Neuromodulation with pulsed radiofrequency of the sphenopalatine ganglion in selected forms of chronic headache

Introduction : The article examines the role of the sphenopalatine ganglion (SPG) in the pathogenesis of various pain syndromes involving the head and neck, particularly in trigeminal autonomic cephalalgias. Materials and methods : A clinical study involving 17 patients from 2017 to 2025 is presented, in which pulsed radiofrequency (PRF) neuromodulation of the SPG was used to treat chronic facial pain and certain types of headache. The interventions, performed under fluoroscopic guidance and mild sedation, demonstrated good safety and a low risk of complications. Results : The results showed that 77% of patients achieved significant pain reduction, especially those with cluster, post-traumatic, and post-dural puncture headaches. PRF proved to be a less invasive and safer alternative to conventional ablative techniques (RF), with its effect attributed to neuromodulation rather than destruction of neural structures. Conclusion : The analysis of the study emphasizes PRF’s potential as a minimally invasive and successful treatment option for chronic cephalalgia, but it also recognizes its limitations, including its small sample size, heterogeneous diagnoses, and brief follow-up period. The authors suggest future controlled studies and exploration of implantable neuromodulation systems for the SPG as a next step in chronic pain management.