An overview of the safety and efficacy of sphenopalatine ganglion stimulation for the treatment of chronic cluster headache

INTRODUCTION: Chronic cluster headache (CCH) is a very severe and disabling primary headache disorder characterized by frequent, unilateral attacks of excruciating pain accompanied by cranial autonomic symptoms without a substantial remission phase. A proportion of patients experience inadequate symptom control or intolerance to conventional therapies, highlighting the need for alternative treatment strategies. AREAS COVERED: This narrative review highlights the anatomical and physiological rationale for sphenopalatine ganglion (SPG) stimulation and summarizes the available clinical evidence regarding its efficacy in acute and preventive treatment of CCH. Furthermore, this review also evaluates SPG's safety profile. This article is based on the currently available literature including data from randomized controlled trials, long-term follow-up studies, and real-world observational reports. EXPERT OPINION: For patients with inadequate response or intolerance to traditional oral preventive options, neuromodulation is a practical alternative. There is both cohort and randomized controlled evidence establishing SPG stimulation efficacy in both acute and potentially preventive treatment of refractory cluster headache, although there is associated surgical risk with serious adverse events reported. SPG stimulation represents a promising option for carefully selected patients with refractory CCH, as an acute treatment, with a potential role in cluster headache prevention. Further controlled studies are needed to more clearly define optimal patient selection, long-term outcomes, and comparative effectiveness.