Low-temperature plasma radiofrequency ablation for the management of refractory cluster headache

Introduction
Although the sphenopalatine ganglion (SPG) has been considered a site of therapeutic potential for cluster headache (CH), the optimal technique of SPG is still to be determined. Low-temperature plasma radiofrequency ablation (LTPRA) has been proposed as an alternative treatment for several neuropathic pain diseases.

Aim
To evaluate the effect of LTPRA of SPG in treating chronic and episodic CH.

Material and methods
The patients with CH, who achieved temporary pain relief following SPG block, treated using LTPRA between January 2015 and October 2017 were reviewed. Seventy-six patients were included: 50 patients suffered from episodic CH and the remaining 26 patients from chronic CH. The primary outcomes were clinical improvement rate, defined as the percentage of partial and complete pain relief results at 1 day, 12 months, and 24 months of follow-up after the operation.

Results
Clinical improvement rates were 92.3%, 92.3% and 73.1% in chronic CH and 73.1%, 84% and 68% in episodic CH at each follow-up time point, respectively. 3 chronic CH patients and 7 episodic CH patients showed no pain relief after the operation. Drooping eyelids were found in 2 cases, one recovered at the 3-month follow-up but another one did not in the 24-month follow-up. No serious complications occurred intraoperatively or postoperatively.

Conclusions
LTPRA can be considered an effective and alternative surgical modality in treating patients with chronic and episodic CH, based on SPG block.