Effectiveness of Novel Sympathetic Nerve Entrapment Point Injections for Chronic Migraine: A Pilot Study.

No studies to date have investigated the ability of sympathetic nerve entrapment point saline (SNEP) injections to achieve long-term pain relief in patients with migraine. Therefore, this study aimed to investigate the safety and long-term efficacy of repeat splenius capitis (SC) SNEP injections in patients with migraine (with/without tension-type headache). This retrospective, single-arm study included 12 patients with migraine. Isotonic saline was injected into their SC approximately six times for 3 months. Headache frequency, duration (hour/week), intensity (using the visual analog scale), and quality of life (using the Headache Impact Test-6) were assessed during the follow-up visits for up to 24 months after the first injection. Changes before and after treatment were assessed using repeated-measures analysis of variance. Significant reductions in headache frequency, duration, and intensity were observed at all assessment points after SNEP injections when compared with the baseline values (p < 0.05), while the patients' headache-related quality of life also improved. Treatment was continued for up to 3 months to maintain these improvements, and no worsening of status or adverse effects were observed in any of the patients over the following 24 months. Our results show that SNEP injections may offer persistent, substantial, and clinically relevant benefits in patients with migraine.

A Pilot Analysis on the Efficacy of Multiple Trigger-Point Saline Injections in Chronic Tension-Type Headache: A Retrospective Observational Study.

This study aimed to investigate the efficacy of new targeted trigger-point injections (TPIs) using isotonic saline in patients with chronic tension-type headache (CTTH). Of 121 patients with headache who were retrospectively reviewed, 19 were included in this study and were categorized into two groups: those who received TPIs more than four times (group 1); and those who received TPIs less than, or equal to, four times (group 2). The patients received ultrasound-guided isotonic saline injections into the active trigger points once weekly. The primary outcome was an effect on headache intensity, determined using the visual analog scale (VAS), whereas the secondary outcome was an effect on quality of life, evaluated using the Henry Ford Hospital Headache Disability Inventory (HDI). The mean symptom duration of the 19 patients (11 men and 8 women; mean age, 52.5 years; and range, 23−81 years) was 16 months. The most frequently injected muscle was the splenius capitis. Patient demographics were similar between the two groups (p > 0.05). Simple linear regression revealed that symptom duration (p = 0.001) and baseline VAS score (p = 0.009) were significantly associated with the number of injections. At one month after the first injection, the mean VAS and HDI scores in group 2 were significantly lower than those in group 1 (p < 0.05), whereas the scores significantly decreased immediately after the last injection in both groups (p < 0.05). No adverse effects were reported in any patient. Our results indicate that the administration of new targeted TPIs using isotonic saline into the head and neck muscles of patients with CTTH can effectively relieve headache intensity and safely improve their quality of life.

A proposal for a new headache classification system for general practitioners.

We proposes a new method of headache classification, which is simpler for use in general practice and is based on a pathophysiological approach, in preference to the International Classification of Headache Disorders (ICHD) broad classification for headaches. In the ICDH classification, three main categories and numerous sub-categories and divisions are available with a view to addressing the symptoms and the aetiology of headache. However, the ICDH classification system is complex, with its many subdivisions, and it is cumbersome to use. Moreover, it is likely that not all medical professionals are readily familiar with it. A new classification system that is easy to learn and clinically user-friendly is necessary for primary care physicians to diagnose and classify headaches. We believe that our study makes a significant contribution to the literature because we propose a new method of classification for headaches that is based on clinical experience and addresses the pathogenesis of headaches.

Thoracolumbar Junction Syndrome Accompanying Renal Artery Stenosis: A Case Report

Flank pain is a common reason for visits to the emergency room. The most common reason warranting hospital visits are urology-related problems. However, there are many other causes, such as musculoskeletal lesions, that difficult to achieve a correct diagnosis. Here, we describe a rare case of flank pain caused by thoracolumbar junction syndrome, accompanying renal artery stenosis. A 54-year-old male with hypertension presented with severe left flank pain for 1 week. Initially, he was diagnosed with left renal artery stenosis by computed tomography and decreased renal function on renal scan (Tc-99m DTPA). Although a stent was inserted into the left renal artery, flank pain persisted with only minor improvement. Through detailed physical examination, he was finally diagnosed with thoracolumbar junction syndrome. After three injections in the left deep paravertebral muscles at the T10-T12 levels, flank pain completely ceased. Clinicians must consider thoracolumbar junction syndrome, when treating patients with flank pain.

Sympathetic Nerve Entrapment Point Injection as an Antireflux Procedure for Refractory Laryngopharyngeal Reflux: A First Case Report of Innovative Autonomic Regulation.

Surgical treatment is not suitable for laryngopharyngeal reflux that is refractory to proton pump inhibitors. We present a case of proton pump inhibitor-refractory laryngopharyngeal reflux that was successfully treated with sympathetic nerve entrapment point injection. The patient had previously been diagnosed with laryngopharyngeal reflux and treated with proton pump inhibitors for six months without substantial improvement. After sympathetic nerve entrapment point injection treatment, her reflux symptom index improved from 15 points to 1 point, and this response was maintained for six months. Hyperexcitability of T5 and T6 sympathetic preganglionic fibers appears to be the main cause of laryngopharyngeal reflux. Sympathetic nerve entrapment point injection may represent an alternative to anti-reflux procedures.