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Kang H, Park S, Jin Y. Ultrasound-guided sphenopalatine ganglion block for effective analgesia during awake fiberoptic nasotracheal intubation: A case report. World J Clin Cases 2024; 12:2451-2456. [PMID: 38765735 PMCID: PMC11099407 DOI: 10.12998/wjcc.v12.i14.2451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/13/2024] [Accepted: 04/03/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Awake fiberoptic nasotracheal intubation (AFNI) is the preferred airway management strategy for patients with difficult airways. However, this procedure can cause significant physical and psychological distress. This case report explores the application of a sphenopalatine ganglion (SPG) block as an alternative analgesic modality to mitigate the discomfort associated with AFNI. CASE SUMMARY A 63-year-old female with a history of right maxillary osteosarcoma underwent craniotomy for a suspected malignant brain lesion. The patient's medical history included prior surgery, chemotherapy, and radiation therapy, resulting in significant jaw impairment and limited neck mobility. Considering the anticipated airway challenges, AFNI was planned. A SPG block was performed under real-time ultrasound guidance, providing effective analgesia during nasotracheal intubation. CONCLUSION The SPG block represents a promising analgesic approach in AFNI, offering potential benefits in alleviating pain involving the nasal and nasopharyngeal regions as well as improving patient cooperation.
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Affiliation(s)
- Hangil Kang
- Department of Anesthesiology and Pain Medicine, National Cancer Center, Goyang-si 10408, Gyeonggi-do, South Korea
| | - Seongjae Park
- Department of Anesthesiology and Pain Medicine, National Cancer Center, Goyang-si 10408, Gyeonggi-do, South Korea
| | - Yehun Jin
- Department of Anesthesiology and Pain Medicine, National Cancer Center, Goyang-si 10408, Gyeonggi-do, South Korea
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2
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Peck J, Zeien J, Patel M, Cornett EM, Berger AA, Hasoon J, Kassem H, Jung JW, Ramírez GF, Fugueroa PC, Singhal NR, Song J, Kaye AM, Kaye AD, Koushik SS, Strand NH, Ganti L. Review of Interventional Therapies for Refractory Pediatric Migraine. Health Psychol Res 2023; 10:67853. [PMID: 36726476 PMCID: PMC9886171 DOI: 10.52965/001c.67853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
This is a review of the latest and seminal evidence in pediatric migraine. It covers the etiology and pathophysiology known today, and then will review treatment options, efficacy and safety, quality of data and indications. Though migraine is usually regarded as an infliction in adults, it is not uncommon in the pediatric population and affects up to 8% of children. Children may experience migraine differently than adults, and present not only with headache but also frequent gastrointestinal symptoms. They are frequently shorter in duration than in adults. Traditional migraine treatment in adults is less effective in children. In this population, adjunct therapies - such as interventional techniques - should be considered when traditional treatment fails, including Botulinum Toxin A (BTA) injections, peripheral nerve and ganglion blocks. BTA injections are FDA approved for migraine prophylaxis in adults, but currently not in children; however, recent evidence shows efficacy and safety in pediatric migraine management. Nerve blocks stop nociceptive afferent fibers through injection of local anesthetics, and it may be associated with the local injection of corticosteroids. Although more common in adults, recent data suggests they are safe and effective in children and adolescents. Blocking the sphenopalatine ganglion can be achieved through nasal approach, and achieves a similar action by blocking the entire ganglion. Interventional techniques may provide a key component in the alleviation of this otherwise debilitating chronic migraine pain. Though most studies have been performed in adults, new studies provide encouraging results for treatment in children.
