Sphenopalatine (pterygopalatine) ganglion stimulation and cluster headache: New hope for ye who enter here

Cluster headache is a devastating primary headache disorder (1) that in its chronic form presents as if approached and consumed by three beasts. Medically intractable chronic cluster headache (2) is among the most challenging of ailments headache specialists can be called on to treat. While we have seen important advances in understanding the disorder with brain imaging (3,4), and the conduct of randomized controlled trials in the last decade (5,6), many patients still suffer far too much. Research in the field is at best pathetically funded; as an example the writer is unaware of any dedicated projects involving the United States National Institutes of Health or United Kingdom (UK) Medical Research Council. Yet at some 0.1% of the population (7,8), cluster headache is as common as multiple sclerosis in the UK (9). Developments are welcome, and this issue of the Journal offers a new twist based on our understanding of the pathophysiology of the condition (10)—the involvement of the cranial parasympathetic outflow through the sphenopalatine ganglion (11).