1
|
Lim T, Anderson S, Stocum R, Ren K, Singleton W, Vallabh J, Noon K, Weaver T. Neuromodulation for the Sphenopalatine Ganglion-a Narrative Review. Curr Pain Headache Rep 2023; 27:645-651. [PMID: 37610504 DOI: 10.1007/s11916-023-01132-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2023] [Indexed: 08/24/2023]
Abstract
PURPOSE OF REVIEW To provide an integrated overview of the current state of knowledge of neuromodulation for the sphenopalatine ganglion (SPG) by reviewing relevant and significant literature. RECENT FINDINGS There are several case reports and clinical trials evaluating neuromodulation for the SPG. We identified two blinded, randomized clinical trials for patients with chronic cluster headache. The randomized trials and additional studies demonstrated the long-term safety, efficacy, and cost-effectiveness of neuromodulation for the SPG. Recent studies in Europe and the USA suggest that SPG neuromodulation is a novel modality with clinical importance for treating acute cluster headaches and reducing the frequency of attacks.
Collapse
Affiliation(s)
- Taehong Lim
- Department of Neurology, The Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - Stephen Anderson
- Department of Physical Medicine and Rehabilitation, The Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - Robert Stocum
- Department of Anesthesiology, The Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - Karen Ren
- Department of Anesthesiology, The Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - Winston Singleton
- Department of Anesthesiology, The Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - Jayesh Vallabh
- Department of Physical Medicine and Rehabilitation, The Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - Kristen Noon
- Department of Anesthesiology, The Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - Tristan Weaver
- Department of Anesthesiology, The Ohio State University, Wexner Medical Center, Columbus, OH, USA.
| |
Collapse
|
2
|
Lund NLT, Petersen AS, Fronczek R, Tfelt-Hansen J, Belin AC, Meisingset T, Tronvik E, Steinberg A, Gaul C, Jensen RH. Current treatment options for cluster headache: limitations and the unmet need for better and specific treatments-a consensus article. J Headache Pain 2023; 24:121. [PMID: 37667192 PMCID: PMC10476341 DOI: 10.1186/s10194-023-01660-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/22/2023] [Indexed: 09/06/2023] Open
Abstract
AIM Treatment for cluster headache is currently based on a trial-and-error approach. The available preventive treatment is unspecific and based on few and small studies not adhering to modern standards. Therefore, the authors collaborated to discuss acute and preventive treatment in cluster headache, addressing the unmet need of safe and tolerable preventive medication from the perspectives of people with cluster headache and society, headache specialist and cardiologist. FINDINGS The impact of cluster headache on personal life is substantial. Mean annual direct and indirect costs of cluster headache are more than 11,000 Euros per patient. For acute treatment, the main problems are treatment response, availability, costs and, for triptans, contraindications and the maximum use allowed. Intermediate treatment with steroids and greater occipital nerve blocks are effective but cannot be used continuously. Preventive treatment is sparsely studied and overall limited by relatively low efficacy and side effects. Neurostimulation is a relevant option for treatment-refractory chronic patients. From a cardiologist's perspective use of verapamil and triptans may be worrisome and regular follow-up is essential when using verapamil and lithium. CONCLUSION We find that there is a great and unmet need to pursue novel and targeted preventive modalities to suppress the horrific pain attacks for people with cluster headache.
Collapse
Affiliation(s)
- Nunu Laura Timotheussen Lund
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, Valdemar Hansens Vej 5, 2600, Glostrup, Denmark.
- Department of Neurology, Sjællands Universitetshospital Roskilde, Roskilde, Denmark.