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Affiliation(s)
| | - Justin Zeien
- Department of AnesthesiologyUniversity of Arizona College of Medicine-Phoenix
| | - Megha Patel
- Department of AnesthesiologyUniversity of Arizona College of Medicine-Phoenix
| | - Elyse M. Cornett
- Department of AnesthesiologyLouisiana State University Shreveport
| | | | - Jamal Hasoon
- Department AnesthesiologyMount Sinai Medical Center
| | - Hisham Kassem
- Department AnesthesiologyCritical Care, and Pain Medicine, Beth Israel Deaconess Medical Center
| | | | | | - Paola Colon Fugueroa
- NeurologyHCA Florida Osceola Hospital & University of Central Florida College if Medicine
| | - Neil R. Singhal
- Valley Anesthesiology and Pain Consultants – Envision Physician Services
| | | | - Adam M. Kaye
- Department of Pharmacy PracticeThomas J. Long School of Pharmacy and Health Sciences, University of the Pacific
| | - Alan D. Kaye
- Department of AnesthesiologyLouisiana State University Shreveport
| | - Sarang S. Koushik
- Valleywise Health Medical Center, Creighton University School of Medicine
| | - Natalie H. Strand
- Department of Anesthesiology and Perioperative MedicineMayo Clinic Phoenix
| | - Latha Ganti
- Neurology and Emergency MedicineUniversity of Central Florida College of Medicine
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3
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Srejic U, Litonius E, Gandhi S, Talke P, Maties O, Siegmueller C, Magsaysay A, Hasen D, Kunwar S, Seth R, Gibson L, Bickler P. Bilateral Superficial Trigeminal Nerve Blocks are not More Effective than a Placebo in Abolishing Post-operative Headache Pain in Pituitary Transsphenoidal Neurosurgery: A Prospective, Randomized, Doubleblinded Clinical Trial. Rev Recent Clin Trials 2023; 18:228-237. [PMID: 36843368 PMCID: PMC10514508 DOI: 10.2174/1574887118666230227113217] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 12/01/2022] [Accepted: 12/09/2022] [Indexed: 02/28/2023]
Abstract
BACKGROUND Pituitary neurosurgery executed via the transsphenoidal endonasal approach is commonly performed for pituitary adenomas. Reasons for prolonged hospital stay include postoperative headache and protracted nausea with or without vomiting. Bilateral superficial trigeminal nerve blocks of the supra-orbital V1 and infra-orbital V2 (SION) nerves performed intra-operatively as a regional anesthetic adjunct to general anesthesia were hypothesized to decrease 6 hours postoperative morphine PCA (patient-controlled analgesia) use by patients. METHODS Forty-nine patients, following induction of general anesthesia for their transsphenoidal surgery, were prospectively randomized in a double-blinded fashion to receive additional regional anesthesia as either a block (0.5% ropivacaine with epi 1:200,000) or placebo/sham (0.9% normal saline). The primary endpoint of the study was systemic morphine PCA opioid consumption by the two groups in the first 6-hours postoperatively. The secondary endpoints included (1) pain exposure experienced postoperatively, (2) incidence of postoperative nausea and vomiting, and (3) time to eligibility for PACU discharge. RESULTS Of the 49 patients that were enrolled, 3 patients were excluded due to protocol violations. Ultimately, there was no statistically significant difference between morphine PCA use in the 6 hours postoperatively between the block and placebo/sham groups. There was, however, a slight visual tendency in the block group for higher pain scores, morphine use p=0.046, and delayed PACU discharge. False discovery rate corrected comparisons at each time point and then revealed no statistically significant difference between the two groups. There were no differences between the two groups for secondary endpoints. CONCLUSION It was found that a 6-hour postoperative headache after endoscopic trans-sphenoidal pituitary surgery likely has a more complicated mechanism involving more than the superficial trigeminovascular system and perhaps is neuro-modulated by other brain nuclei.
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Affiliation(s)
- Una Srejic
- Deparment of Anesthesiology and Pain Management, University of California, San Diego (UCSD) Medical Centre, San Diego, CA, USA
| | - Erik Litonius
- Department of Anesthesiology, Helsinki University Central Hospital, Intensive Care, Emergency Medicine and Pain, Helsinki, Finland
| | - Seema Gandhi
- Department of Anesthesiology, University of California, San Francisco (UCSF) Medical Centre, San Francisco, CA, USA
| | - Pekka Talke
- Department of Anesthesiology, University of California, San Francisco (UCSF) Medical Centre, San Francisco, CA, USA
| | - Oana Maties
- Department of Anesthesiology, University of California, San Francisco (UCSF) Medical Centre, San Francisco, CA, USA
| | - Claas Siegmueller
- Department of Anesthesiology, University of California, San Francisco (UCSF) Medical Centre, San Francisco, CA, USA
| | - Avic Magsaysay
- Department of Family Comprehensive Cancer Center, University of California, San Francisco (UCSF) Medical Centre, San Francisco, CA, USA
| | - Daniel Hasen
- Department of Anesthesiology, University of California, San Francisco (UCSF) Medical Centre, San Francisco, CA, USA
| | - Sandeep Kunwar
- Department of Neurosurgery, University of California, San Francisco (UCSF) Medical Centre, San Francisco, CA, USA
| | - Rahul Seth
- Department of Facial Plastic Surgery, Head and Neck Surgery, University of California, San Francisco (UCSF) Medical Centre, San Francisco, CA, USA
| | - Lizbeth Gibson
- Department of Neurosurgery, University of California, San Francisco (UCSF) Medical Centre, San Francisco, CA, USA
| | - Philip Bickler
- Department of Anesthesiology, University of California, San Francisco (UCSF) Medical Centre, San Francisco, CA, USA
