1 Recommendations

Guidance

1.1 Current evidence on the efficacy of implantation of a sphenopalatine ganglion stimulation device for chronic cluster headache, in the short term (up to 2 months), is adequate. With regard to safety, a variety of complications have been documented, most of which occur early and resolve; surgical revision of the implanted system is sometimes needed. Therefore, this procedure should only be used with special arrangements for clinical governance, consent and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page.

1.2 Clinicians wishing to implant a sphenopalatine ganglion stimulation device for chronic cluster headache should:

Inform the clinical governance leads in their NHS trusts.
Ensure that patients understand the uncertainty about the procedure's safety and long‑term efficacy and provide them with clear written information. Patients should be informed about other treatment options. In addition, the use of NICE's information for the public is recommended.
Audit and review clinical outcomes of all patients having sphenopalatine ganglion stimulation (see section 7.1).

1.3 The selection of patients for implantation of a sphenopalatine ganglion stimulation device and their management should be done by multidisciplinary teams specialising in refractory headache.

1.4 Clinicians should enter details about all patients being implanted with a sphenopalatine ganglion stimulation device onto the national Neuromodulation register hosted by the National Institute for Cardiovascular Outcomes Research (NICOR). Clinical outcomes should also be reviewed locally.

1.5 NICE encourages further research on sphenopalatine ganglion stimulation for chronic cluster headache. Reported outcomes should include long‑term efficacy and device durability.