Efficacy of Sphenopalatine Ganglion Radiofrequency in Refractory Chronic Cluster Headache

World Neurosurg. 2019 Feb;122:e262-e269. doi: 10.1016/j.wneu.2018.10.007. Epub 2018 Oct 11.

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.

Keywords: Chronic cluster headache; Pulsed radiofrequency; Radiofrequency ablation; Refractory; Sphenopalatine ganglion.

MeSH terms

  • Adult
  • Cluster Headache / therapy*
  • Female
  • Follow-Up Studies
  • Ganglia, Autonomic
  • Humans
  • Male
  • Middle Aged
  • Pain Measurement
  • Pulsed Radiofrequency Treatment*
  • Radiofrequency Ablation*
  • Treatment Outcome
  • Young Adult