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4
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Wahab S, Kataria S, Woolley P, O'Hene N, Odinkemere C, Kim R, Urits I, Kaye AD, Hasoon J, Yazdi C, Robinson CL. Literature Review: Pericranial Nerve Blocks for Chronic Migraines. Health Psychol Res 2023; 11:74259. [PMID: 37139462 PMCID: PMC10151122 DOI: 10.52965/001c.74259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
Purpose of Review Headaches, especially migraines, are one of the most pervasive neurological disorders affecting up to 15.9% of the population. Current methods of migraine treatment include lifestyle changes, pharmacologic, and minimally invasive techniques such as peripheral nerve stimulation (PNS) and pericranial nerve blocks (PNB). Recent Findings PNBs are used to treat and prevent migraines and involves injection of local anesthetics with or without corticosteroids. PNBs include the greater occipital, supraorbital, supratrochlear, lesser occipital, auriculotemporal, sphenopalantine ganglion, and cervical root nerve blocks. Of the PNBs, the most extensively studied is the greater occipital nerve block (GONB) which has been shown to be an efficacious treatment for migraines, trigeminal neuralgia, hemi-crania continua, and post-lumbar puncture, post-concussive, cluster, and cervicogenic headaches but not medication overuse and chronic tension type headaches. Summary In this review, we aim to summarize the recent literature on PNBs and their efficacy in the treatment of migraines including a brief discussion of peripheral nerve stimulation.
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Affiliation(s)
- Stephanie Wahab
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston, MA
| | - Saurabh Kataria
- Louisiana State University Health Shreveport, Department of Neurology, Shreveport, LA
| | - Parker Woolley
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston, MA
| | - Naanama O'Hene
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston, MA
| | - Chima Odinkemere
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston, MA
| | - Rosa Kim
- Georgetown University Hospital, Department of General Surgery, Medstar, Washington, DC
| | | | - Alan D Kaye
- Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA
| | - Jamal Hasoon
- UTHealth McGovern Medical School, Department of Anesthesiology, Critical Care and Pain Medicine, Houston, TX
| | - Cyrus Yazdi
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston, MA
| | - Christopher L Robinson
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston, MA
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Malik A, Thom S, Haber B, Sarani N, Ottenhoff J, Jackson B, Rance L, Ehrman R. Regional Anesthesia in the Emergency Department: an Overview of Common Nerve Block Techniques and Recent Literature. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2022. [DOI: 10.1007/s40138-022-00249-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Abstract
Purpose of Review
This review seeks to discuss the use of RA in the ED including benefits of administration, types of RA by anatomic location, complications and management, teaching methods currently in practice, and future applications of RA in the ED.
Recent Findings
The early use of RA in pain management may reduce the transition of acute to chronic pain. Multiple plane blocks have emerged as feasible and efficacious for ED pain complaints and are now being safely utilized.
Summary
Adverse effects of opioids and their potential for abuse have necessitated the exploration of substitute therapies. Regional anesthesia (RA) is a safe and effective alternative to opioid treatment for pain in the emergency department (ED). RA can manage pain for a wide variety of injuries while avoiding the risks of opioid use and decreasing length of stay when compared to other forms of analgesia and anesthesia, without compromising patient satisfaction.
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Transnasal sphenopalatine ganglion block for pain relief during panretinal photocoagulation laser for diabetic retinopathy: a pre and post interventional study. Sci Rep 2022; 12:10964. [PMID: 35768623 PMCID: PMC9243058 DOI: 10.1038/s41598-022-14745-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 06/13/2022] [Indexed: 11/10/2022] Open
Abstract
This study was performed to utilize transnasal Sphenopalatine Ganglion (SPG) block for pain reliving during panretinal photocoagulation (PRP) in diabetic patients with diabetic retinopathy. This pre and post interventional study was performed on 20 patients with proliferative diabetic retinopathy. The first PRP treatment session of all the patients is performed with no transnasal SPG block, but before holding the second session, all the patients underwent transnasal SPG block and pain levels during and after PRP were compared to each other. Before the transnasal SPG block, each nostril of all the cases was inspected for finding any obstruction in each PRP session. Transnasal SPG block was also performed in with 2% lidocaine. The mean age of the included cases was 52.84 ± 8.62 years old (from 36 to 72 years old). All the cases underwent two PRP lasers treatment sessions with the same characteristic (spot size, power and duration) for each patient. In the first and second PRP treatment sessions, the mean NRS scores were obtained immediately after the PRP laser (8.4 vs. 4.2), 15 min (8.2 vs. 4.2), 1 h (8.0 vs. 4.1), and 24 h (5.4 vs. 3.6) after the PRP respectively. The mean NRS scores significantly reduced during the second PRP treatment session compared to the first session (p < 0.001). Transnasal SPG block is a safe and effective strategy used for relieving pain caused by the PRP laser treatment in patients with diabetic retinopathy.
