title: Stimulation of the sphenopalatine ganglion in intractable cluster headache: expert consensus on patient selection and standards of care.
abstract: Chronic cluster headache (CCH) is a debilitating headache disorder with a significant impairment of the patients' lives. Within the past decade, various invasive neuromodulatory approaches have been proposed for the treatment of CCH refractory to standard preventive drug, but only very few randomized controlled studies exist in the field of neuromodulation for the treatment of drug-refractory headaches. Based on the prominent role of the cranial parasympathetic system in acute cluster headache attacks, high-frequency sphenopalatine ganglion (SPG) stimulation has been shown to abort ongoing attacks in some patients in a first small study. As preventive effects of SPG-stimulation have been suggested and the rate of long-term side effects was moderate, SPG stimulation appears to be a promising new treatment strategy.
  
  
  OBJECTIVE
  As SPG stimulation is effective in some patients and the first commercially available CE-marked SPG neurostimulator system has been introduced for cluster headache, patient selection and care should be standardized to ensure maximal efficacy and safety. As only limited data have been published on SPG stimulation, standards of care based on expert consensus are proposed to ensure homogeneous patient selection and treatment across international headache centres. Given that SPG stimulation is still a novel approach, all expert-based consensus on patient selection and standards of care should be re-reviewed when more long-term data are available.
authors.affiliation: Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Germany t.juergens@uke.de.
authors.forename: Tim P
authors.initials: TP
authors.lastname: Jürgens
authors.affiliation: Headache Research Unit, Department of Neurology, University of Liège, Belgium.
authors.forename: Jean
authors.initials: J
authors.lastname: Schoenen
authors.affiliation: Department of Oral & Maxillofacial Surgery, Copenhagen University Hospital (Rigshospitalet), Denmark.
authors.forename: Jørgen
authors.initials: J
authors.lastname: Rostgaard
authors.affiliation: Department of Oral & Maxillofacial Surgery, Copenhagen University Hospital (Rigshospitalet), Denmark.
authors.forename: Søren
authors.initials: S
authors.lastname: Hillerup
authors.affiliation: Hospital Clinico Universitario, Catholic University of Valencia, Spain.
authors.forename: Miguel J A
authors.initials: MJ
authors.lastname: Láinez
authors.affiliation: Department of Oral & Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Germany.
authors.forename: Alexandre T
authors.initials: AT
authors.lastname: Assaf
authors.affiliation: Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Germany.
authors.forename: Arne
authors.initials: A
authors.lastname: May
authors.affiliation: Danish Headache Center, Glostrup Hospital, University of Copenhagen, Denmark.
authors.forename: Rigmor H
authors.initials: RH
authors.lastname: Jensen
mesh_terms: D003027:Cluster Headache / Q000628:therapy*; D032921:Consensus; D004599:Electric Stimulation Therapy / Q000379:methods*; D005726:Ganglia, Parasympathetic / Q000502:physiology*; D006801:Humans; D018579:Patient Selection; D059039:Standard of Care
keywords: Cluster headache; neuromodulation; patient selection; sphenopalatine ganglion; standards of care; stimulation