Sphenopalatine Ganglion Stimulation

What is Sphenopalatine Ganglion Stimulation?

The sphenopalatine ganglion (SPG) is a nerve bundle behind the bony structure of the nose that has been long recognized to be associated with pain pathways of certain headache disorders, such as cluster headache.

Why Has Neurostimulation Been Pursued to Target the SPG?

The SPG ganglion is an important neural relay station for facial sensation. For that reason, SPG neurostimulation was pursued as a form of therapy to control headaches and facial pains. Ensuing clinical trials indicated that applying electrical stimulation to this nerve bundle via a small neurostimulator, implanted through the back of the mouth, under the cheek of the upper jaw, can moderate nerve activity that occurs in some facial pain conditions, like chronic headaches, which are a major public health problem. (1) SPG stimulation is potentially less economically burdensome than drug treatments that are less effective than neurostimulation in relieving chronic neuropathic pain (2).

SPG stimulation has been an available therapy for episodic and cluster headache in Europe since 2012. (2)

Recent SPG Neurostimulation Research

In Europe, a multicenter clinical trial from 2010 – 2013, the Pathway CH-1 study, showed an overall reduction in disability from cluster headache in participants who used a handheld controller to activate an implanted SPG neurostimulator at the start of a headache attack. Of the 32 participants, 68% had a reduction in pain during the attack of at least 50%, had at least 50% fewer attacks, or both. (2)

A subsequent U.S. clinical trial, Pathway CH-2, was expected to be completed in January 2017.

The SPG is connected to a complex neural pathway involved in headache that is associated with the occipital nerves along the neck and scalp via a structure called the cervicofacial ramus. Several nerves form the SPG. They branch off from the main facial nerve, the trigeminal ganglion, which is responsible for pain and other sensations of facial structures, including the internal surface of the nose. (Image: Wikimedia)


References

1. Schoenen J, Jensen RH, Lantéri-Minet M, et al. Stimulation of the sphenopalatine ganglion (SPG) for cluster headache treatment. Pathway CH-1: A randomized, sham-controlled study. Cephalalgia. 2013;33(10):816-830.

2. Pietzsch JB, Garner A, Gaul C, May A. Cost-effectiveness of stimulation of the sphenopalatine ganglion (SPG) for the treatment of chronic cluster headache: a model-based analysis based on the Pathway CH-1 study. The Journal of Headache and Pain. 2015;16:48. doi:10.1186/s10194-015-0530-8. doi:10.1177/0333102412473667.


Reviewed July 1, 2016
Damien Haton Pietrin, MD, PhD
Head Chief of Staff
Interventional Pain Center
Clinique Sainte-Marie
Cergy-Pontoise, France

Head Chief Physicist
Fundamental Neuromodulation Physics Laboratory, NFPLAB
Université du Plateau de Saclay-CEA
Orsay, France

Last Updated on Tuesday, April 25, 2017 11:06 AM