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Patel D, Taljaard M, Yadav K, James D, Perry JJ. Current practice for primary headache disorders and perspectives on peripheral nerve blocks among emergency physicians in Canada: A national survey. Headache 2022; 62:512-521. [PMID: 35403242 DOI: 10.1111/head.14293] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 02/24/2022] [Accepted: 02/28/2022] [Indexed: 01/23/2023]
Abstract
OBJECTIVE This national postal survey aimed to examine Canadian emergency physicians' practice patterns with respect to drug treatment and perspectives on peripheral nerve blocks. BACKGROUND The treatment of primary headache disorders in the emergency department is variable. METHODS We surveyed 500 emergency physicians listed in the Canadian Medical Directory according to a modified Dillman's method: an initial invitation was followed by up to four reminders to nonresponders. Physicians were asked questions regarding their frequency of medication administration and perspectives toward peripheral nerve blocks. RESULTS Of 500 mailed surveys, 468 were delivered and 179 physicians responded (response rate = 38.2%). The majority of physicians were men (92/144, 63.9%); 80.6% (116/144) had been in practice for greater than or equal to 10 years with 50.7% (75/148) in a community or district general teaching hospital. Commonly used pharmacotherapies for primary headaches were intravenous dopamine receptor antagonists (69%), co-administration of ketorolac and a dopamine receptor antagonist (54.2%), intravenous fluid boluses (54%), nonsteroidal anti-inflammatory drugs (NSAIDs) alone (53.5%), and acetaminophen (51.4%). Only 80 of 144 physicians (55.6%) reported previous experience with peripheral nerve blocks (95% confidence interval [CI] = 48%-65%). The majority (68/80, 85.0%) agreed peripheral nerve blocks are safe and 55.1% (43/78) agreed they are effective. The vast majority (118/140, 84.3%) would consider peripheral nerve blocks as a first-line treatment option given sufficient evidence from a future trial (95% CI = 78%-90%). CONCLUSION NSAIDs alone, as well as dopamine receptor antagonists with or without ketorolac are commonly used for primary headache in Canadian emergency departments. A large proportion of physicians have never used a peripheral nerve block in their practice; among those who have experience with peripheral nerve blocks, the majority find them safe and effective. The majority of respondents would consider peripheral nerve blocks as a first-line treatment option given sufficient evidence from a future trial.
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Affiliation(s)
- Dilan Patel
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Monica Taljaard
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Krishan Yadav
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Emergency Medicine, University of Ottawa, Ontario, Canada
| | - Daniel James
- Department of Anesthesia and Pain Medicine, University of Ottawa, Ontario, Canada.,Department of Emergency Medicine, University of Ottawa, Ontario, Canada
| | - Jeffrey J Perry
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Emergency Medicine, University of Ottawa, Ontario, Canada
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8
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Morgan A, Romanello G. Use of the Sphenopalatine Ganglion Block to Treat Migraine Headaches in the Emergency Department. Cureus 2022; 14:e21428. [PMID: 35103222 PMCID: PMC8769957 DOI: 10.7759/cureus.21428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2022] [Indexed: 11/05/2022] Open
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9
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Smith CR, Fox WC, Robinson CP, Garvan C, Babi MA, Pizzi MA, Lobmeyer E, Bursian A, Maciel CB, Busl KM. Pterygopalatine Fossa Blockade as Novel, Narcotic-Sparing Treatment for Headache in Patients with Spontaneous Subarachnoid Hemorrhage. Neurocrit Care 2021; 35:241-248. [PMID: 33403584 DOI: 10.1007/s12028-020-01157-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/16/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Severe headache is a hallmark clinical feature of spontaneous subarachnoid hemorrhage (SAH), affecting nearly 90% of patients during index hospitalization, regardless of the SAH severity or presence of a culprit aneurysm. Up to 1 in 4 survivors of SAH experience chronic headaches, which may be severe and last for years. Data guiding the optimal management of post-SAH headache are lacking. Opioids, often in escalating doses, remain the guideline-recommended mainstay of acute therapy, but pain relief remains suboptimal. METHODS This study is a case series of adult patients who received bilateral pterygopalatine fossa (PPF) blockade for the management of refractory headaches after spontaneous SAH (aneurysmal and non-aneurysmal) at a single tertiary care center. We examined pain scores and analgesic requirements before and after block placement. RESULTS Seven patients (median age 54 years, 3 men, four aneurysmal and three non-aneurysmal) received a PPF-block between post-bleed day 6-11 during index hospitalization in the neurointensive care unit. The worst pain recorded in the 24-h period before the block was significantly higher than in the period 4 h after the block (9.1 vs. 3.1; p = 0.0156), and in the period 8 h after the block (9.1 vs. 2.8; p = 0.0313). The only complication was minor oozing from the needle insertion sites, which subsided completely with gauze pressure within 1 min. CONCLUSIONS PPF blockade might constitute a promising opioid-sparing therapeutic strategy for the management of post-SAH headache that merits further prospective controlled randomized studies.
