The following is a summary of “SYMPATHETIC NERVE ENTRAPMENT POINT INJECTION AS AN ADJUVANT TREATMENT FOR INTRACTABLE CLUSTER HEADACHE: A CASE REPORT,” published in the July 2023 issue of Emergency Medicine by Nah et al.

Cluster headache (CH) is a medical condition distinguished by intense pain on one side of the head, extending from the area around the eye to the temples, accompanied by autonomic symptoms on the same side of the body. While most patients exhibit positive responses to pharmaceutical interventions or oxygen therapy, there are cases where specific individuals may not indicate the desired outcomes. In this case report, researchers present the introduction of sympathetic nerve entrapment point injection (SNEPI), a novel adjunctive therapy for cluster headaches (CH). Researchers suggest two patients diagnosed with cluster headache (CH) who exhibited a poor response to pharmacological intervention and 100% oxygen therapy but demonstrated improvement following sphenopalatine ganglion blockade (SNEPI).

Patient 1, a 42-year-old male, presented to the Emergency Department (ED) with a severe periorbital right frontal headache accompanied by rhinorrhea on the same side, conjunctival injection, and eyelid swelling. The symptoms did not achieve complete resolution with pharmacological intervention or oxygen therapy but demonstrated improvement following a suboccipital nerve block injection into the trigger point of the splenius capitis (SC) muscle; subsequently, the pain was absent for 1 month. Patient 2, a 26-year-old female, arrived at the emergency department (ED) reporting a severe headache in the right supraorbital-temporal-occipital area, accompanied by tearing and redness of the conjunctiva on the same side. The patient was prescribed multiple medications for their chronic headache, but no improvement was observed. However, the patient experienced a significant improvement in symptoms following a procedure known as SNEPI, which involved injecting medication into the tender points of the spinal cord and deep muscles along the spine at levels T1-2. 

As a result, the patient’s pain was effectively managed, allowing for a reduction in medication dosage for three months. Why is it essential for an emergency physician to know of this? Cluster headaches can induce intense acute pain; occasionally, pharmaceutical intervention or inhalation of oxygen may prove ineffective. SNEPI, a cost-effective and readily executable procedure, may be considered an adjunctive therapy for refractory cluster headaches in the emergency department. Cluster headache (CH), or trigeminal autonomic cephalalgia, is a primary headache disorder. The patient presents with pronounced unilateral pain in the supraorbital, orbital, and temporal regions, accompanied by autonomic manifestations on the same side. Episodes can endure from 15 to 180 minutes and manifest up to eight times per day for multiple weeks, typically succeeded by a period of relief devoid of pain. Of all cluster headaches, 10-15% exhibit a chronic pattern, with a remission period that does not exceed 1 month.

Source: sciencedirect.com/science/article/abs/pii/S0736467923002305