responses were measured using von Frey test, acetone test, and Hargreave's test at preinjury and postinjury time points. In both models, we evaluated results of DRG stimulation with unipolar PRF (45 V) versus bipolar PRF (5 V), stimulation at DRG vs. SN, and repetitive stimulations. RESULTS Both unipolar and bipolar PRFs reduced SNI- or CFA-induced pain for a similar duration. In the SNI model, PRF-DRG had a stronger effect on tactile pain than PRF-SN but lower effect on cold allodynia, whereas in the CFA model PRF-DRG and PRF-SN showed similar effects. Repetitive PRF stimulation, by open technique or implantation method, produced analogous effect by each stimulus, and no evident analgesic tolerance or neurological deficit was shown. CONCLUSIONS PRF temporarily attenuates neuropathic and inflammatory pain. Bipolar PRF generates significant analgesia with a much lower electrical power than unipolar PRF. Meanwhile, the minor variant effects between PRF-DRG and PRF-SN may indicate distinct mechanisms. The sustained-analgesia by repetitive treatments suggests implantation technique could be a promising choice.
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Affiliation(s)
- Ren-Yu Huang
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
| | - Lawrence Poree
- Department of Anesthesia, University of California at San Francisco, San Francisco, CA, USA
| | - Kok-Yuen Ho
- Raffles Pain Management Centre, Raffles Hospital, Singapore, Singapore
| | - Shih-Ying Tsai
- Department of Anesthesiology, School of Medicine, China Medical University, Taichung, Taiwan
| | - Yu-Chen Liu
- Department of Anesthesiology, China Medical University Hospital, Taichung, Taiwan
| | - Ping-Heng Tan
- Department of Biomedical Engineering, E-DA Hospital, I-Shou University, Kaohsiung, Taiwan.,Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - Yeong-Ray Wen
- Department of Anesthesiology, School of Medicine, China Medical University, Taichung, Taiwan.,Department of Anesthesiology, China Medical University Hospital, Taichung, Taiwan.,Department of Anesthesiology, Pain Management and Research Center, China Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Acupuncture Science, College of Chinese Medicine, China Medical University, Taichung, Taiwan
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Malo-Urriés M, Estébanez-de-Miguel E, Bueno-Gracia E, Tricás-Moreno JM, Santos-Lasaosa S, Hidalgo-García C. Sensory function in headache: a comparative study among patients with cluster headache, migraine, tension-type headache, and asymptomatic subjects. Neurol Sci 2020; 41:2801-2810. [DOI: 10.1007/s10072-020-04384-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 03/28/2020] [Indexed: 10/24/2022]
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Kelderman T, Vanschoenbeek G, Crombez E, Paemeleire K. Safety and efficacy of percutaneous pulsed radiofrequency treatment at the C1-C2 level in chronic cluster headache: a retrospective analysis of 21 cases. Acta Neurol Belg 2019; 119:601-605. [PMID: 31482444 DOI: 10.1007/s13760-019-01203-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 08/20/2019] [Indexed: 12/22/2022]
Abstract
We performed a study of the safety and efficacy of percutaneous pulsed radiofrequency (PRF) treatment directed at C1 and C2 levels as performed at our local pain clinic in refractory chronic cluster headache (CCH) patients. We identified 21 CCH patients treated with PRF (240 s, max. 45 V, max. 42 °C) directed at the ganglion and/or nerve root of C1 and C2. Data were collected through retrospective analysis of patients' files and include demographic variables, onset and duration of the headache, mean attack frequency, and prior pharmacological treatment. Safety and reduction of attack frequency in the first 3 months after a first PRF treatment was the primary outcome parameter of this study. All patients had been treated with at least two prophylactic drugs and 19 (90%) had previously been treated with verapamil, lithium, and topiramate. Ten patients (47.6%) reported no meaningful effect, four patients (19%) reported a meaningful reduction of < 50%, and seven patients (33.3%) reported a reduction in headache burden of at least 50% in the 3 months following treatment. Two patients reported occurrence or increase in frequency of contralateral cluster attacks. No other adverse events were reported or detected at follow-up. Upper cervical PRF treatment appears to be a safe procedure that could prove effective in the treatment of patients with refractory CCH and warrants a prospective study.
