Effect of Radiofrequency Ablation of Sphenopalatine Ganglion in Cluster Headache
Authors: Sabry Sabry Magdy , Fawzy Elbeltagy Yasser Mohamed , Mady Osama Mostafa , Eldin Hassan Mohamed Eldamasy Mostafa Hossam 
Published: November 2024

Abstract

Background
Cluster headache (CH) is a severe and disabling primary headache that belongs to the group of autonomic trigeminal headaches. According to the criteria of the International Classification of Headache Disorders, it is characterized by episodic unilateral headache attacks ranging in duration from 5 to 180 minutes, accompanied by parasympathetic ipsilateral symptoms. Approximately 10% of CHs are chronic, generating recurrent attacks with no pain free periods longer than 1 month for a minimum of 1 year, and 10% of them become refractory to pharmacologic treatments. Chronic refractory cluster headache (CCHr) is a devastating condition with profound negative effects on the life of patients, a fact that has lead to it being known as the suicide headache.

Objective
To evaluate the efficacy of sphenopalatine ganglion RFA treatment in patients suffering from cluster headache with the demonstration of the immediate and long-term clinical effectiveness.

Patients and Methods
An electronic database search (PubMed, SCOPUS, Embase, Web of Science, and the Cochrane database) using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted with the goal of identifying all available studies related to radiofrequency Of Sphenopalatine Ganglion In Cluster headache to 2022.

Results
There were 3 (20%) patients remained headache free and off medications for the duration of the follow-up (18-24 months), 3(20%) patients reported no change or increase in the headache intensity and/or frequency during the first few post-procedure weeks before noticing improvements in their headache pattern. However, 7(46.7%) patients reported change in the headache pattern with return to the episodic form of cluster headache at a mean follow-up period of 18 months. Those patients were eventually able to cut down on their preventive medications, namely verapamil and lithium.

Data Extraction
If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, and adequate information and defined assessment measures.

Conclusion
The current study showed that sphenopalatine ganglion is a promising target for treating cluster headache with radiofrequency ablation. Radiofrequency ablation of sphenopalatine ganglion was safe and effective in the treatment of cluster headache. Radiofrequency ablation of sphenopalatine ganglion resulted in significant reduction in duration of cluster attacks, duration of cluster periods, mean attack frequency, mean attack intensity and pain disability index and there was significant increase in the duration of remission. Literature showed that there were no major adverse events related to the procedure. Further clinical studies with larger sample size and longer follow-up are needed to confirm our results and to identify risk factors of adverse events.