Sphenopalatine Ganglion Pulsed Radiofrequency for the Treatment of Refractory Chronic SUNCT and SUNA: A Prospective Case Series

Objectives We aimed to evaluate the safety and effectiveness of sphenopalatine ganglion pulsed radiofrequency (SPG‐PRF) for the treatment of patients with refractory chronic short‐lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and with cranial autonomic symptoms (SUNA). Background SPG‐PRF is a minimally invasive, non‐neurodestructive procedure already tested in refractory chronic cluster headache with mixed outcomes. However, no data have been produced in SUNCT/SUNA. Methods This was a prospective clinical audit of outcomes. Consecutive patients with chronic SUNCT/SUNA refractory to medical treatments and treated with SPG‐PRF, were included in the analysis. The SPG‐PRF was performed percutaneously via a lateral, infra‐zygomatic approach. Responders were defined as patients with a reduction in number and/or severity of headache episodes by ≥30% for ≥3 months. Responders to the first procedure were offered to have the treatment repeated. Results Nine patients (6 female) were analyzed. After a median follow‐up of 30 months (range 2‐30), 7 patients were considered responders to the treatment (77.8%) for a median of 6 months (range: 4‐10), 1 patient obtained 40% improvement for 2 months, and 1 patient did experience any improvement. No procedure‐related immediate or delayed side effects were reported. Three patients (33.3%) experienced a worsening of the head pain for 2‐4 weeks immediately after the procedure. Four responders had SPG‐PRF repeated; a reproducible response was obtained in two of them. Conclusions In our small series of patients with refractory chronic SUNCT/SUNA, SPG‐PRF was a safe and effective treatment modality. The potential reproducible positive effect of subsequent treatments may prevent or delay the use of more invasive and costly interventions for at least a proportion of these patients.