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Chen Z, Ren H, Zhao C, Luo F. Long-term Outcomes of Computerized Tomography-Guided Sphenopalatine Ganglion-Targeted Pulsed Radiofrequency for Refractory Cluster Headache. Pain Pract 2019; 20:289-296. [PMID: 31677216 DOI: 10.1111/papr.12853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 10/13/2019] [Accepted: 10/31/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To further evaluate the efficacy and safety of computerized tomography-guided sphenopalatine ganglion-targeted pulsed radiofrequency treatment for patients with refractory episodic and chronic cluster headache (CH). METHODS Forty-five patients with refractory episodic CH and 14 patients with chronic CH who underwent computerized tomography-guided sphenopalatine ganglion-targeted pulsed radiofrequency between January 2011 and December 2018 at the Beijing Tiantan Hospital were included and analyzed in this retrospective cohort study. RESULTS A total of 59 patients underwent 106 computerized tomography-guided pulsed radiofrequency procedures throughout the observational period. Effective remission was observed in 95.6% and 64.3% of patients with refractory episodic and chronic CH, respectively. Repeated computerized tomography-guided sphenopalatine ganglion-targeted pulsed radiofrequency procedures for recurrent CH was also proven to be effective. No severe side effects or complications were observed in this study. CONCLUSION The computerized tomography-guided sphenopalatine ganglion-targeted pulsed radiofrequency procedure is an effective, safe, and repeatedly effective strategy for refractory CH. For patients who have not responded to conservative treatment, this minimally invasive intervention is a reliable alternative.
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Affiliation(s)
- Zheng Chen
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hao Ren
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chunmei Zhao
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fang Luo
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Li J, Ren H, Wang B, Wu D, Luo F. Multicentre, prospective, randomised, controlled, blinded-endpoint study to evaluate the efficacy and safety of pterygopalatine ganglion pulsed radiofrequency treatment for cluster headache: study protocol. BMJ Open 2019; 9:e026608. [PMID: 30904875 PMCID: PMC6475260 DOI: 10.1136/bmjopen-2018-026608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Single-centre reports on small groups of patients have shown that pterygopalatine ganglion pulsed radiofrequency treatment in patients with refractory cluster headache (CH) can quickly relieve pain without significant side effects. However, a randomised controlled trial is still necessary to evaluate whether pterygopalatine ganglion pulsed radiofrequency (PRF) treatment is a viable treatment option for patients with CH who are not responding to drug treatment. METHODS AND ANALYSIS This investigation is a multicentre, prospective, randomised, controlled, blinded-endpoint study. We will enrol 80 patients with CH who are not responding to medication. The enrolled patients will be randomly divided into two groups: the nerve block (NB) group and the PRF group. All patients will undergo CT-guided pterygopalatine ganglion puncture. A mixture containing steroids and local anaesthetics will be slowly injected into the patients in the NB group. The patients in the PRF group will be treated with PRF at 42°C for 360 s. After treatment, the duration of cluster periods; degree of pain during headache attacks; frequency of headache attacks; duration of each headache attack; dose of auxiliary analgesic drugs; duration of remission; degree of patient satisfaction; effectiveness rates at 1 day, 3 days, 1 week, 2 weeks, 1 month, 3 months, 6 months, and 1 year after the procedure; and intraoperative and postoperative adverse events will be compared between the two groups. ETHICS AND DISSEMINATION This study was approved by the institutional ethics committee of the Beijing Tiantan Hospital (approval number: KY 2018-027-02). The results of the study will be published in peer-reviewed journals, and the findings will be presented at scientific meetings. TRIAL REGISTRATION NUMBER NCT03567590; Pre-results.
