Guidance
The National Institute for Health and Care Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Implantation of a sphenopalatine ganglion stimulation device for chronic cluster headache, in June 2015.
August 2019: The device used in this procedure no longer has a current CE mark. The CE mark is necessary for medical devices to be marketed in the European Union. A non-CE marked device can only be used in the context of clinical investigations with MHRA and research ethics approval.
Description
Cluster headaches are characterised by episodes of unilateral periorbital pain, conjunctival injection, lacrimation and rhinorrhoea. This form of neurovascular headache most commonly affects middle-aged men. Headache attacks can last from a few minutes to several hours and can occur many times a day, over several days. Chronic cluster headaches can be separated by headache-free periods of less than 1 month, or not separated at all.
The usual treatments for acute cluster headache attacks are oxygen inhalation and/or with or without medications such as triptans. Medications such as corticosteroids, verapamil and occipital nerve blocks are used to prevent or reduce the number of attacks. Surgical treatments are reserved for patients with distressing symptoms that are refractory to medical treatments. They include deep brain stimulation to modulate central processing of pain signals and radiofrequency ablation to interrupt trigeminal sensory or autonomic pathways.
Coding and clinical classification codes for this guidance