Treatment for Acute and Chronic Headaches
Available at Interventional Radiology
People with chronic headaches experience debilitating headaches at least fifteen days out of every month. These headaches can be very severe and limit a personís ability to carry out their usual activities of daily living. Chronic headaches affect approximately 5% of the population. While there are many types of headaches, the most common include migraine headaches, cluster headaches, and headaches due to trigeminal neuralgia, tension, sinusitis, temporomandibular joint (TMJ) dysfunction, and head and neck cancer.
Migraine headaches often affect one side of the head, and can be potentially triggered by certain environmental factors, hormones, stress, certain foods and physical activity. They may be preceded by visual disturbances, sensory or motor abnormalities, or generalized irritability. The migraine trigger is felt to initiate a series of complex abnormal nerve signals, which also affect the vascular system of the head and neck leading to a cascade of events creating the debilitating headache.
Cluster headaches are described as excruciating headaches, which can affect one side of the head and often occur without warning. They may last from fifteen minutes to many hours. Although there is no known cause of cluster headaches, the pain is felt to trigger an abnormal pathway of nerve impulses in the hypothalamus (located in the center of the brain) and stimulate the trigeminal nerve. The trigeminal nerve is responsible for sensation of the front of the head as well as of the eye and jaw.
Trigeminal neuralgia is also related to abnormal stimulation of the trigeminal nerve. The pain associated with trigeminal neuralgia is intense facial pain described as electric shocks lasting from seconds to hours. There are often cycles of pain and remission lasting months to years. Sometimes, post-herpetic neuralgia of the trigeminal nerve can also cause similar symptoms.
The temporomandibular joint, better known as TMJ, connects the lower jaw to the skull in front of the ear. The joint, with complex muscle attachments, is very flexible which allows for the smooth movements that enable talking and chewing. TMJ dysfunction is complex and may be related to teeth clenching, muscle spasm or to a disorder of the joint cushion itself. The trigeminal nerve, mentioned previously, is responsible for TMJ sensation and is pathologically stimulated with TMJ dysfunction.
Numerous medications have been prescribed to terminate headache pain and prevent their recurrence. These medications have worked with varying degrees of success, some of which have side effects that cause patients to stop taking them. Other treatments have been performed which may or may not help with headache relief including massage, cognitive behavioral therapy, acupuncture, and botox injections.
There is an accepted, minimally invasive therapy for chronic headaches called a sphenopalatine ganglion (SPG) nerve block. Research has shown that this procedure could help provide potential long-term relief of chronic headache sufferers who do not respond to the typical and alternative treatments mentioned above.
What is the sphenopalatine ganglion (SPG)?
A ganglion represents many nerves grouped together that send messages to other nerves. Some ganglia help control movement and some help with sensation including pain and temperature, while others help with both. The SPG is located in the back of the nasal cavity, outside of the brain, and as a result, is the only ganglion exposed to the environment. It has very close connections with many nerves, including the trigeminal nerve, which send signals to and from the brain controlling sensation, pain and certain movements. Many studies have demonstrated that the SPG is directly involved in the pathway of numerous forms of headache and, when stimulated, can worsen symptoms and cause debilitating chronic headaches. By disrupting the function of the nerves in the SPG, it is possible to reduce the facial pain and headaches experienced by many patients, leading to significant improvement in symptoms and quality of life.
What is involved with an SPG block?
Although there are different approaches to blocking the SPG, the "needle-less" intranasal approach is the simplest, most common, and least risky. After an anesthetic spray is given into each nostril, you will be asked to lie down with your neck slightly extended. An x-ray machine (called a fluoroscope) will be used to guide a small (spaghetti sized) catheter into each nostril (see figure below). A very small amount of contrast (x-ray dye) is injected to confirm adequate position of the catheter. This is then followed by the administration of concentrated xylocaine to block the SPG. The entire procedure takes between 15 to 30 minutes and does not require sedation.
How successful is this procedure?
Studies have shown that up to 80% of patients with one of the headache syndromes previously described will show significant improvement of their typical symptoms. Almost 2 out of 3 patients show complete or near complete resolution of symptoms within 24 hours of the procedure, many of these patients continue to have improvement one week after the procedure. 58% of patients report sustained improvement at one month and 50% at three months. The majority of the patients studied were able to decrease or stop their medications altogether. If significant relief is achieved, the procedure can be repeated and potentially lead to additional long term relief. Headaches related to allergies, muscle tension, or degenerative disc disease in the cervical spine are much less likely to respond long term to the SPG block.
What are the risks involved?
The risks and side effects of transnasal SPG block are few. Significant allergy to xylocaine and x-ray dye can occur but is rare. Infection and nosebleed (epistaxis) from nasal irritation is also very rare. You may experience a bitter taste from the medicine as well as a temporary numbness in the nose, mouth and throat from the therapeutic xylocaine.
How can I schedule a consultation to find out if I am a candidate for this procedure?
If you would like a consultation to discuss this treatment option and assess your candidacy for this procedure, please call Interventional Radiology at 518-262-5149.
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