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Affiliation(s)
- Jin Li
- Department of Anesthesiology and Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hao Ren
- Department of Anesthesiology and Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Baoguo Wang
- Department of Anesthesiology, Beijing Sanbo Brian Hospital, Capital Medical University, Beijing, China
| | - Dasheng Wu
- Department of Pain Management, Jilin Province People’s Hospital, Changchun, China
| | - Fang Luo
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Crespi J, Bratbak D, Dodick D, Matharu M, Jamtøy KA, Tronvik E. Prediction of the sphenopalatine ganglion localization in computerized tomography images. CEPHALALGIA REPORTS 2019. [DOI: 10.1177/2515816318824690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: The sphenopalatine ganglion (SPG) is a target for several headache syndromes. Most of the groups targeting the SPG do not localize it directly, and this might account for some therapeutic failures. As the SPG cannot be seen on computerized tomography (CT) scans, magnetic resonance image (MRI) must be used to visualize the ganglion. It would be advantageous to be able to predict the location of the SPG on CT scans for those using fluoroscopy or CT-guided injections and for those in whom MRI is not accessible or contraindicated. Methods: We localized the SPG in 21 Caucasian patients (21 right and 17 left ganglia; total 38) in 3 tesla MR images subsequently fused with CT scans. We measured the distance from the SPG to two bony landmarks identified on CT scans. We then applied the average distances to find an estimated position of the SPG. The first landmark was the center of the anterior opening of the vidian canal (VC). The second landmark was a point on the sphenoidal bone, defined in an axial plane at the level of the center of the VC (S-point). The predicted position of the SPG measured from the VC and the sphenoidal bone were referred to as, respectively, vcSPG and sSPG. Finally, the distances between the SPG, as seen on MRI, and predicted vcSPG/sSPG were calculated. Results: The average distance between SPG as seen on the MRI images and the estimated position based on CT images were 1.82 mm (SD 0.83, range 0.22–3.57 mm) for vcSPG and 2.09 mm (SD 0.99, range 0.71–4.79 mm) for sSPG. Conclusions: The localization of the SPG can be predicted on CT images using bony landmarks. Localization of the SPG may be important in achieving successful therapeutic outcomes for treatments that are directed toward the SPG.
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Affiliation(s)
- Joan Crespi
- Department of Neurology, St Olav’s University Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Norwegian Advisory Unit on Headaches, Trondheim, Norway
| | - Daniel Bratbak
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Neurosurgery, St Olav’s University Hospital, Trondheim, Norway
| | - David Dodick
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Mayo Clinic, Phoenix, AZ, USA
| | - Manjit Matharu
- UCL Queen Square Institute of Neurology and The National Hospital of Neurology and Neurosurgery, London, UK
| | - Kent Are Jamtøy
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Maxillofacial Surgery, St Olav’s University Hospital, Trondheim, Norway
| | - Erling Tronvik
- Department of Neurology, St Olav’s University Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Norwegian Advisory Unit on Headaches, Trondheim, Norway
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Salgado-López L, de Quintana-Schmidt C, Belvis Nieto R, Roig Arnall C, Rodríguez Rodriguez R, Álvarez Holzapfel MJ, Molet-Teixidó J. Efficacy of Sphenopalatine Ganglion Radiofrequency in Refractory Chronic Cluster Headache. World Neurosurg 2018; 122:e262-e269. [PMID: 30315985 DOI: 10.1016/j.wneu.2018.10.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 10/01/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND In the literature, there are only short series of radiofrequency of the sphenopalatine ganglion (SPG) to treat chronic refractory cluster headache (CCHr) with variable results. Furthermore, there is no consensus on which methodology to use: radiofrequency ablation (RFA) or pulsed radiofrequency (PRF). METHODS We conducted a prospective analysis of 37 patients with CCHr who underwent RFA or PRF of the SPG in our center between 2004 and 2015. RESULTS The mean age of the patients was 40 years (range, 26-59 years). PRF was performed in 24 patients, and RFA was performed in 13 patients. A total of 5 patients (13.5%) experienced complete clinical relief of both pain and parasympathetic symptoms, 21 patients (56.8%) had partial and transient relief, and 11 patients (29.7%) did not improve. There was no evidence of significant superiority of one radiofrequency modality over the other (P = 0.48). There were no complications associated with the technique. The passage of time tended to decrease the efficacy of both techniques (P < 0.001). The mean follow-up was 68.1 months (range, 15-148 months). To our knowledge, this is the series with the largest number of patients and the longest follow-up period published in the literature. CONCLUSIONS Radiofrequency of the SPG is a safe, fast, and partially effective method for the treatment of CCHr. Given its low rate of complications and its low economic cost, we think it should be one of the first invasive treatment options, prior to techniques with greater morbidity and mortality, such as neuromodulation.