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Affiliation(s)
- Cameron R Smith
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA
| | - W Christopher Fox
- Department of Neurology, McKnight Brain Institute, University of Florida College of Medicine, 1149 Newell Drive, L3-100, Gainesville, FL, 32610, USA
| | - Christopher P Robinson
- Department of Neurology, McKnight Brain Institute, University of Florida College of Medicine, 1149 Newell Drive, L3-100, Gainesville, FL, 32610, USA
- Department of Neurosurgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Cynthia Garvan
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Marc-Alain Babi
- Department of Neurology, McKnight Brain Institute, University of Florida College of Medicine, 1149 Newell Drive, L3-100, Gainesville, FL, 32610, USA
- Department of Neurosurgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Michael A Pizzi
- Department of Neurology, McKnight Brain Institute, University of Florida College of Medicine, 1149 Newell Drive, L3-100, Gainesville, FL, 32610, USA
- Department of Neurosurgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Erica Lobmeyer
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Alberto Bursian
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Carolina B Maciel
- Department of Neurology, McKnight Brain Institute, University of Florida College of Medicine, 1149 Newell Drive, L3-100, Gainesville, FL, 32610, USA
- Department of Neurosurgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Katharina M Busl
- Department of Neurology, McKnight Brain Institute, University of Florida College of Medicine, 1149 Newell Drive, L3-100, Gainesville, FL, 32610, USA.
- Department of Neurosurgery, University of Florida College of Medicine, Gainesville, FL, USA.
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Abstract
Purpose of Review Migraine is a common disorder which in many cases can be adequately treated with medications. However, there are some patients who may either not respond to medications or have contraindications to their use. In this review, we will evaluate the available literature on the interventional procedures available to treat patients with episodic migraine. We will review the technical details of performing the procedures, the potential mechanisms of action, and available data on their effectiveness. Recent Findings Recent studies conducted on the subject of interventional procedures including peripheral nerve blocks and onabotulinumtoxinA indicate that some patients with episodic migraine may find benefit from such procedures. Summary In patients with episodic migraine whom traditional treatments have not been effective or are contraindicated, interventional procedures may offer an opportunity to provide additional treatment options.
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Affiliation(s)
| | - Mandy Whitt
- Norton Neuroscience Institute, Louisville, KY, USA
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11
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Berger AA, Hasoon J. Sphenopalatine ganglion block for abortive treatment of a migraine headache. Saudi J Anaesth 2020; 14:548-549. [PMID: 33447208 PMCID: PMC7796753 DOI: 10.4103/sja.sja_810_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 12/29/2019] [Indexed: 11/18/2022] Open
Affiliation(s)
- Amnon A Berger
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA
| | - Jamal Hasoon
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA
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12
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Hernandez N, Guvernator G, Ansoanuur G, Ge M, Tabansi P, Le TT, Obeidat SS, de Haan J. Relief of Secondary Headaches with High Thoracic Erector Spinae Plane Block. Local Reg Anesth 2020; 13:49-55. [PMID: 32606918 PMCID: PMC7319503 DOI: 10.2147/lra.s249250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 05/23/2020] [Indexed: 12/19/2022] Open
Abstract
Intractable headaches can be debilitating, often leading to significant distress, prolonged medical treatment, and unanticipated hospital admissions. There have been significant advances in the treatment of primary intractable headaches such as migraines, tension headaches, and cluster headaches beyond medical management. Treatments may now include interventional strategies such as trigger-point injections, peripheral nerve stimulators, or peripheral nerve and ganglion blocks. There are few studies, however, describing the use of interventional techniques for the management of intractable secondary headaches, including those attributed to injury or infection. A new regional anesthetic technique, the erector spinae plane (ESP) block, was initially used for neuropathic thoracic pain. ESP block has since been reported to provide acute and chronic pain relief of the shoulder, spine, abdomen, pelvis, thorax, and lower extremity. Additionally, there has been one case report to describe the use of the ESP block in the treatment of refractory tension headache. We report four cases of effective analgesia for intractable secondary headache resistant to medical management with high thoracic ESP blocks. In each case, the ESP block provided instant pain relief. We suggest that the findings of this case series indicate that the ESP block may be a useful intervention in patients with severe secondary headache or posterior cervical pain where conventional therapies have limited success, though more studies are necessary.
