Thunderclap Headache Caused by Minimally Invasive Medical Procedures: Description of 2 Cases

Chalaupka, Flavio Devetag; Caneve, Giorgio; Mauri, M.; Zaiotti, Giuseppe

doi:10.1111/j.1526-4610.2006.00699.x

Cited by 17 publications

(9 citation statements)

References 8 publications

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“…There are isolated case reports involving adverse events following intradiscal injection of ozone. These include a case of transient bilateral blindness following injection of a large volume of ozone to the disc without radiographic control, 43 a nerve root injury associated with a pressure spike during the injection, 44 a thunderclap headache attributed to puncture of the thecal sac, 45 a severe case of discitis requiring revision surgery, 46 and a fatal septicemia due to E. Coli infection. 47 Two meta-analysis of intradiscal ozone have been published and both concluded that intradiscal ozone injection is both safe and effective in patients with disc herniation.…”

Section: Introductionmentioning

confidence: 99%

Five and Ten Year Follow-up on Intradiscal Ozone Injection for Disc Herniation

Buric

Rigobello

Hooper³

2014

Int J Spine Surg

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BackgroundDisc herniation is the most common cause for spinal surgery and many clinicians employ epidural steroid injections with limited success. Intradiscal injection of ozone gas has been used as an alternative to epidural steroids and surgical discectomy. Early results are positive but long-term data are limited.MethodsOne hundred and eight patients with confirmed contiguous disc herniation were treated with intradiscal injection of ozone in 2002-2003. One-hundred seven patients were available for telephone follow-up at 5 years. Sixty patients were available for a similar telephone follow-up at ten years. Patients were asked to describe their clinical outcome since the injection. Surgical events were documented. MRI images were reviewed to assess the reduction in disc herniation at six months.ResultsMRI films demonstrated a consistent reduction in the size of the disc herniation. Seventy-nine percent of patients had a reduction in herniation volume and the average reduction was 56%. There were 19 patients that ultimately had surgery and 12 of them occurred in the first six months after injection. One of these 12 was due to surgery at another level. Two surgeries involved an interspinous spacer indicated by stenosis or DDD. All other surgeries were discectomies. Of the patients that avoided surgery 82% were improved at 5 years and 88% were improved at 10 years. Other than subsequent surgeries, no spine-related complications were experienced.Conclusions/Level of EvidenceWe conclude that ozone is safe and effective in approximately 75% of patients with disc herniation and the benefit is maintained through ten years. This is a retrospective review and randomized trials are needed.Clinical RelevanceIntradiscal ozone injection may enable patients to address their pain without multiple epidural injections and surgery. The benefit of ozone is durable and does not preclude future surgical options. The risk reward profile for this treatment is favorable.

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Section: Introductionmentioning

confidence: 99%

Five and Ten Year Follow-up on Intradiscal Ozone Injection for Disc Herniation

Buric

Rigobello

Hooper³

2014

Int J Spine Surg

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“…In 2007, Devetag Chalaupka et al . [ 3 ] reported a 27-year-old man as the first case of a severe headache due to pneumocephalus after epidural puncture of oxygen-ozone therapy. In this case, the symptom of a thunderclap headache and the image findings of pneumocephalus were similar to those reported by Devetag Chalaupka et al .…”

mentioning

confidence: 99%

“…In this case, the symptom of a thunderclap headache and the image findings of pneumocephalus were similar to those reported by Devetag Chalaupka et al . [ 3 ] Fortunately, both cases of thunderclap headache second to pneumocephalus (oxygen-ozone gas) resolved with no further symptoms. Physicians should be aware of this potential complication of minimally invasive oxygen-ozone therapy and be prepared to diagnose and treat this complication.…”

mentioning

confidence: 99%

Thunderclap Headache Caused by an Inadvertent Epidural Puncture During Oxygen-ozone Therapy for Patient with Cervical Disc Herniation

Wang

Williams

et al. 2016

Chinese Medical Journal

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“…Previous studies have also shown that a thunderclap headache is caused by an inadvertent intrathecal puncture during oxygen–ozone therapy for lumbar disk herniation. 13 However, in our cohort, no patients reported this complication not only during the procedure but also in subsequent days.…”

Section: Methodsmentioning

confidence: 55%

Computed tomography-guided percutaneous ozone injection of the Gasserian ganglion for the treatment of trigeminal neuralgia

Liu

Chen³

et al. 2018

JPR

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ObjectiveThe aim of this study was to evaluate the therapeutic effect of computed tomography (CT)-guided percutaneous ozone injection for refractory trigeminal neuralgia.DesignA retrospective evaluation was performed in the study.SettingThe study was conducted at a university hospital pain center.Patients and methodsA total of 29 patients with a clinical diagnosis of refractory trigeminal neuralgia were enrolled. All patients were treated with a percutaneous ozone injection and one patient was excluded. There were 21 patients with classical trigeminal neuralgia (group A) and seven patients with painful trigeminal neuropathy caused by post-herpetic neuralgia (group B). The percutaneous injection was an oxygen–ozone mixture at an ozone concentration of 30 μg/mL into the Gasserian ganglion performed under CT guidance. The number of procedures performed varied from one to as many as 16. Outcomes were evaluated using visual analog scale (VAS) pain scores.ResultsThe combined VAS scores were 7.11 ± 1.23 pretreatment, 2.86 ± 1.69 posttreatment (P < 0.05) and 3.25 ± 2.01 after 6-month follow-up (P < 0.05). In group A, the VAS scores were 7.10 ± 1.04 pretreatment and 2.90 ± 1.84 posttreatment (P < 0.05). In group B, the VAS scores were 7.14 ± 1.77 pretreatment and 2.71 ± 1.25 posttreatment (P < 0.05). After 6-months follow-up, the VAS score was 3.38 ± 2.18 in group A and 2.86 ± 1.46 in group B, a decrease compared to pretreatment (P < 0.05). VAS of Group A and B showed no difference not only in pretreatment but also in postreatment and follow-up.ConclusionPercutaneous ozone injection is a safe and effective treatment for patients with refractory trigeminal neuralgia.

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Thunderclap Headache Caused by Minimally Invasive Medical Procedures: Description of 2 Cases

Cited by 17 publications

References 8 publications

Five and Ten Year Follow-up on Intradiscal Ozone Injection for Disc Herniation

Five and Ten Year Follow-up on Intradiscal Ozone Injection for Disc Herniation

Thunderclap Headache Caused by an Inadvertent Epidural Puncture During Oxygen-ozone Therapy for Patient with Cervical Disc Herniation

Computed tomography-guided percutaneous ozone injection of the Gasserian ganglion for the treatment of trigeminal neuralgia

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