Abstract
Chronic headaches are a major source of morbidity in the pediatric population, affecting physical function, school attendance, social capacity, mood, and sleep. In adults, repetitive sphenopalatine ganglion (SPG) blockade has been studied as a preventive treatment for chronic migraines. This case series aims to evaluate the SPG block for the preventive treatment of chronic daily headache (CDH) in adolescents. We prospectively evaluated 17 adolescents (14 females, 14 ± 1 year) with CDH not responding to cognitive behavioral therapy (CBT), physiotherapy, and standard medications. Each patient received 10 SPG blocks (two blocks/week) using the Tx360® device. At the end of treatment, 10 patients (59%) reported a Patient’s Global Impression of Change (PGIC) score ≥ 67%, and 3 months after the end of treatment, nine patients (53%) sustained a PGIC ≥ 67%. There was also a statistically significant reduction in the depression subscale of the Revised Children’s Anxiety and Depression Scale (RCADS) at the end of treatment and 3 months post-treatment compared with baseline. The procedure was well tolerated with no adverse effects. In our study, the use of repeat SPG blockade was associated with sustained benefits on the PGIC and the depression subscale of the RCADS when used as preventive headache treatment in adolescents with refractory CDH.
Highlights
Headaches are a common neurological disorder in children, affecting as many as 88%of the pediatric population [1]
Up to 4% of children and adolescents suffer from headaches included in the umbrella term “chronic daily headache” (CDH), defined as having at least
Patients were recruited to the study if they had a diagnosis of CDH, defined as having at least 15 headache days per month for at least 3 months, and did not respond to the standard multidimensional treatment program, which consists of physiotherapy, cognitive behavioral therapy (CBT), and pharmacological treatments including abortive and preventive medications
Summary
Headaches are a common neurological disorder in children, affecting as many as 88%of the pediatric population [1]. Headaches are a common neurological disorder in children, affecting as many as 88%. Up to 4% of children and adolescents suffer from headaches included in the umbrella term “chronic daily headache” (CDH), defined as having at least. 15 headache days per month [2]. Chronic headaches reduce quality of life by affecting school attendance, social capacity, physical function, mood, and sleep [1,3,4]. The sphenopalatine ganglion (SPG), known as the pterygopalatine ganglion, is a complex parasympathetic structure that has been successfully targeted to treat various headache disorders and facial pain syndromes in adults [7]. SPG blocks have been performed for decades, using techniques of varying invasiveness and accuracy [9]. A non-invasive medication delivery device called the Tx360®
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