| | - Anja Sofie Petersen
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, Valdemar Hansens Vej 5, 2600, Glostrup, Denmark
| | - Rolf Fronczek
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
- Stichting Epilepsie Instellingen Nederlands (SEIN), Sleep-Wake Centre, Heemstede, The Netherlands
| | - Jacob Tfelt-Hansen
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Forensic Medicine, Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Andrea Carmine Belin
- Centre for Cluster Headache, Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Tore Meisingset
- Norwegian Advisory Unit On Headaches, St. Olav University Hospital, Trondheim, Norway
- NorHEAD, Norwegian Headache Research Centre, NTNU, Trondheim, Norway
| | - Erling Tronvik
- Norwegian Advisory Unit On Headaches, St. Olav University Hospital, Trondheim, Norway
- NorHEAD, Norwegian Headache Research Centre, NTNU, Trondheim, Norway
| | - Anna Steinberg
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Charly Gaul
- Charly Gaul, Headache Center, Frankfurt, Germany
| | - Rigmor Højland Jensen
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, Valdemar Hansens Vej 5, 2600, Glostrup, Denmark
| |
Collapse
|
3
|
Urits I, Schwartz R, Smoots D, Koop L, Veeravelli S, Orhurhu V, Cornett EM, Manchikanti L, Kaye AD, Imani F, Varrassi G, Viswanath O. Peripheral Neuromodulation for the Management of Headache. Anesth Pain Med 2020; 10:e110515. [PMID: 34150578 PMCID: PMC8207880 DOI: 10.5812/aapm.110515] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/02/2020] [Accepted: 11/17/2020] [Indexed: 12/18/2022] Open
Abstract
Context Neuromodulation is an expanding field of study for headache treatment to reduce pain by targeting structures within the nervous system that are commonly involved in headache pathophysiology, such as the vagus nerve (VNS), occipital nerves, or sphenopalatine ganglion (SPG) for stimulation. Pharmaceutical medical therapies for abortive and prophylactic treatment, such as triptans, NSAIDs, beta-blockers, TCAs, and antiepileptics, are effective for some individuals, but the role that technology plays in investigating other therapeutic modalities is essential. Peripheral neuromodulation has gained popularity and FDA approval for use in treating certain headaches and migraine headache conditions, particularly in those who are refractory to treatment. Early trials found FDA approved neurostimulatory implant devices, including Cephaly and SpringTMS, improved patient-oriented outcomes with reductions in headaches per month (frequency) and severity. Evidence Acquisition This was a narrative review. The sources for this review are as follows: Searching on PubMed, Google Scholar, Medline, and ScienceDirect from 1990 - 2019 using keywords: Peripheral Neuromodulation, Headache, vagus nerve, occipital nerves, sphenopalatine ganglion. Results The first noninvasive neurostimulator device approved for migraine treatment was the Cefaly device, an external trigeminal nerve stimulation device (e-TNS) that transcutaneously excites the supratrochlear and supraorbital branches of the ophthalmic nerve. The second noninvasive neurostimulation device receiving FDA approval was the single-pulse transcranial magnetic stimulator, SpringTMS, positioned at the occiput to treat migraine with aura. GammaCore is a handheld transcutaneous vagal nerve stimulator applied directly to the neck at home by the patient for treatment of cluster headache (CH) and migraine. Several other devices are in development for the treatment of headaches and target headache evolution at different levels and inputs. The Scion device is a caloric vestibular stimulator (CVS) which interfaces with the user through a set of small cones resting in the ear canal on either side and held in place by modified over-ear headphones. The pulsante SPG Microstimulator is a patient-controlled device implanted in the patient’s upper jaw via an hour-long oral procedure to target the sphenopalatine ganglion. The occipital nerve stimulator (ONS) is an invasive neuromodulation device for headache treatment that consists of an implanted pulse generator on the chest wall connected to a subcutaneous lead with 4 - 8 electrodes that is tunneled the occiput. Conclusions The aim of this review is to provide a comprehensive overview of the efficacy, preliminary outcomes, and limitations of neurostimulatory implants available for use in the US and those pending further development.
Collapse
Affiliation(s)
- Ivan Urits
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Department of Anesthesiology, LSU Health Shreveport, Shreveport, LA, USA
| | - Ruben Schwartz
- Department of Anesthesiology, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Daniel Smoots
- Department of Anesthesiology, Creighton University School of Medicine - Phoenix Regional Campus, Phoenix, AZ, USA
| | - Lindsey Koop
- Department of Anesthesiology, Creighton University School of Medicine - Phoenix Regional Campus, Phoenix, AZ, USA
| | - Suhitha Veeravelli
- Department of Anesthesia, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | - Vwaire Orhurhu
- University of Pittsburgh Medical Center, Williamsport, PA, USA
| | - Elyse M. Cornett
- Department of Anesthesiology, LSU Health Shreveport, Shreveport, LA, USA
- Corresponding Author: Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Postal Code: 33932, Shreveport, LA, USA.
