Midterm Clinical Outcomes of Repetitive Transnasal Sphenopalatine Ganglion Blockade in Chronic Migraine

Selin Balta; Meltem Uyar; Cihat Özgüncü

doi:10.19161/etd.1263664

TR EN

Kronik Migrende Tekrarlayan Transnasal Sfenopalatin Gangliyon Blokajının Orta Dönem Klinik Sonuçları

Öz

Amaç: Kronik migren, yaşam kalitesini olumsuz yönde etkilemektedir ve yüksek oranda özürlülüğe neden olmaktadır. Günümüzde kronik migrenli hastalara yönelik spesifik profilaktik tedavi seçeneklerine gereksinim vardır. Çalışmamızda tekrarlanan transnasal sphenopalatin gangliyon blokajının kronik migrenli hastalardaki baş ağrılı gün sayısı, atak şiddeti, atak sayısı, atak süresi, ilaç kötüye kullanımı ve epizodik migrene dönüşüm üzerindeki sonuçlarını ve tedaviye yanıt oranını değerlendirmeyi amaçladık. Gereç ve Yöntem: Bu çalışma retrospektif dizayndadır. Nöroloji kliniklerince ağrı kliniğine yönlendirilen, en az altı aydır kronik migren tanılı ve profilaktik tedavilere yanıtsız veya profilaktik tedavileri tolere edememiş hastalar değerlendirildi. Çalışmaya haftada bir kez dört seans bilateral transnasal sfenopalatin gangliyon blokajı uygulanmış olan hastalar dahil edildi. Blokaj 30 dakika boyunca 0.5 cc’lik 0.5% bupivakain emdirilmiş swap çubukları ile uygulanmıştı. Bulgular: Çalışmaya 40 hasta dahil edildi. Hastaların birinci, üçüncü, altıncı ve dokuzuncu ay takiplerinde başlangıca göre baş ağrılı gün sayısı, atak şiddeti ve atak sıklığı parametrelerinde istatistiksel olarak anlamlı iyileşme olduğu saptandı (p değerleri <0.001). Başlangıçtaki ilaç suistimalinin dokuzuncu ayda %55 (n = 22)’den %25 (n = 10)’e gerilediği ve bu gerilemenin istatistiksel olarak anlamlı olduğu saptandı (p değerleri <0.001). Dokuzuncu ayda hastaların 14 (35%)’ünün çok düşük frekanslı, 8 (20%)’inin düşük frekanslı 7 (%17.5)’sinin yüksek frekanslı epizodik migrene dönüştüğü saptandı. Hastaların tedaviye yanıt oranı birinci, üçüncü, altıncı ve dokuzuncu aylarda sırasıyla %26, %31, %30 ve %28 idi. Hayati tehlike arz eden veya komorbidite yaratan herhangi bir yan etki saptanmadı. Sonuç: Basit bir uygulama aracı gerektiren ve uygulaması kolay olan Spg blokajı, kronik migren profilaksisinde güvenli bir seçenek olabilir.

Anahtar Kelimeler

Midterm Clinical Outcomes of Repetitive Transnasal Sphenopalatine Ganglion Blockade in Chronic Migraine

Abstract

Aim: Chronic migraine affects quality of life negatively, causing high rates of disabilities. There is a requirement for specific prophylactic treatment options in chronic migraine patients. We aimed to evaluate effects of repetitive transnasal sphenopalatine ganglion blockade (SPG) on headache days, severity and duration of attacks, drug abuse, conversion to episodic migraine, and responses to chronic migraine treatment. Materials and Methods: Diagnosed with chronic migraine for at least six months, patients referred to the algology clinic and unresponsive to prophylactic treatments or not tolerating prophylactic treatments were evaluated in the study with a retrospective design. Patients undergoing four-session bilateral transnasal SPG blockade per week were included. SPG was performed with 0.5 cc 0.5% bupivacaine-impregnated swab sticks for 30 minutes. Results: In first, third, sixth, and ninth month follow-ups of 40 patients included, a statistically significant improvement was found in number of headache days and parameters of attack severity and frequency, compared to baseline values (p<0.001). Baseline drug abuse decreased from 55% (n=22) to 25% (n=10) at month nine, and regression was statistically significant (p<0.001). Of 40 patients, migraine severity was detected to turn into very low frequency in 14 (35%), low frequency in eight (20%), and high-frequency episodic migraines in seven (17.5%) patients at month nine. Patients’ responses were 26, 31, 30, and 28% in first, third, sixth, and ninth months, respectively. No life-threatening or comorbid side effects were detected. Conclusion: Requiring a simple administration tool and easy-to-administer, SPG may be a safe alternative for chronic migraine prophylaxis.

Keywords

Supporting Institution

none

Thanks

none.

