Sphenopalatine ganglion neurostimulation for the treatment of cluster headache and migraine: a narrative review

Abstract Sphenopalatine ganglion (SPG) neurostimulation has emerged as a promising therapy for patients with refractory cluster headache and selected cases of migraine. This narrative review provides a comprehensive synthesis of the current evidence on SPG neurostimulation as a novel therapeutic strategy for headache management. As a key parasympathetic ganglion involved in the trigeminal autonomic reflex, the SPG constitutes a logical and clinically relevant target for neuromodulation in the treatment of severe headache disorders. Clinical evidence supports the efficacy of SPG neurostimulation in aborting acute cluster headache attacks and reducing attack frequency in chronic cases, while limited data suggest potential acute pain relief in migraine. Long-term follow-up indicates sustained efficacy in cluster headache, including improved quality of life and reduced medication use. Adverse effects are mostly mild and transient. Serious complications are rare, but include procedure- or device-related events such as infection or venous injury reported in some studies. Future research should prioritize optimizing electrode placement, stimulation parameters, and long-term outcome evaluation, and further clarify the underlying mechanisms to improve clinical efficacy and safety.