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Affiliation(s)
- Nadia Hernandez
- Department of Anesthesiology, Division of Regional Anesthesiology and Acute Pain Medicine, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX 77030, USA
| | - Grace Guvernator
- Department of Anesthesiology, Division of Regional Anesthesiology and Acute Pain Medicine, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX 77030, USA
| | - George Ansoanuur
- Department of Neurology, Division of Trauma, Concussion and Sports Neuromedicine, University of Florida College of Medicine, Gainesville, FL 32610, USA
| | - Michelle Ge
- Department of Anesthesiology, Division of Chronic Pain Management, McGovern Medical School, Houston, TX 77030, USA
| | - Precious Tabansi
- Department of Anesthesiology, Division of Regional Anesthesiology and Acute Pain Medicine, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX 77030, USA
| | - Thanh-Thuy Le
- Department of Anesthesiology, Division of Regional Anesthesiology and Acute Pain Medicine, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX 77030, USA
| | - Salameh S Obeidat
- Department of Anesthesiology, Beth-Israel Deaconness Medical Center, Harvard Medical School, Boston, MA, USA
| | - Johanna de Haan
- Department of Anesthesiology, Division of Regional Anesthesiology and Acute Pain Medicine, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX 77030, USA
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13
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Soni PP, Lee M, Shadbehr N, Ahmed ZA. Recent Advances in the Management of Migraine in Older Patients. Drugs Aging 2020; 37:463-468. [PMID: 32578024 DOI: 10.1007/s40266-020-00776-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Although the prevalence of migraine tends to decrease in the fifth to sixth decades of life, there are still a significant number of patients > 65 years of age who experience migraine or have new-onset migraine. Because these older patients are often excluded from clinical trials, there are fewer evidence-based treatment guidelines for them. Migraine treatment in the older population requires careful consideration of changes in medication metabolism and increased medical comorbidities. Furthermore, older patients can present with an atypical migraine phenotype and have a higher rate of secondary headache, which may lead to a delay in diagnosis and subsequent treatment. Classic preventive treatments for migraine, including tricyclic antidepressants, antiepileptic drugs, and beta blockers, often have intolerable side effects. In addition, the presence of coronary artery disease, stroke, and peripheral arterial disease precludes the use of typical rescue medications such as triptans. As such, there has been a dire need for novel acute and preventive treatments for older adults. The purpose of this review is to provide an update on novel acute and preventive treatments for migraine in the older population. The advantages of these therapies include their efficacy, favorable side-effect profile, particularly in patients with atherosclerotic disease, as well as their tolerability.
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Affiliation(s)
- Payal P Soni
- Center for Neurologic Restoration, Headache Section, Cleveland Clinic Foundation, Neurological Institute, 9500 Euclid Ave, Desk C21, Cleveland, OH, 44195, USA
| | - Michelle Lee
- Center for Neurologic Restoration, Headache Section, Cleveland Clinic Foundation, Neurological Institute, 9500 Euclid Ave, Desk C21, Cleveland, OH, 44195, USA
| | - Nasima Shadbehr
- Center for Neurologic Restoration, Headache Section, Cleveland Clinic Foundation, Neurological Institute, 9500 Euclid Ave, Desk C21, Cleveland, OH, 44195, USA
| | - Zubair A Ahmed
- Center for Neurologic Restoration, Headache Section, Cleveland Clinic Foundation, Neurological Institute, 9500 Euclid Ave, Desk C21, Cleveland, OH, 44195, USA.
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14
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Nagib M, Hood P, Matteo J. Sphenopalatine Ganglion Block: Treatment of Migraine and Trigeminal Neuralgia Associated With Multiple Sclerosis. Cureus 2020; 12:e8522. [PMID: 32656035 PMCID: PMC7346333 DOI: 10.7759/cureus.8522] [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] [Indexed: 11/27/2022] Open
Abstract
Head and facial pain are a burden to many people both directly and indirectly. This is manifested not only as a personal burden but also as a financial one in the form of sick leaves from work and loss of workplace productivity. These costs stem from emergency department visits, hospitalizations, preventative treatments, and medical management. Medical management of migraine headaches and other causes of facial pain often proves insufficient, and sphenopalatine ganglion block (SPGB) provides an innovative, adjunctive outpatient treatment option with excellent results in alleviating symptoms. We present a case of a young female suffering from headache and orofacial pain secondary to multiple sclerosis (MS) and trigeminal neuralgia (TN) refractory to traditional medical management, who underwent SPGB with immediate relief of her symptoms. Due to its effectiveness, the role of the SPGB in the treatment of various other conditions causing headache and orofacial pain, such as MS or even TN, continues to expand providing relief and restoring functionality.
