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Observational Study
. 2018 Nov;58(10):1519-1529.
doi: 10.1111/head.13398. Epub 2018 Sep 14.

Long-Term Outcome of Patients With Intractable Chronic Cluster Headache Treated With Injection of Onabotulinum Toxin A Toward the Sphenopalatine Ganglion - An Observational Study

Irina Aschehoug  1 , Daniel Fossum Bratbak  1   2 , Erling Andreas Tronvik  1   3   4
Affiliations
Observational Study

Long-Term Outcome of Patients With Intractable Chronic Cluster Headache Treated With Injection of Onabotulinum Toxin A Toward the Sphenopalatine Ganglion - An Observational Study

Irina Aschehoug et al. Headache. 2018 Nov.

Abstract

Objectives: To investigate long-term outcomes in per-protocol chronic cluster headache patients (n = 7), 18 and 24 months after participation in "Pilot study of sphenopalatine injection of onabotulinumtoxinA for the treatment of intractable chronic cluster headache."

Methods: Data were collected prospectively through headache diaries, HIT-6, and open questionnaire forms at 18 and 24 months after the first treatment. Patients had access to repeated injections when needed.

Results: An overall significant reduction in cluster headache attack frequency per month (57.3 ± 35.6 at baseline vs 12.4 ± 15.2 at month 18 and 24.6 ± 19.2 at month 24) was found. In addition, there was a reduction in attacks with severe and unbearably intensity (50.0 ± 38.3 at baseline vs 10.1 ± 14.7 at month 18 and 16.6 ± 13.7 at month 24) and an increase in attack free days (4.2 ± 5.9 at baseline vs 19.1 ± 9.4 at month 18 and 12.9 ± 8.8 at month 24).

Conclusions: Our findings suggest sustained headache relief after repeated onabotulinumtoxinA injections toward the sphenopalatine ganglion in intractable chronic cluster headache. A placebo-controlled trial with long-term follow-up is warranted.

Keywords: botulinum toxin; chronic cluster headache; cluster headache; headache; sphenopalatine ganglion.

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Figures

Figure 1
Figure 1
MultiGuide – a novel surgical navigation device to perform the injections. [Color figure can be viewed at https://wileyonlinelibrary.com]
Figure 2
Figure 2
An illustration of sphenopalatine ganglion block with botulinum toxin type A with lateral injection technique in an outpatient, office‐based setting. [Color figure can be viewed at https://wileyonlinelibrary.com]
Figure 3
Figure 3
Retrospectively collected data on number of cluster headache attacks per month per per‐protocol patient during a 24‐month period. IU = units of onabotulinumtoxinA; B = baseline; M = month in follow‐up after first injection of onabotulinumtoxinA. The first 6 months displayed are part of the pilot study. Months 18 and 24 are the months with prospectively collected data presented in this paper. The time of injection of onabotulinumtoxinA is marked with arrows. Patient 5 had a failed first injection as denoted in the pilot study.
See this image and copyright information in PMC

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