Cluster Headache—Acute and Prophylactic Therapy

Avi Ashkenazi, MD; Todd Schwedt, MD

Disclosures

Headache. 2011;51(2):272-286. 

In This Article

Peripheral Nerve and Sphenopalatine Ganglion Block

Efficacy of GON block in CH treatment was suggested by Anthony in the 1980s.[62] More recently, the procedure was investigated as CH treatment in a number of studies, with the majority showing positive results.[63–66] Peres et al evaluated the effect of GON block in 14 patients with CH.[63] Patients received GON block ipsilateral to the head pain using lidocaine 1% and triamcinolone 40 mg. Patients were evaluated before and 1 week after the block. Nine (64%) patients had good or moderate response. The procedure was well tolerated. Ambrosini et al evaluated the effect of suboccipital injection of lidocaine 2% with betamethasone, compared with lidocaine and saline, in 23 CH patients in a randomized, controlled study.[64] The CH attacks disappeared within 72 hours in 85% of the lidocaine + betamethasone group (with 61% remaining attack free for 4 weeks) compared with none in the lidocaine + saline group. Injections were well tolerated. Afridi et al examined the efficacy of GON block, using lidocaine 2% and methylprednisolone, in patients with refractory chronic daily headache.[65] Their sample included 19 patients with CH who received 22 injections. Thirteen of the injections (59%) resulted in a complete or partial response, with a median duration of 12 and 21 days, for complete and partial response, respectively. In contrast to these results, Busch et al reported on only minor headache improvement in 60% of 15 CH patients who received GON block using prilocaine.[66]

Endoscopically guided sphenopalatine ganglion (SPG) blockade has been evaluated by Felisati et al for CH treatment.[67] Of 20 refractory CCH patients who underwent the procedure, 11 experienced significant, albeit temporary, symptom relief.

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