Refractory Chronic Cluster – SPG Stimulation — SCE Neurology MCQ

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HardHeadache & Facial PainRefractory Chronic Cluster – SPG StimulationSCE Neurology

A 45-year-old man with chronic cluster headache (cluster periods lasting >1 year without remission) has failed verapamil, lithium, topiramate, and occipital nerve blocks. What neuromodulation therapy has NICE approved for refractory chronic cluster headache?

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Correct answer: A — Sphenopalatine ganglion stimulation

Sphenopalatine ganglion (SPG) stimulation using an implanted device has been evaluated for refractory chronic cluster headache. NICE IPG527 (2015) states it may be used with normal arrangements for clinical governance. The SPG is a parasympathetic ganglion involved in the trigeminal-autonomic reflex that mediates the autonomic features of cluster headache. Stimulation can abort acute attacks and reduce attack frequency. A: TMS is approved for migraine. C: VNS is for epilepsy/depression. D: tDCS is experimental. E: ONS has some evidence but SPG stimulation is more specifically evaluated for cluster headache.

Reference: NICE IPG527 SPG Stimulation for Chronic Cluster Headache (2015)