The Effect of Regional Anesthetic Sphenopalatine Ganglion Block on Self-Reported Pain in Patients With Status Migrainosus.

BACKGROUND: Status migrainosus (SM) is defined as a debilitating migraine attack lasting more than 72 hours in patients previously known to suffer from migraine headache. Typically, these attacks fail to respond to over the counter and abortive medications. The sphenopalatine ganglion (SPG) plays a critical role in propagating both pain and the autonomic symptoms commonly associated with migraines. SPG block via transnasal lidocaine is moderately effective in reducing migraine symptoms, but this approach is often poorly tolerated and the results are inconsistent. We proposed that an SPG block using a suprazygomatic injection approach would be a safe and effective option to abort or alleviate pain and autonomic symptoms of SM. METHODS: Through a retrospective records review, we identified patients with a well-established diagnosis of migraine, based on the International Headache Society criteria. Patients selected for study inclusion were diagnosed with SM, had failed to respond to 2 or more abortive medications, and had received a suprazygomatic SPG block. Patients had also been asked to rate their pain on a 1-10 Likert scale, both before and 30 minutes after the injection. RESULTS: Eighty-eight consecutive patients (20 men and 68 women) received a total of 252 suprazygomatic SPG block procedures in the outpatient headache clinic after traditional medications failed to abort their SM. At 30 minutes following the injections, there was a 67.2% (±26.6%) reduction in pain severity with a median reduction of 5 points (IQR= -6 to -3) on the Likert scale (ranging from 1 to 10). Overall, patients experienced a statistically significant reduction in pain severity (P < .0001). CONCLUSION: The SPG is known to play an integral role in the pathophysiology of facial pain and the trigeminal autonomic cephalalgias, although its exact role in the generation and maintenance of migraine headache remains unclear. Regional anesthetic suprazygomatic SPG block is potentially effective for immediate relief of SM. We believe the procedure is simple to perform and has minimal risk.

Artificial neural network learns to differentiate normal TMJs and nonreducing displaced disks after training on incisor-point chewing movements.

Previous authors have described four frontal gum-chewing patterns associated with normal and abnormal TMJ disk-condyle relationships. The objective of this study was to create an automatic detection capability (expert system) by training an artificial neural network to recognize nonreducing displaced disks from frontal chewing data. Sixty-eight (68) subjects, 29 with normal joints, 18 with unilateral nonreducing displaced disks and 21 with bilateral nonreducing displaced disks were selected from a continuous series of patients seeking treatment for TMD. Right-sided gum chewing was recorded from all patients. Left-sided chewing was also recorded from the right unilateral patients. 50% of the vertical, lateral and timing values at 10%, 65% and 100% of opening and at 30%, 70% and 90% of closing were used to train an artificial neural network. The remaining 50% were used for testing. All normal subjects were detected as normal (specificity = 100%). Two bilateral and two unilateral patients were not detected (sensitivity = 91.8%). Four (4) patients received the wrong classification (unilateral vs. bilateral) and one patient received both (undecided) for an overall accuracy = 86.8%. The artificial neural network detected, at an acceptable level of error, the presence and type of nonreducing disk displacement from frontal plane jaw recordings of gum chewing in a group of real patients seeking treatment for TMD. Since it is very inexpensive to conduct, mastication analysis appears to have the potential of an excellent cost/benefit ratio.