sphenopalatine ganglion

28 November 2013

Unusual Botox Treatment For Cluster Headache

This is Botox treatment like you’ve never seen before, and it could help patients with cluster headaches fight back.

Using Botox (botulinum toxin) for cluster isn’t new. Injections have been given to patients with varying success (take this study as an example).

But a unique treatment using Botox, if successful, could change the way we treat cluster in significant ways.

How it Works

Erling Tronvik and Dr. Daniel Bratbak at the Norwegian University of Science and Technology (NTNU) have developed a system designed to deliver botulinum toxin directly to the sphenopalatine ganglion, a bundle of nerve cells behind the nose. And the treatment doesn’t require surgery.

A press release from the NTNU explains:

The gear they have developed looks a pistol with a very thin barrel, just the thickness of a knitting needle. The barrel is inserted up through the nose of the patient, and by passing through a natural hole in the nasal wall, the mouth of the barrel comes to a bundle of nerves behind the sinuses.

The surgeon pulls the trigger of the pistol, which shoots a dose of Botox to the area around the nerve bundle. The whole process takes about a half-an-hour.

Could this non-surgical procedure actually fight cluster more directly and provide significant relief? And if it does, could it help patients with other types of headache as well?

Will it work?

This treatment is brand new, and patients are still being recruited for a trial. So we have to speculate – could it work?

The sphenopalatine ganglion has been a target for cluster research for a long time, because it is an important playing in a cluster attack. It’s also important in other types of chronic pain. Similar treatments are being used, such as the SphenoCath.

Although some patients have found relief through surgical treatments directed at the nerve cluster, these types of treatments haven’t yet found widespread acceptance.

It is true that Botox seems to impact pain messages sent through nerves. Could a more direct approach work better than traditional injections?

It doesn’t seem like Tronvik and Bratbak are sure, and it’s unclear why they have chosen this approach.

Dr. Alexander Mauskop from the New York Headache Clinic expressed his skepticism earlier this month, concluding,”Until we have some evidence that this treatment works we have to work with the standard approaches to cluster headaches, which include, occipital nerve blocks, oxygen, a course of steroid medications, sumatriptan (imitrex) injections, verapamil, lithium, and other drugs.“

As with any new treatment, we simply have to sit and wait. But we always hope that a new and unique treatment may help cluster headache patients, who suffer from one of the most intense pain disorders in existence.

7 August 2013

A New Neurostimulation Device to fight Cluster Headache (and Migraine?)

James Discoveries & Stats, Treatments 0

Cluster headache researchers have been interested in treatments focused on the sphenopalatine ganglion for the past few years. The sphenopalatine ganglion is a nerve center which seems to be key in the symptoms of cluster.

In the past, this ganglion has been targeted by drugs which basically keep the area from feeling pain. Other treatments actually aim to destroy it.

These methods have brought relief to some, though not all sufferers.

Now there are ongoing tests of a device to stimulate the sphenopalatine ganglion using a small implanted device. The device may be controlled by the patient, and so used on demand.

This is in some ways preferable to strong drugs or an irreversible surgery. But, of course, although minimally invasive it’s still surgery.

But with the severe limitations of treatment for cluster, this is one to watch. It’s a treatment that’s still very new, and still being studied. But so far, the results are good.

Even patients who have been rather unsuccessfully treated in the past for cluster found that this treatment was a big help, significantly lowering their pain and increasing their quality of life. Although it doesn’t seem to work for everyone, the fact that it’s helping a significant number and that it is a treatment that will likely be improved with study is very encouraging.

Some researchers have wondered if the same treatment would work for migraine. A small study suggested that it may help some migraineurs as well, which could be good news for those who have not yet found good treatment.

For more information, read:

Neurostimulation for Primary Headache Disorders

Stimulation of the sphenopalatine ganglion (SPG) for cluster headache treatment. Pathway CH-1: A randomized, sham-controlled study.

Electrical stimulator for cluster headaches.

A remote-controlled device to stop severe headache pain

5 July 2013

What is behind the dreaded Cluster Headache?

James Information 7

Just what causes one person to be a cluster headache sufferer? As with many headache disorders, the cause of cluster headache is not completely understood. But we are getting closer.

So here’s the question – what parts of the body are involved in the cluster attack? And how are they involved?

1. The hypothalamus: The hypothalamus is now thought to be the launching pad of the cluster attack. It first becomes a suspect because it controls your 24 hour clock. Cluster is a very regular disorder, in that it comes in cycles (hence the name – cluster).

About the size of a almond, the hypothalamus is found right above the brain stem. Thanks to modern imaging techniques, we can see differences in the brain of a cluster headache sufferer.

2. The trigeminal nerve: Parts of the trigeminal nerve are activated during a cluster attack. This is a very important nerve in your face and jaw. It’s involved in the eye pain, tearing and redness of cluster. It can also help bring on the congestion.

3. The sphenopalatine ganglion: A “ganglion” is a group of nerve cells. This particular ganglion is located behind the nose. Some cluster patients have found relief after surgery on the sphenopalatine ganglion.

4. Blood vessels: Changes in blood flow may be involved in cluster, but we know now it’s not as central as we once thought. There can be changes in blood flow, but the question is whether or not this is a result of an attack or a part of the cause.

5. Histamine: Histamine has been a suspect because you can sometimes trigger an attack with histamine. However, so far research has not been convincing.

We’re learning more and more about just how the hypothalamus is activating during a cluster attack. Thanks to modern imaging and analyzing techniques (such as voxel based morphometry), we can see more of what goes on during an attack. This has led to better treatments, but we still have a long way to go.