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Affiliation(s)
- Laura Salgado-López
- Department of Neurosurgery, University Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
| | | | - Robert Belvis Nieto
- Department of Neurology, University Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Carles Roig Arnall
- Department of Neurology, University Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | - Joan Molet-Teixidó
- Department of Neurosurgery, University Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Abstract
Cluster headache (CH) is a debilitating primary headache disorder. Although uncommon, affecting only 0.1% of population, it is one of the most painful conditions known to humankind. Three strategies are employed for effective treatment of CH, namely, abortive therapy, transitional therapy, and preventive therapy. Being an uncommon condition, there is a paucity of large-scale controlled trials and evidence of various therapies are based on smaller studies. This review primarily focuses on therapies with highest quality of evidence and also on the emerging therapies for CH.
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Affiliation(s)
- William S. Kingston
- Centre for Headache, Women's College Hospital, University of Toronto, Toronto, ON, USA
| | - David W. Dodick
- Department of Neurology, Mayo Clinic, Scottsdale, Arizona, USA
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12
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Ho KWD, Przkora R, Kumar S. Sphenopalatine ganglion: block, radiofrequency ablation and neurostimulation - a systematic review. J Headache Pain 2017; 18:118. [PMID: 29285576 PMCID: PMC5745368 DOI: 10.1186/s10194-017-0826-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 11/24/2017] [Indexed: 12/02/2022] Open
Abstract
Background Sphenopalatine ganglion is the largest collection of neurons in the calvarium outside of the brain. Over the past century, it has been a target for interventional treatment of head and facial pain due to its ease of access. Block, radiofrequency ablation, and neurostimulation have all been applied to treat a myriad of painful syndromes. Despite the routine use of these interventions, the literature supporting their use has not been systematically summarized. This systematic review aims to collect and summarize the level of evidence supporting the use of sphenopalatine ganglion block, radiofrequency ablation and neurostimulation. Methods Medline, Google Scholar, and the Cochrane Central Register of Controlled Trials (CENTRAL) databases were reviewed for studies on sphenopalatine ganglion block, radiofrequency ablation and neurostimulation. Studies included in this review were compiled and analyzed for their treated medical conditions, study design, outcomes and procedural details. Studies were graded using Oxford Center for Evidence-Based Medicine for level of evidence. Based on the level of evidence, grades of recommendations are provided for each intervention and its associated medical conditions. Results Eighty-three publications were included in this review, of which 60 were studies on sphenopalatine ganglion block, 15 were on radiofrequency ablation, and 8 were on neurostimulation. Of all the studies, 23 have evidence level above case series. Of the 23 studies, 19 were on sphenopalatine ganglion block, 1 study on radiofrequency ablation, and 3 studies on neurostimulation. The rest of the available literature was case reports and case series. The strongest evidence lies in using sphenopalatine ganglion block, radiofrequency ablation and neurostimulation for cluster headache. Sphenopalatine ganglion block also has evidence in treating trigeminal neuralgia, migraines, reducing the needs of analgesics after endoscopic sinus surgery and reducing pain associated with nasal packing removal after nasal operations. Conclusions Overall, sphenopalatine ganglion is a promising target for treating cluster headache using blocks, radiofrequency ablation and neurostimulation. Sphenopalatine ganglion block also has some evidence supporting its use in a few other conditions. However, most of the controlled studies were small and without replications. Further controlled studies are warranted to replicate and expand on these previous findings. Electronic supplementary material The online version of this article (10.1186/s10194-017-0826-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kwo Wei David Ho
- Department of Neurology, University of Florida, PO Box 100236,1149 Newell Drive, Room L3-100, Gainesville, FL, 32611, USA.
