Chronic Migraine Clinical Trial
Official title:
Intra-arterial Sphenopalatine Ganglion Block for Patients With Refractory Headache
The purpose of this study is to evaluate the safety and efficacy of intra-arterial (IA) delivery of Dexamethasone and Ketorolac into the arteries supplying the sphenopalatine ganglion (SPG) - a collection of neurons that plays an important role in headache disorders - in patients with refractory migraine, cluster headache and trigeminal neuralgia. All patients must fail standard treatments prior to enrollment in the trial.
The investigators propose an outpatient, minimally invasive method to deliver Dexamethasone
and Ketorolac to the SPG via the intra-arterial route. A microcatheter will be advanced via
the radial (preferably) or the femoral artery (in case the radial approach is not feasible)
using fluoroscopic guidance and standard interventional techniques, into the distal internal
maxillary artery. This artery is a branch of the external carotid artery and supplies the
territory of the sphenopalatine ganglion. The microcatheter will be advanced to the ostium of
the distal small branches that supply the SPG (i.e. small arteries feeding the vasa
nervosum). Once the microcatheter is in a good position, 15 mg Dexamethasone Sodium Phosphate
and 15 mg of Ketorolac Tromethamine will be infused over 30 minutes.
The procedure will be performed with local anesthetic at the arterial puncture site.
Conscious sedation will be used for anxious participants. After the procedure, the
participant will be observed for 5 hours in ICU setting and then discharged to home.
The procedure will be performed unilaterally for participants with cluster headache and
trigeminal neuralgia. The procedure could be performed bilaterally for participants with
migraine.
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