References

Arnold M. Headache classification committee of the international headache society (IHS) the international classification of headache disorders. Cephalalgia. 2018;38(1):1-211.
Natoli J, Manack A, Dean B, Butler Q, Turkel C, Stovner L, et al. Global prevalence of chronic migraine: a systematic review. Cephalalgia. 2009:no-no.
Manack AN, Buse DC, Lipton RB. Chronic migraine: epidemiology and disease burden. Current pain headache reports. 2011;15(1):70-8.
Tassorelli C, Diener H-C, Dodick DW, Silberstein SD, Lipton RB, Ashina M, et al. Guidelines of the International Headache Society for controlled trials of preventive treatment of chronic migraine in adults. 2018;38(5):815-32.
Sun-Edelstein C, Rapoport AM. Update on the pharmacological treatment of chronic migraine. Current painheadache reports. 2016;20(1):1-8.
Yarnitsky D, Goor‐Aryeh I, Bajwa ZH, Ransil BI, Cutrer FM, Sottile A, et al. 2003 Wolff Award: possible parasympathetic contributions to peripheral and central sensitization during migraine. Headache: The journal of head face pain. 2003;43(7):704-14.
Burkett JG, Robbins MS, Robertson CE, Mete M, Saikali NP, Singh RBH, et al. Sphenopalatine ganglion block in primary headaches: An American Headache Society member survey. Neurology: Clinical Practice. 2020;10(6):503-9.
Bratbak DF, Nordgård S, Stovner LJ, Linde M, Dodick DW, Aschehoug I, et al. Pilot study of sphenopalatine injection of onabotulinumtoxinA for the treatment of intractable chronic migraine. Cephalalgia. 2017;37(4):356-64.

Tepe N, Tertemiz OF. The effectiveness of sphenopalatine ganglion blockade in chronic migraine resistant to medical treatment. Neurology Asia. 2021;26(4).
Additional I, Candido KD, Masonic AI. A novel revision to the classical transnasal topical sphenopalatine ganglion block for the treatment of headache and facial pain. Pain physician. 2013;16:E769-E78.
Barad M, Ailani J, Hakim SM, Kissoon NR, Schuster NM. Percutaneous Interventional Strategies for Migraine Prevention: A Systematic Review and Practice Guideline. Pain Medicine. 2022;23(1):164-88.
Tassorelli C, Diener H-C, Dodick DW, Silberstein SD, Lipton RB, Ashina M, et al. Guidelines of the International Headache Society for controlled trials of preventive treatment of chronic migraine in adults. Cephalalgia. 2018;38(5):815-32.
Jedynak J, Eross E, Gendolla A, Rettiganti M, Stauffer VLJTJoH, Pain. Shift from high-frequency to lowfrequency episodic migraine in patients treated with Galcanezumab: results from two global randomized clinical trials. 2021;22(1):1-10.
Cady R, Saper J, Dexter K, Manley HR. A Double‐Blind, Placebo‐Controlled Study of Repetitive Transnasal Sphenopalatine Ganglion Blockade With T x360® as Acute Treatment for Chronic Migraine. Headache: The Journal of Head and Face Pain. 2015;55(1):101-16.
Bobker S, Ehrlich A, Recchioni C, Levin M, Riggins NJJAAD. Retrospective Chart Review: The Feasibility of a Self-Administered Nasal Spray Targeting the Sphenopalatine Ganglion (SPG) in Treatment of Chronic Migraine. 2022;2(1).
Additional I, Candido KD, Masonic AIJPp. A novel revision to the classical transnasal topical sphenopalatine ganglion block for the treatment of headache and facial pain. 2013;16:E769-E78.
Krebs K, Rorden C, Androulakis XM. Resting state functional connectivity after sphenopalatine ganglion blocks in chronic migraine with medication overuse headache: a pilot longitudinal fMRI study. Headache: The Journal of Head Face Pain. 2018;58(5):732-43.
Maizels M, Scott B, Cohen W, Chen W. Intranasal lidocaine for treatment of migraine: a randomized, doubleblind, controlled trial. JAMA psychiatry. 1996;276(4):319-21.
Munakata J, Hazard E, Serrano D, Klingman D, Rupnow MF, Tierce J, et al. Economic burden of transformed migraine: results from the American Migraine Prevalence and Prevention (AMPP) Study. Headache: The Journal of Head Face Pain. 2009;49(4):498-508.
Adams AM, Serrano D, Buse DC, Reed ML, Marske V, Fanning KM, et al. The impact of chronic migraine: The Chronic Migraine Epidemiology and Outcomes (CaMEO) Study methods and baseline results. Cephalalgia. 2015;35(7):563-78.
Ashina S, Buse D, Maizels M, Manack A, Serrano D, Turkel C, et al., editors. Self-reported anxiety as a risk factor for migraine chronification: results from the American Migraine Prevalence and Prevention (AMPP) study. Headache; 2010: WILEY-BLACKWELL PUBLISHING, INC COMMERCE PLACE, 350 MAIN ST, MALDEN 02148 ….

Details

Primary Language

English

Subjects

Health Care Administration

Journal Section

Research Article

Authors

Selin Balta ^*
0000-0002-9248-6778
Türkiye

Meltem Uyar
0000-0001-8531-6351
Türkiye

Cihat Özgüncü
0000-0001-7755-9409
Türkiye

Publication Date

March 19, 2024

Submission Date

March 11, 2023

Acceptance Date

July 19, 2023

Published in Issue

Year 2024 Volume: 63 Number: 1

DOI

https://doi.org/10.19161/etd.1263664

IZ

https://izlik.org/JA32ZA64UU

Cite

RIS / Bibtex

Vancouver

1.Selin Balta, Meltem Uyar, Cihat Özgüncü. Midterm Clinical Outcomes of Repetitive Transnasal Sphenopalatine Ganglion Blockade in Chronic Migraine. EJM. 2024 Mar. 1;63(1):56-63. doi:10.19161/etd.1263664