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Affiliation(s)
- Michael Nagib
- Interventional Radiology, University of Florida College of Medicine, Jacksonville, USA
| | - Preston Hood
- Interventional Radiology, University of Florida College of Medicine, Jacksonville, USA
| | - Jerry Matteo
- Radiology, University of Florida College of Medicine, Jacksonville, USA
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15
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Ahmadifard M, Yarahmadi S, Ardalan A, Ebrahimzadeh F, Bahrami P, Sheikhi E. The Efficacy of Topical Basil Essential Oil on Relieving Migraine Headaches: A Randomized Triple-Blind Study. Complement Med Res 2020; 27:310-318. [PMID: 32155616 DOI: 10.1159/000506349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 02/03/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Complementary therapies have been increasingly used for the prevention and treatment of migraine so that there is a need for studies in this setting. This study sought to determine the effects of basil essential oil on the severity and frequency of migraine attack headaches. METHODS A triple-blind clinical trial study was performed on 144 patients diagnosed with migraine. Patients were randomly allocated by a stratified method to four groups of 36 titled basil essential oil 2, 4, 6%, and placebo groups. Medications were used topically every 8 h for 3 successive months. In addition, each individual received 325 mg of acetaminophen every 12 h. The severity and frequency of migraine attacks were measured prior to the study, at weeks 2, 4, 8, and 12. The visual analog scale was used to measure pain intensity. The marginal model and generalized estimation equations were used to compare changes in the intensity and frequency of pain over time. RESULTS The interaction of the dose and time factors was significant on both pain intensity (p < 0.001) and frequency of attack (p < 0.001). The odds ratio of higher pain intensity and rate ratio of higher frequency of attack in the intervention groups compared to the placebo group were decreased over the study time. CONCLUSION Time lapse and higher doses of basil essential oil would reduce both the intensity and frequency of migraine attacks.
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Affiliation(s)
- Mahdieh Ahmadifard
- Young Researchers Club, Khorramabad Branch, Islamic Azad University, Khorramabad, Iran
| | - Sajad Yarahmadi
- Department of Critical Care Nursing, Faculty of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran, .,Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran,
| | - Arash Ardalan
- Providence Saint Joseph Medical Center, Burbank, California, USA
| | - Farzad Ebrahimzadeh
- Department of Biostatistics, School of Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Parviz Bahrami
- Department of Neurology, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Elham Sheikhi
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
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16
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Chang B, Zhu W, Zhu J, Li S. Long-term efficacy of superficial temporal artery ligation and auriculotemporal nerve transection for temporal cluster headache in adolescent. Childs Nerv Syst 2019; 35:2385-2389. [PMID: 31289856 DOI: 10.1007/s00381-019-04277-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 06/25/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Cluster headache is a primary headache disorder, which has affected up to 0.1% population. Superficial temporal artery ligation combined with auriculotemporal nerve transection (SLAT) is one of the surgical alternatives to treat the drug-resistant temporal cluster headache (TCH). The current work aimed to assess the effect of SLAT on TCH patients based on the very long-term clinical follow-up. METHODS The current retrospective study had enrolled 20 adolescent TCH patients undergoing SLAT between December 2016 and January 2018. The headache diaries as well as the pain severity questionnaire of the visual analog scale (VAS) had been collected to measure the pain severity before and after surgery. RESULTS The pain-free rates 3 days, as well as 1, 6, and 12 months, after SLAT surgery were 2.00%, 10.00%, 25.00%, and 70.00%, respectively. The frequency of TCH attack daily was found to be markedly reduced on the whole; besides, the pain degree was also remarkably decreased. CONCLUSIONS Results in this study indicate that the sustained headache can be relieved after SLAT in adolescent patients with intractable TCH.
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Affiliation(s)
- Bowen Chang
- Department of Neurosurgery, XinHua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200092, China
| | - Wanchun Zhu
- Department of Neurosurgery, XinHua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200092, China
| | - Jin Zhu
- Department of Neurosurgery, XinHua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200092, China
| | - Shiting Li
- Department of Neurosurgery, XinHua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200092, China.
