Nerves And Vessels In The Pterygopalatine Fossa And Symptoms Of Cluster Headache

Abstract

SYNOPSISThe study evaluates the contribution of activated parasympathetic and sensory nerve fibres in the sphenopalatine ganglion area, and of vasodilation in surrounding vessels in this narrow region (pterygopalatine fossa), to the pain and signs of autonomic dysfunction seen during attacks of cluster headache. Agents with anesthetic and vasoconstrictor effects were applied nasally to reach this area. It was found that the anesthetic effect is the most important, both regarding pain and autonomic symptoms. The effectiveness was also evaluated: this treatment is useful to stop attacks of cluster headache, but the beneficial effect is less than that reported in previous studies. (Headache 27:528-532, 1987)

Medial portion of M. Temporalis and its potential involvement in facial pain

“…The pterygopalatine ganglion and its branches should not be affected (see Hardebo and Elner, 1987) because there is no muscle or tendon to entrap them from behind. The pterygopalatine ganglion and its branches should not be affected (see Hardebo and Elner, 1987) because there is no muscle or tendon to entrap them from behind.…”

5‐HT1D Receptor Immunoreactivity in the Sphenopalatine Ganglion: Implications for the Efficacy of Triptans in the Treatment of Autonomic Signs Associated With Cluster Headache

“…The single study that did quantify retrograde labeling, following injections of True Blue onto the surface of the middle cerebral artery of rats, counted every section throughout the entire SPG and reported only 16 retrograde labeled cells 36 . In addition, one of the studies used anterograde tracing from the SPG 35 and therefore it is possible that the reported labeling of terminals in the vasculature might have resulted from uptake of tracer by axons of passage that originate from outside of the SPG, because axons of sympathetic and sensory neurons are known to pass through the SPG 8 . Thus, there appears to be a lack of definitive evidence that a significant number of postganglionic parasympathetic neurons, originating in the SPG, innervate the cerebral vasculature or vasculature of the dura.…”

“…Reflex activation of the brainstem parasympathetic nuclei and autonomic outflow through peripheral parasympathetic ganglia may also contribute to trigeminovascular activation and pain 1 . Importantly, the activation of parasympathetic outflow may explain the many autonomic signs associated with cluster headache (and migraine) during the attack 1,8 …”

Interdisciplinary management of headache disorders

“…Local anesthetic blockade of the SPG can be accomplished through intranasal transmucosal topical application or by transcutaneous or intraoral injections. 129 SPG blockade has primarily been studied as a treatment for acute and chronic cluster headache 56,[130][131][132][133][134][135] ; however, the list of indications has expanded over the last several years to include trigeminal neuralgia, migraine headaches, posttraumatic headache, and atypical facial pain. 136 Percutaneous radiofrequency ablation of the SPG has been recently described in multiple case series and studies and may be an effective long-term therapy for patients who have good response to diagnostic SPG blocks.…”