Can SPG Stimulation Relieve Chronic Cluster Headache Pain?

Sphenopalatine ganglion (SPG) stimulation may be a safe and an effective treatment option for patients with chronic cluster headache, according to findings of a new study.

“Chronic cluster headache is the most disabling form of cluster headache. The mainstay of treatment is attack prevention, but the available management options have little efficacy and are associated with substantial [adverse] effects,” the researchers wrote. “In this study, we aimed to assess the safety and efficacy of [SPG] stimulation for treatment of chronic cluster headache.”

To conduct their study, the researchers enrolled 93 patients aged 22 years or older with chronic cluster headache. The patients were from 21 different US headache centers and had reported a minimum of 4 cluster headache attacks per week that were unsuccessfully controlled by preventive treatments.

The researchers randomly assigned 45 participants to receive stimulation of SPG and 48 participants to receive a sham control that delivered a cutaneous electrical stimulation.

“The primary efficacy endpoint…was the difference between groups in the proportion of stimulation-treated ipsilateral cluster attacks for which relief from pain was achieved 15 minutes after the start of stimulation without the use of acute drugs before that timepoint,” the study authors wrote.

Participants who had at least 1 attack during the 4-week experimental phase were included in the efficacy analyses. In turn, data on 36 participants in the SPG stimulation group and 40 participants in the control group were analyzed.

In all, pain relief at 15 minutes was reached in 62.46% of the attacks experienced among the SPG stimulation group and in 38.87% of the attacks experienced among the control group.

By the end of the open-label phase, 9 serious adverse events were reported, 5 of which were unrelated to the device implantation procedure or stimulation device. Further, there were no unanticipated serious adverse events.

—Colleen Murphy

Reference:

Goadsby PJ, Sahai-Srivastava S, Kezirian EJ, et al. Safety and efficacy of sphenopalatine ganglion stimulation for chronic cluster headache: a double-blind, randomised controlled trial. Lancet Neurol. 2019;18(12):1081-1090. https://doi.org/10.1016/S1474-4422(19)30322-9.