Abstract
A 50-year-old man with left-sided cluster headache (CH) was treated with stellate ganglion block (SGB). He had onset of episodic CH at age 41. Until 3 years ago, episodes of CH 1-2 attacks par day, had occurred every 12 months over 4 to 8 weeks. An attack carted for 30 to 60 minutes with tearing of the eye, nasal stuffiness and rhinorrhea. Three months ago, CH occurred for the first time in 3 years. The initially severe headache evolved into a series of discrete, severe, left-sided headaches of 90 to 120 minutes' duration that occurred 4 to 7 times a day. Associated symptoms included ipsilateral lacrimation, nasal congestion, rhinorrhea and conjunctival injection. This time he responded little to drug treatment including oxygen inhalation, ergotamine, verapamil, predonisolon, lithium carbonate, indomethacin, etc. Sumatriptan was not available in Japan at that time. The results of general physical and neurologic examinations were unremarkable. Brain MRI was normal. Left SGB with 4 to 6mL of 1 or 0.5% mepivacaine was carried out twice a week. A headache diary had been kept by the patient (Fig. 1). Right after the first SGB performed with 4mL of 0.5% mepivacaine, the frequency and duration of headache diminished by half. After the 9th SGB, the attacks of headache subsided. Sympathetic ipsilateral hypofunction in CH patients had been pointed out. Sympathetic activation is considered to be one of the triggers of CH. Repeated ipsilateral SGBs possibly suppressed sympathetic activation, reducing is headache attacks in this patient.
