A New article “Neuromodulation in cluster headache” has just been published on Chronic Cluster Headaches Treatment. (See Pub Med Abstract below) I find it very interesting that while they describe Deep Brain Stimulation, Occipital Nerve Stimulation and various types of surgical intervention they do not discuss direct neurostimulation through the trigeminal nerve. It is a well known fact that almost 100% of headaches have a large trigeminal nerve component.
Various Surgical procedures of the trigeminal nerve and sphenopalatine ganglion are discussed but not the more effective and safer procedures of Sphenopalatine Ganglion blocks. The MiRx protocol has been shown to be extremely effective using the Tx360 device. The standard intranasal approach is extremely effective and has advantages of being the most cost effective method of SPG blocks and the only one patients can self administer to abort cluster headaches before they occur.
Physiologic Dentistry utilizes neurostimulation to relax muscles and eliminate noxious input into the trigeminal nervous system. It is a long term physiologic correction and can be used in conjunction with occipital nerve stimulation or Spenopalatine Ganglion Blocks for highly effective treatment.
High risk testament that is best avoided if possible is surgical treatment by radio surgery or ablation of the Sphenopalatine Ganglion.
The Treatment of Choice for Chronic Cluster Headaches that I recommend is non-invasive treatment utilizing an ULF TENS and a Physiologic Diagnostic Orthotic as the first step combined with safe effective and inexpensive SPG Blocks for the majority of patients. Both of these treatments have have efficacy and minimal risk. If additional relief is required occipital stimulation should be consider.
Another recent article in Headache. 2014 Oct 23. doi: 10.1111/head.12458. on use of TX360 for Sphenopalatine Ganglion Blocks (SPG Blocks) for chronic migraine concluded “SPG blockade with bupivacaine delivered repetitively for 6 weeks with the Tx360® device demonstrates promise as an acute treatment of headache in some subjects with CM. Statistically significant headache relief is noted at 15 and 30 minutes and sustained at 24 hours for SPG blockade with bupivacaine vs saline. The Tx360® device was simple to use and not associated with any significant or lasting adverse events. Further research on sphenopalatine ganglion blockade is warranted.
Pub Med abstract
Adv Tech Stand Neurosurg. 2015;42:3-21. doi: 10.1007/978-3-319-09066-5_1.
Neuromodulation in cluster headache.
Fontaine D1, Vandersteen C, Magis D, Lanteri-Minet M.
Author information
Abstract
Medically refractory chronic cluster headache (CH) is a severely disabling headache condition for which several surgical procedures have been proposed as a prophylactic treatment. None of them have been evaluated in controlled conditions, only open studies and case series being available. Destructive procedures (radiofrequency lesioning, radiosurgery, section) and microvascular decompression of the trigeminal nerve or the sphenopalatine ganglion (SPG) have induced short-term improvement which did not maintain on long term in most of the patients. They carried a high risk of complications, including severe sensory loss and neuropathic pain, and consequently should not be proposed in first intention.Deep brain stimulation (DBS), targeting the presumed CH generator in the retro-hypothalamic region or fibers connecting it, decreased the attack frequency >50 in 60 % of the 52 patients reported. Complications were infrequent: gaze disturbances, autonomic disturbances, and intracranial hemorrhage (2).Occipital nerve stimulation (ONS) was efficient (decrease of attack frequency >50 %) in about 70 % of the 60 patients reported, with a low risk of complications (essentially hardware related). Considering their respective risks, ONS should be proposed first and DBS only in case of ONS failure.New on-demand chronically implanted SPG stimulation seemed to be efficient to abort CH attacks in a pilot controlled trial, but its long-term safety needs to be further studied.