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17
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Chi PW, Hsieh KY, Chen KY, Hsu CW, Bai CH, Chen C, Hsu YP. Intranasal lidocaine for acute migraine: A meta-analysis of randomized controlled trials. PLoS One 2019; 14:e0224285. [PMID: 31644605 PMCID: PMC6808552 DOI: 10.1371/journal.pone.0224285] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/09/2019] [Indexed: 11/18/2022] Open
Abstract
Background Intranasal lidocaine has been shown to be effective in treating patients with acute migraines; however, its efficacy is still controversial. In this study, we intend to assess the efficacy and safety of intranasal lidocaine compared with a placebo or an active comparator for the treatment of migraines. Method PubMed, EMBASE, Cochrane library, and Scopus databases were searched from their inceptions to November 2018. Randomized controlled studies investigating the efficacy of intranasal lidocaine compared with a placebo or an active comparator were selected. Two reviewers independently extracted and synthesized data using a random-effects model. The primary outcome was pain intensity. The secondary outcomes were success rate, the need for rescue medicine, and relapse occurrences. We registered the study at PROSPERO with an ID of CRD42018116226. Results Six studies (n = 613) were eligible for the meta-analysis. Overall, the results revealed that the study population who was administered intranasal lidocaine had a lower pain intensity at 5 min (standardized mean difference (SMD) = -0.61; 95% CI = -1.04 to -0.19) and 15 min (SMD = -0.72; 95% CI = -1.14 to -0.19), had a higher success rate (RR = 3.55; 95% CI: 1.89 to 6.64) and a less frequent need for rescue medicine (RR = 0.51; 95% CI = 0.36 to 0.72) than the control group. These beneficial effects were not observed when an antiemetic was administered. Furthermore, intranasal lidocaine use had no significant influence on the relapse rate (RR = 0.89; 95% CI = 0.51–1.56), regardless of the use of antiemetics. Using lidocaine caused local irritation in up to 49.4% of the patients in one report but did not cause major adverse events. Conclusion Intranasal lidocaine can be considered a useful option for patients with an acute migraine. It yields a high success rate, a low pain intensity, an infrequent need for rescue medicine, and tolerable adverse events. The administration of antiemetics is an important confounding factor.
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Affiliation(s)
- Pei-Wen Chi
- Emergency Department, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Kun-Yi Hsieh
- Emergency Department, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Kuan-Yu Chen
- Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan
| | - Chin-Wang Hsu
- Emergency Department, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chyi-Huey Bai
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chiehfeng Chen
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
- Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Evidence-based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yuan-Pin Hsu
- Emergency Department, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- * E-mail:
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18
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Koyuncu Irmak D, Kilinc E, Tore F. Shared Fate of Meningeal Mast Cells and Sensory Neurons in Migraine. Front Cell Neurosci 2019; 13:136. [PMID: 31024263 PMCID: PMC6460506 DOI: 10.3389/fncel.2019.00136] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/20/2019] [Indexed: 12/24/2022] Open
Abstract
Migraine is a primary headache disorder which has complex neurogenic pathophysiological mechanisms still requiring full elucidation. The sensory nerves and meningeal mast cell couplings in the migraine target tissue are very effective interfaces between the central nervous system and the immune system. These couplings fall into three categories: intimacy, cross-talk and a shared fate. Acting as the immediate call-center of the neuroimmune system, mast cells play fundamental roles in migraine pathophysiology. Considerable evidence shows that neuroinflammation in the meninges is the key element resulting in the sensitization of trigeminal nociceptors. The successive events such as neuropeptide release, vasodilation, plasma protein extravasation, and mast cell degranulation that form the basic characteristics of the inflammation are believed to occur in this persistent pain state. In this regard, mast cells and sensory neurons represent both the target and source of the neuropeptides that play autocrine, paracrine, and neuro-endocrine roles during this inflammatory process. This review intends to contribute to a better understanding of the meningeal mast cell and sensory neuron bi-directional interactions from molecular, cellular, functional points of view. Considering the fact that mast cells play a sine qua non role in expanding the opportunities for targeted new migraine therapies, it is of crucial importance to explore these multi-faceted interactions.
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Affiliation(s)
- Duygu Koyuncu Irmak
- Department of Histology and Embryology, School of Medicine, Biruni University, Istanbul, Turkey
| | - Erkan Kilinc
- Department of Physiology, School of Medicine, Bolu Abant İzzet Baysal University, Bolu, Turkey
| | - Fatma Tore
- Department of Physiology, School of Medicine, Biruni University, Istanbul, Turkey
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