| | - Rene Przkora
- Department of Anesthesiology, University of Florida, 1600 SW Archer Road, PO Box 100254, Gainesville, FL, 32610, USA
| | - Sanjeev Kumar
- Department of Anesthesiology, University of Florida, 1600 SW Archer Road, PO Box 100254, Gainesville, FL, 32610, USA
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Oostendorp RAB, Elvers H, Mikolajewska E, Roussel N, van Trijffel E, Samwel H, Nijs J, Duquet W. Cervico-cephalalgiaphobia: a subtype of phobia in patients with cervicogenic headache and neck pain? A pilot study. J Man Manip Ther 2016; 24:200-9. [PMID: 27582619 DOI: 10.1179/2042618615y.0000000015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVES The term 'cephalalgiaphobia' was introduced in the mid-1980s and defined as fear of migraine (attacks). We hypothesized that a specific subtype of cephalalgiaphobia affects patients with cervicogenic headache (CEH). This study aimed to: (1) define the term 'cervico-cephalalgiaphobia'; (2) develop a set of indicators for phobia relevant to patients with CEH; and (3) apply this set to a practice test in order to estimate the frequency of cervico-cephalalgiaphobia in the Dutch primary care practice of manual physical therapy. METHODS A systematic approach was used to develop a definition and potential indicators for cervico-cephalalgiaphobia. An expert group appraised the definition and the set of indicators (score per indicator: never; sometimes; often/always). An invitation to participate in the practice test was sent to Dutch manual physical therapy practices (n = 56) representing 134 manual physical therapists (MPTs). The cut-off point for percentages of scores for coverage of the indicators was set at ≥ 60%. RESULTS The expert group agreed with the proposed definition of cervico-cephalalgiaphobia. A set of eight indicators for cervico-cephalalgiaphobia was selected from 10 initial indicators. Thirty-six MPTs provided data from 46 patients diagnosed with CEH. The coverage of 'often/always' was substantial for the indicators, 'Short-term positive results in previous manual physical therapeutic treatment', 'Shorter interval between treatment sessions', 'Fear of "locked facet joints" of the neck', 'More frequent manipulation', and 'Fear of increase in headaches'. Coverage was also substantial for 'never' regarding 'Long-term positive results in previous manual physical therapeutic treatment'. 'Confirmation of "locked facet joints" of the cervical spine by MPT as a cause for increase of CEH' scored 'often/always' in all patients. Coverage for 'Increased use of medication with insufficient effect' was substantial, scoring as 'sometimes' in 39 (84.8%) patients. DISCUSSION Cervico-cephalalgiaphobia was defined and a set of eight indicators formulated based on the literature and clinical expertise. The practice test provides valuable information on the frequency of indicators for cervico-cephalalgiaphobia in the Dutch manual physical therapy practice, suggesting that cervico-cephalalgiaphobia is common in patients with CEH.
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Affiliation(s)
- Rob A B Oostendorp
- Department of Manual Therapy, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Campus Jette, Belgium; Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, The Netherlands; Pain in Motion International Research Group (www.paininmotion.be), Vrije Universiteit Brussel, Campus Jette, Belgium
| | - Hans Elvers
- Department of Public Health and Research, Radboud University Nijmegen Medical Centre, The Netherlands; Institute for Methodology and Statistics Beuningen, The Netherlands
| | - Emilia Mikolajewska
- Department of Physiotherapy, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland; Rehabilitation Clinic, Clinical Military Hospital No. 10 with Polyclinic, Bydgoszcz, Poland; Neurocognitive Laboratory, Centre for Modern Interdisciplinary Technologies, Nicolaus Copernicus University, Torun, Poland
| | - Nathalie Roussel
- Pain in Motion International Research Group (www.paininmotion.be), Vrije Universiteit Brussel, Campus Jette, Belgium; Department of Rehabilitation Sciences and Physiotherapy (REVAKI), Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - Emiel van Trijffel
