• Stewart J Tepper, Ali Rezai, Samer Narouze, Charles Steiner, Pouya Mohajer, and Mehdi Ansarinia.
• Center for Headache and Pain, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave. T33, Cleveland, OH 44195, USA.
• Headache. 2009 Jul 1;49(7):983-9.

BackgroundWe report preliminary results of a novel acute treatment for intractable migraine. The sphenopalatine ganglion (SPG) has sensorimotor and autonomic components and is involved in migraine pathophysiology.MethodsIn 11 patients with medically refractory migraine, the sphenopalatine fossa was accessed with a 20-gauge needle using the standard infrazygomatic transcoronoid approach under fluoroscopy. Patients underwent temporary unilateral electric stimulation of the SPG with a Medtronic 3057 test stimulation lead after induction of full-blown migraine. Both sham and active stimulations with different settings were carried out for < or =60 minutes, and then the lead was removed.ResultsIn 11 evaluations, 2 patients were pain-free within 3 minutes of stimulation. Three had pain reduction; 5 had no response; 1 was not stimulated. Five patients had no pain relief. Stimulation settings: mean amplitude of 1.2V, mean pulse rate of 67 Hz, mean pulse width of 462 micros. Lack of headache relief appeared linked to suboptimal lead placement, poor physiologic sensory response to localization stimulation, and diagnosis of medication overuse headache.ConclusionThis study suggests a possible role for SPG stimulation in the treatment of refractory migraine headaches.

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