Láinez Miguel Ja, Marti Ana Suller
1 Department of Neurology, Hospital Clínico Universitario Valencia, Spain.
2 Department of Neurology, Universidad Católica de Valencia, Spain.
Cephalalgia. 2016 Oct;36(12):1149-1155. doi: 10.1177/0333102416644968. Epub 2016 Jul 11.
Objectives The cluster headache is the most excruciatingly painful primary headache. In some patients, neither preventive treatment nor acute treatment is effective or treatment is poorly tolerated. The sphenopalatine ganglion (SPG) has an important role in the pathophysiology of cluster headache and, for this reason, SPG stimulation has been used to treat cluster headache. Methods We have reviewed the published literature on the role of the SPG in cluster headache and the use of different treatments targeting the SPG. Results Multiple procedures have been used over the SPG to treat pain and trigemino-autonomic symptoms in patients with refractory cluster headache. After obtaining good results in a small number of patients, a miniaturized stimulator was developed. Stimulation of the SPG with this device proved to be efficacious in acute and preventive treatment in a clinical trial involving patients with chronic refractory cluster headache. Implantation of the device is minimally invasive and the most frequent side-effects are mild, such as paraesthesia and pain over the maxillary area. In patients who have used the SPG device for longer than one year, the therapeutic effect remains effective and the side-effects decrease. Conclusions The reported studies have demonstrated that SPG stimulation is a safe and effective treatment for chronic cluster headache. Long-term studies have shown that the effect remains over time and this treatment could be a good choice in patients with chronic refractory headache. We need more data about its potential use in other forms of headache, such as other trigemino-autonomic headaches or migraine.
目的 丛集性头痛是最令人痛苦的原发性头痛。在一些患者中，预防性治疗和急性治疗均无效，或治疗耐受性差。蝶腭神经节（SPG）在丛集性头痛的病理生理学中起重要作用，因此，SPG刺激已被用于治疗丛集性头痛。方法 我们回顾了已发表的关于SPG在丛集性头痛中的作用以及针对SPG的不同治疗方法的文献。结果 已采用多种针对SPG的方法来治疗难治性丛集性头痛患者的疼痛和三叉神经自主神经症状。在少数患者取得良好效果后，开发了一种小型化刺激器。在一项涉及慢性难治性丛集性头痛患者的临床试验中，用该装置刺激SPG在急性和预防性治疗中均被证明有效。该装置的植入微创，最常见的副作用轻微，如感觉异常和上颌区域疼痛。使用SPG装置超过一年的患者，治疗效果持续有效，副作用减少。结论 已报道的研究表明，SPG刺激是治疗慢性丛集性头痛的一种安全有效的方法。长期研究表明，随着时间推移效果持续存在，这种治疗方法可能是慢性难治性头痛患者的一个不错选择。我们需要更多关于其在其他形式头痛（如其他三叉神经自主神经性头痛或偏头痛）中潜在应用的数据。
