A case of sympathetically mediated headache treated with stellate ganglion blockade.
BACKGROUND
Chronic pain following trauma may be mediated in part by the sympathetic nervous system. There is evidence of sympathetic nervous system dysfunction in patients who suffer from posttraumatic headaches. Not all patients will obtain relief from conventional and antineuropathic medications. Furthermore, the development of adverse effects may limit therapeutic dosing or continuation of these medications.


METHODS
A pediatric case of posttraumatic headache is described. The patient failed medical therapy, and a single stellate ganglion blockade was performed for possible sympathetic involvement. Following sympathetic blockade, the patient's headaches resolved completely. The analgesia proved to be long lasting as the patient reported no further headaches at monthly follow-up intervals. The patient did not require any further analgesic medication after the single procedure.


CONCLUSIONS
Posttraumatic headache is difficult to treat. Although there is evidence of sympathetic nervous system dysfunction in some patients, the extent to which this influences pain remains to be determined. While most cases are treated with a combination of nonpharmacological and pharmacological measures, sympathetic blockade via the stellate ganglion may be an alternative for those patients not responding to conventional therapy.
Chan
Chin-wern
CW
Department of Paediatric Anaesthesia and Pain Management, The Royal Children's Hospital, Parkville, Victoria, Australia. cchan89@hotmail.com
Chalkiadis
George A
GA
D002648:Child; D005131:Eye Injuries / Q000150:complications* / Q000503:physiopathology; D006261:Headache / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D009407:Nerve Block; D013233:Stellate Ganglion / Q000503:physiopathology*; D013564:Sympathetic Nervous System / Q000503:physiopathology*