Stimulation of the sphenopalatine ganglion in intractable cluster headache: Expert consensus on patient selection and standards of care

TY - JOUR

T1 - Stimulation of the sphenopalatine ganglion in intractable cluster headache

T2 - Expert consensus on patient selection and standards of care

AU - Jürgens, Tim P

AU - Schoenen, Jean

AU - Rostgaard, Jørgen

AU - Hillerup, Søren

AU - Láinez, Miguel J A

AU - Assaf, Alexandre T

AU - May, Arne

AU - Jensen, Rigmor H

N1 - © International Headache Society 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

PY - 2014/11/13

Y1 - 2014/11/13

N2 - CONTEXT AND OVERVIEW: Chronic cluster headache (CCH) is a debilitating headache disorder with a significant impairment of the patients' lives. Within the past decade, various invasive neuromodulatory approaches have been proposed for the treatment of CCH refractory to standard preventive drug, but only very few randomized controlled studies exist in the field of neuromodulation for the treatment of drug-refractory headaches. Based on the prominent role of the cranial parasympathetic system in acute cluster headache attacks, high-frequency sphenopalatine ganglion (SPG) stimulation has been shown to abort ongoing attacks in some patients in a first small study. As preventive effects of SPG-stimulation have been suggested and the rate of long-term side effects was moderate, SPG stimulation appears to be a promising new treatment strategy.AIMS AND CONCLUSION: As SPG stimulation is effective in some patients and the first commercially available CE-marked SPG neurostimulator system has been introduced for cluster headache, patient selection and care should be standardized to ensure maximal efficacy and safety. As only limited data have been published on SPG stimulation, standards of care based on expert consensus are proposed to ensure homogeneous patient selection and treatment across international headache centres. Given that SPG stimulation is still a novel approach, all expert-based consensus on patient selection and standards of care should be re-reviewed when more long-term data are available.

AB - CONTEXT AND OVERVIEW: Chronic cluster headache (CCH) is a debilitating headache disorder with a significant impairment of the patients' lives. Within the past decade, various invasive neuromodulatory approaches have been proposed for the treatment of CCH refractory to standard preventive drug, but only very few randomized controlled studies exist in the field of neuromodulation for the treatment of drug-refractory headaches. Based on the prominent role of the cranial parasympathetic system in acute cluster headache attacks, high-frequency sphenopalatine ganglion (SPG) stimulation has been shown to abort ongoing attacks in some patients in a first small study. As preventive effects of SPG-stimulation have been suggested and the rate of long-term side effects was moderate, SPG stimulation appears to be a promising new treatment strategy.AIMS AND CONCLUSION: As SPG stimulation is effective in some patients and the first commercially available CE-marked SPG neurostimulator system has been introduced for cluster headache, patient selection and care should be standardized to ensure maximal efficacy and safety. As only limited data have been published on SPG stimulation, standards of care based on expert consensus are proposed to ensure homogeneous patient selection and treatment across international headache centres. Given that SPG stimulation is still a novel approach, all expert-based consensus on patient selection and standards of care should be re-reviewed when more long-term data are available.

U2 - 10.1177/0333102414530524

DO - 10.1177/0333102414530524

M3 - Journal article

C2 - 24740514

SN - 0333-1024

VL - 34

SP - 1100

EP - 1010

JO - Cephalalgia : an international journal of headache

JF - Cephalalgia : an international journal of headache

IS - 13

ER -