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Cluster headache: potential options for medically refractory patients (when all else fails)
Stewart J Tepper1, Mark J Stillman
1Headache Center, Neurological Center for Pain, Cleveland Clinic, Cleveland, OH, USA.
Headache
|July 2, 2013
Summary
Evidence supports several treatments for refractory conditions, including occipital nerve blocks, deep brain stimulation, and sphenopalatine ganglion (SPG) interventions like blocks, radiofrequency ablation, and neurostimulation.
Area of Science:
- Neurology
- Pain Management
- Neurosurgery
Background:
- Refractory conditions pose significant treatment challenges.
- Identifying effective interventions is crucial for patient care.
Purpose of the Study:
- To review and summarize evidence for various treatment modalities.
- To highlight effective interventions for refractory conditions.
Main Methods:
- Literature review of existing evidence.
- Analysis of treatment efficacy for specific conditions.
Main Results:
- Mixed anesthetic/steroid occipital nerve blocks show strong evidence, applicable to non-refractory cases.
- Deep brain stimulation is a supported intervention.
- Sphenopalatine ganglion (SPG) interventions, including blocks, radiofrequency ablation, and neurostimulation (e.g., ATI SPG Neurostimulator), are effective.
- SPG Neurostimulator has EU approval and reimbursement in multiple countries.
Conclusions:
- Multiple evidence-based treatment options exist for refractory conditions.
- Occipital nerve blocks and SPG interventions offer promising therapeutic avenues.
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