gms | German Medical Science

Objective: Different neuromodulation methods are established to treat chronic headache and several reports indicate that sphenopalatin ganglion (SPG) stimulation offers advantages in Cluster headache over other other stimulation methods as occipital nerve stimulation. Limited evidence exists for both methods regarding both long-term efficacy and mechanism of action. We report on a patient suffering from chronic cluster headache with >20 attacks/months, who partially benefits from ONS and underwent additional SPG stimulation.

Method: The patient is a 47-year-old male suffering from cluster headache therapy refractory to conventional medical treatment. He underwent ONS in another department via a midline approach at the C0/1 level with two octrodes connected with an IPG in the buttock (EonMini, St. Jude Medical). Reported initial reduction in headache days (from 25 to 4 days/months, VAS 10/10 to VAS 4/10) was lost after three months of treatment, when he consulted our department. A dislocation of one electrode was seen and a technically successful revision was performed. However, the patient reported stable conditions after 6 months with 20 headache days per months (VAS 8/10, required up to 60 triptane injections /month). As the patient still remained severely disabled and was unable to work, we considered an additional SPG stimulation.

Results: A permanent SPG stimulation device (ATI) on the left side was implanted in collaboration with the ENT department, no adverse events occurred. Stimulation was switched on 4 weeks postoperatively. Using conventional stimulation parameters (120 Hz, 434µs, 1.6mA, 1+, 3-), pain relief was achieved with a significant decrease in cluster attacks (6 attacks/months). Additionally, a reduction in triptane use to 8 injections per months was noted.

Conclusions: This case report indicates that a combination of different neuromodulation methods to influence the trigemino-autonomic system is feasible, effective and safe.