- SOMT Educational Institute for Musculoskeletal Therapy, Softwareweg 5, 3821 BN, Amersfoort, The Netherlands
| | - Han Samwel
- Department Medical Psychology, Radboud University Nijmegen Medical Centre, The Netherlands
| | - Jo Nijs
- Pain in Motion International Research Group (www.paininmotion.be), Vrije Universiteit Brussel, Campus Jette, Belgium; Department of Physiotherapy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Campus Jette, Belgium; Department of Physiotherapy and Rehabilitation, University Hospital Brussels, Belgium
| | - William Duquet
- Department of Statistics, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium
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Robbins MS, Robertson CE, Kaplan E, Ailani J, Charleston L, Kuruvilla D, Blumenfeld A, Berliner R, Rosen NL, Duarte R, Vidwan J, Halker RB, Gill N, Ashkenazi A. The Sphenopalatine Ganglion: Anatomy, Pathophysiology, and Therapeutic Targeting in Headache. Headache 2015; 56:240-58. [DOI: 10.1111/head.12729] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 10/15/2015] [Accepted: 10/15/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Matthew S. Robbins
- Montefiore Headache Center; Bronx NY USA
- Department of Neurology; Montefiore Medical Center, Albert Einstein College of Medicine; Bronx NY USA
| | | | - Eugene Kaplan
- The Kaplan Headache Center, Optimum Health Medical Group, PLLC; Clifton Park NY USA
| | - Jessica Ailani
- Department of Neurology; Medstar Georgetown University Medical Center; Washington DC USA
| | - Larry Charleston
- Department of Neurology; University of Michigan Health System; Ann Arbor MI USA
| | - Deena Kuruvilla
- Department of Neurology; Yale School of Medicine; New Haven CT USA
| | | | - Randall Berliner
- Department of Neurology; Montefiore Medical Center, Albert Einstein College of Medicine; Bronx NY USA
| | - Noah L. Rosen
- Pain and Headache Center, Cushing Neuroscience Institute, Department of Neurology, Hofstra North Shore LIJ Medical Center; Manhasset NY USA
| | - Robert Duarte
- Pain and Headache Center, Cushing Neuroscience Institute, Department of Neurology, Hofstra North Shore LIJ Medical Center; Manhasset NY USA
| | | | | | | | - Avi Ashkenazi
- Department of Medicine (Neurology); Doylestown Hospital; Doylestown PA USA
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Fang L, Jingjing L, Ying S, Lan M, Tao W, Nan J. Computerized tomography-guided sphenopalatine ganglion pulsed radiofrequency treatment in 16 patients with refractory cluster headaches: Twelve- to 30-month follow-up evaluations. Cephalalgia 2015; 36:106-12. [PMID: 25896484 DOI: 10.1177/0333102415580113] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 02/06/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Sphenopalatine ganglion percutaneous radiofrequency thermocoagulation treatment can improve the symptoms of cluster headaches to some extent. However, as an ablation treatment, radiofrequency thermocoagulation treatment also has side effects. OBJECTIVE To preliminarily evaluate the efficacy and safety of a non-ablative computerized tomography-guided pulsed radiofrequency treatment of sphenopalatine ganglion in patients with refractory cluster headaches. METHODS We included and analysed 16 consecutive cluster headache patients who failed to respond to conservative therapy from the Pain Management Center at the Beijing Tiantan Hospital between April 2012 and September 2013 treated with pulsed radiofrequency treatment of sphenopalatine ganglion. RESULTS Eleven of 13 episodic cluster headaches patients and one of three chronic cluster headaches patient were completely relieved of the headache within an average of 6.3 ± 6.0 days following the treatment. Two episodic cluster headache patients and two chronic cluster headache patients showed no pain relief following the treatment. The mean follow-up time was 17.0 ± 5.5 months. All patients enrolled in this study showed no treatment-related side effects or complications. CONCLUSION Our data show that patients with refractory episodic cluster headaches were quickly, effectively and safely relieved from the cluster period after computerized tomography-guided pulsed radiofrequency treatment of sphenopalatine ganglion, suggesting that it may be a therapeutic option if conservative treatments fail.
