Sphenopalatine Ganglion Stimulation May Help Treat, Prevent Cluster Headache

Treatment of cluster headache (CH) by sphenopalatine ganglion (SPG) stimulation has long-term benefits in the prevention of attacks and a reduction in disability associated with the disease, according to the results of a 24-month follow-up to the Pathway Cluster Headache (CH)-1 trial reported in the Journal of Headache and Pain.¹

CH is by definition the most painful form of headache and in its chronic form may produce multiple daily attacks that severely limit function. Studies have reported that up to 75% of patients with chronic CH experience severe disability and 20% have suicidal thoughts.^2,3 Treatment has focused on acute pain relief using multiple drugs, but for many patients the headaches remain refractory to treatment.

The original Pathway CH-1 trial published in 2013 by Schoenen et al⁴ demonstrated the efficacy of SPG stimulation not only in acute pain relief from cluster headache attacks but also unanticipated continuing benefits in the prevention of future attacks.  As a result, the investigators designed a follow-up study to explore the long-term effects of SPG stimulation.

A cohort of 33 patients from the original Pathway CH-1 trial with CH refractory to treatment were included in the follow-up study.¹ The patients had a minimum of 4 attacks weekly at baseline and were monitored for 24 months following implantation near the SPG of a microstimulating device, which is believed to interrupt the trigeminal autonomic signal involved in pain activation in CH. The patients controlled the timing and frequency of the stimulation in response to their CH attacks.

Of the 33 patients, 11 (30%) experienced 1 to 3 headache-free periods during follow-up, considered to be “remissions.”  The duration of the longest remission for each patient was a mean of 149 +97 days, effectively converting these headaches from chronic to episodic types of CH.

In addition, SPG stimulation reduced the disability associated with CH. Patients who responded to SPG stimulation also reported a significant reduction in the number of medications they used for acute pain relief, including triptans, which all study patients were receiving at baseline.

The original Pathway CH-1 study reported complete pain relief in 67.1% of patients, along with significant improvement in clinical symptoms in 68% when attacks were only treated acutely using SPG stimulation.⁴ The acute efficacy of SPG stimulation in arresting attacks was not diminished by prophylactic use in the follow-up study.^.1

The 2 studies have significant implications for the management of CH, particularly in patients who have chronic attacks that are refractory to treatment. As the preventive benefits of SPG stimulation were not part of the initial clinical trial design, further studies of the neuromodulating effects of this therapy may help to extend its use.

References

1. Barloese MC, Jürgens TP, May A, et al. Cluster headache attack remission with sphenopalatine ganglion stimulation: experiences in chronic cluster headache patients through 24 months. J Headache Pain. 2016;17:67.
2. Jurgens TP, Gaul C, Lindwurm A, et al. Impairment in episodic and chronic cluster headache. Cephalalgia. 2011;31:671-682.
3. D’Amico D, Rigamonti A, Solari A, et al. Health-related quality of life in patients with cluster headache during active periods. Cephalalgia. 2002;22:818-821.
4. Schoenen J, Jensen RH, Lantéri-Minet M, et al. Stimulation of the sphenopalatine ganglion (SPG) for cluster headache treatment. Pathway CH-1: a randomized, sham-controlled study.  Cephalgia. 2013;33:816-830.