| | | | - Alan D. Kaye
- Department of Anesthesiology, LSU Health Shreveport, Shreveport, LA, USA
| | - Farnad Imani
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
- Corresponding Author: Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | | | - Omar Viswanath
- Department of Anesthesiology, LSU Health Shreveport, Shreveport, LA, USA
- Department of Anesthesiology, Creighton University School of Medicine - Phoenix Regional Campus, Phoenix, AZ, USA
- Department of Anesthesia, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
- Valley Anesthesiology and Pain Consultants – Envision Physician Services, Phoenix, AZ, USA
| |
Collapse
|
4
|
Schmerzärzte dürfen nicht wegsehen: Was passiert bei Ausfall eines Medizinprodukteherstellers? Schmerz 2020; 34:282-284. [DOI: 10.1007/s00482-020-00470-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
5
|
The need for continued care after sponsor closure. Lancet Neurol 2020; 19:205. [DOI: 10.1016/s1474-4422(20)30023-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 01/10/2020] [Indexed: 11/23/2022]
|
6
|
Goadsby PJ, Rezai AR, Dodick DW. The need for continued care after sponsor closure - Authors' reply. Lancet Neurol 2020; 19:205-206. [PMID: 32085831 DOI: 10.1016/s1474-4422(20)30024-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 01/10/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Peter J Goadsby
- National Institute for Health Research-Wellcome Trust King's Clinical Research Facility and South London and the Maudsley Biomedical Research Centre, King's College London, London SE5 9PJ, UK.
| | - Ali R Rezai
- Rockefeller Neuroscience Institute, West Virginia University School of Medicine, Morgantown, WV, USA
| | - David W Dodick
- Department of Neurology, Mayo Clinic, Scottsdale, AZ, USA
| |
Collapse
|
7
|
Goadsby PJ, Sahai-Srivastava S, Kezirian EJ, Calhoun AH, Matthews DC, McAllister PJ, Costantino PD, Friedman DI, Zuniga JR, Mechtler LL, Popat SR, Rezai AR, Dodick DW. Safety and efficacy of sphenopalatine ganglion stimulation for chronic cluster headache: a double-blind, randomised controlled trial. Lancet Neurol 2019; 18:1081-1090. [DOI: 10.1016/s1474-4422(19)30322-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 07/29/2019] [Accepted: 07/29/2019] [Indexed: 11/17/2022]
|
8
|
Wei DY, Khalil M, Goadsby PJ. Managing cluster headache. Pract Neurol 2019; 19:521-528. [PMID: 31278205 PMCID: PMC6902063 DOI: 10.1136/practneurol-2018-002124] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 01/10/2019] [Accepted: 03/18/2019] [Indexed: 11/04/2022]
Abstract
Cluster headache is a neurological disorder that presents with unilateral severe headache associated with ipsilateral cranial autonomic symptoms. Cluster headache attacks often occur more than once a day, and typically manifesting in bouts. It has a point prevalence of 1 in 1000 and is the most common trigeminal autonomic cephalalgia. This article aims to guide general neurologists to an accurate diagnosis and practical management options for cluster headache patients.
Collapse
Affiliation(s)
- Diana Y Wei
- Headache Group, Department of Basic and Clinical Neuroscience, King's College London, London, UK
| | - Modar Khalil
- Headache Group, Department of Basic and Clinical Neuroscience, King's College London, London, UK
- Department of Neurology, Hull Royal Infirmary, Hull, UK
| | - Peter J Goadsby
- Headache Group, Department of Basic and Clinical Neuroscience, King's College London, London, UK
- NIHR-Wellcome Trust King's Clinical Research Facility, SLaM Biomedical Research Centre, King's College Hospital, London, UK
| |
Collapse
|
9
|
Nwazota N, Pyati S, Fisher K, Roy L. Device review: Pulsante™ sphenopalatine ganglion microstimulator. Pain Manag 2019; 9:535-541. [PMID: 31782695 DOI: 10.2217/pmt-2018-0082] [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: 11/21/2022] Open
Abstract
Cluster headache (CH) is a primary headache disorder. The use of neuromodulation in treatment of CH is well documented. The sphenopalatine ganglion (SPG) has long been a target for management of CH. Intervention at the level of the SPG can interrupt the trigemino-autonomic reflex, which mediates CH pain. The Pulsante system is the only device on the market created for SPG stimulation. The Pulsante device consists of the device body, a lead with six stimulating electrodes placed in the pterygopalatine fossa, and a fixation plate to allow anchoring of the device to the maxilla. Stimulation is administered via a patient-controlled handheld remote control held over the cheek. SPG stimulation is an important treatment option for CH patients.
Collapse
Affiliation(s)
- Nenna Nwazota
- Department of Anesthesiology, Duke University, Durham, NC 27710, USA
| | - Srinivas Pyati
- Department of Anesthesiology, Durham VA Medical Center, Durham, NC 27710, USA
| | - Kyle Fisher
- Department of Anesthesiology, Duke University, Durham, NC 27710, USA
| | - Lance Roy
- Department of Anesthesiology, Duke University, Durham, NC 27710, USA
| |
Collapse
|