Abstract

Background: OnabotulinumtoxinA (BTA) injections targeting the sphenopalatine ganglion (SPG) have been used in patients with refractory chronic cluster headache and idiopathic facial pain, causing a neuronal block.

This study evaluated real world data on the effectiveness of BTA injections targeting the SPG in treating refractory primary headache disorders and neuropathic facial pain.

Method: We conducted a retrospective observational cohort study of patients who underwent treatment with a BTA injection of the SPG. Primary outcome focused on the impact on the number of headache attacks and pain intensity on an 11-point Numeric Rating Scale (NRS). As secondary outcomes, quality of life objectified by the Headache Impact Test-6 (HIT-6) questionnaire, patient satisfaction and Patient Global Impression of Change (PGIC) were analyzed.

Results: A total of 43 patients received treatment. In primary headache disorders, NRS declined from 7.7 points baseline to 5.0 (p = 0.017) and attack frequency from 64 attacks per month baseline to 24 based on 17 patients. Analgetic consumption declined in 50% of patients. For facial pain disorders, NRS improved from 6.5 baseline to 4.5 (p = 0.028) based on 10 patients. Better responses on NRS were seen when the needle tip was precisely positioned on the reflection of the lateral wall of the nasal cavity.

Conclusion: This real world study has shown that BTA injections have a favorable effect on pain sensation and quality of life in the treatment of primary headache disorders.