Sphenopalatine endoscopic ganglion block: A revision of a traditional technique for cluster headache

Giovanni Felisati, Flavio Arnone, Paolo Lozza, Massimo Leone, Marcella Curone, Gennaro Bussone

Research output: Contribution to journalArticle

Abstract

The diagnosis of chronic cluster headache (CH), the most painful form of headache, is based on typical clinical features characterized by strictly unilateral pain with no side shift and ipsilateral oculofacial autonomic phenomena. The attacks occur several times a day for periods of 1 to 2 months in the episodic form of the disease or less frequently on a daily basis in the chronic form. The pathogenesis of CH involves the activation of parasympathetic nerve structures located within the sphenopalatine ganglion (SPG), which explains many of the associated symptoms, whereas the activation of the ipsilateral hypothalamic gray matter may explain its typical circadian and circannual periodicity. A number of surgical approaches have been tried in cases of chronic CH resistant to pharmacologic therapy, of which SPG blockade has been shown to have certain efficacy. We have adopted a new technique based on endoscopic ganglion blockade that approaches the pterigo-palatine fossa by way of the lateral nasal wall and consists of the injection of a mixture of local anesthetics and corticosteroids, which was performed in 20 selected patients with chronic CH, according to the International Headache Society criteria (18 male, 2 female; mean age 40 yr), who were selected for SPG blockade because they were totally drug resistant. The symptoms improved significantly, but always only temporarily, in 11 cases. These results should be considered rather good because, unlike other frequently used techniques, SPG blockade is not invasive and should therefore always be attempted before submitting patients to more invasive surgical approaches.

Original languageEnglish
Pages (from-to)1447-1450
Number of pages4
JournalLaryngoscope
Volume116
Issue number8
DOIs
Publication statusPublished - Aug 2006

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Sphenopalatine Ganglion Block
Cluster Headache
Ganglia
Headache
Periodicity
Local Anesthetics
Nose
Adrenal Cortex Hormones
Pain
Injections

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Sphenopalatine endoscopic ganglion block : A revision of a traditional technique for cluster headache. / Felisati, Giovanni; Arnone, Flavio; Lozza, Paolo; Leone, Massimo; Curone, Marcella; Bussone, Gennaro.

In: Laryngoscope, Vol. 116, No. 8, 08.2006, p. 1447-1450.

Research output: Contribution to journalArticle

Felisati, Giovanni ; Arnone, Flavio ; Lozza, Paolo ; Leone, Massimo ; Curone, Marcella ; Bussone, Gennaro. / Sphenopalatine endoscopic ganglion block : A revision of a traditional technique for cluster headache. In: Laryngoscope. 2006 ; Vol. 116, No. 8. pp. 1447-1450.
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