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Affiliation(s)
- Luo Fang
- Department of Anesthesiology and Pain Management, Beijing Tiantan Hospital, Capital Medical University, China
| | - Lu Jingjing
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China
| | - Shen Ying
- Department of Anesthesiology and Pain Management, Beijing Tiantan Hospital, Capital Medical University, China
| | - Meng Lan
- Department of Anesthesiology and Pain Management, Beijing Tiantan Hospital, Capital Medical University, China
| | - Wang Tao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China
| | - Ji Nan
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China
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Bendersky DC, Hem SM, Yampolsky CG. Unsuccessful pulsed radiofrequency of the sphenopalatine ganglion in patients with chronic cluster headache and subsequent successful thermocoagulation. Pain Pract 2015; 15:E40-5. [PMID: 25728125 DOI: 10.1111/papr.12288] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 12/07/2014] [Accepted: 12/09/2014] [Indexed: 01/03/2023]
Abstract
We present the results of pulsed and continuous radiofrequency (CRF) of the sphenopalatine ganglion in a case series of 3 patients with chronic cluster headache (CCH). Three patients were referred to our neurosurgical department because of CCH, which was refractory to pharmacological treatment. They underwent pulsed radiofrequency of the sphenopalatine ganglion (PRF-SPG), and the procedure was performed through an infrazygomatic approach. In the PRF procedures, we applied 2 cycles of PRF at 42°C and 45 V for 120 seconds, with a pulse frequency of 2 Hz and a pulse width of 20 ms. In those procedures where thermocoagulation was carried out, 2 CRF lesions at 80°C for 90 seconds each were performed. Following corticosteroid and local anesthetic (40 mg of methylprednisolone and 1 mL of 1% lidocaine) injection, 2 patients had no pain relief at all, whereas the third one experienced a partial response, which lasted only 1 month and his pain then returned to its baseline level. Thus, this outcome was assessed as a nonsustained partial response. Therefore, all of them underwent a CRF lesioning of the SPG, and after this procedure, they achieved complete pain relief until the end of the follow-up period. Furthermore, the associated autonomic manifestations disappeared. The 3 patients presented in this case series failed to achieve adequate pain relief after PRF-SPG. However, these same patients subsequently underwent a successful CRF of the SPG.
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Affiliation(s)
| | - Santiago Matias Hem
- Department of Neurosurgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Lemley KJ, Hunter SK, Bement MKH. Conditioned Pain Modulation Predicts Exercise-Induced Hypoalgesia in Healthy Adults. Med Sci Sports Exerc 2015; 47:176-84. [DOI: 10.1249/mss.0000000000000381] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Schoenen J, Jensen RH, Lantéri-Minet M, Láinez MJA, Gaul C, Goodman AM, Caparso A, May A. Stimulation of the sphenopalatine ganglion (SPG) for cluster headache treatment. Pathway CH-1: a randomized, sham-controlled study. Cephalalgia 2013; 33:816-30. [PMID: 23314784 PMCID: PMC3724276 DOI: 10.1177/0333102412473667] [Citation(s) in RCA: 260] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background The pain and autonomic symptoms of cluster headache (CH) result from activation of the trigeminal parasympathetic reflex, mediated through the sphenopalatine ganglion (SPG). We investigated the safety and efficacy of on-demand SPG stimulation for chronic CH (CCH). Methods A multicenter, multiple CH attack study of an implantable on-demand SPG neurostimulator was conducted in patients suffering from refractory CCH. Each CH attack was randomly treated with full, sub-perception, or sham stimulation. Pain relief at 15 minutes following SPG stimulation and device- or procedure-related serious adverse events (SAEs) were evaluated. Findings Thirty-two patients were enrolled and 28 completed the randomized experimental period. Pain relief was achieved in 67.1% of full stimulation-treated attacks compared to 7.4% of sham-treated and 7.3% of sub-perception-treated attacks (p < 0.0001). Nineteen of 28 (68%) patients experienced a clinically significant improvement: seven (25%) achieved pain relief in ≥50% of treated attacks, 10 (36%), a ≥50% reduction in attack frequency, and two (7%), both. Five SAEs occurred and most patients (81%) experienced transient, mild/moderate loss of sensation within distinct maxillary nerve regions; 65% of events resolved within three months. Interpretation On-demand SPG stimulation using the ATI Neurostimulation System is an effective novel therapy for CCH sufferers, with dual beneficial effects, acute pain relief and observed attack prevention, and has an acceptable safety profile compared to similar surgical procedures.
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Affiliation(s)
- Jean Schoenen
- Headache Research Unit, Department of Neurology, CHR Citadelle, Liège University, B-4000 Liège, Belgium.
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Current World Literature. Curr Opin Support Palliat Care 2012; 6:289-98. [DOI: 10.1097/spc.0b013e328353e091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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