Stellate Ganglion Block as an Early Intervention in Sympathetically Maintained Headache and Orofacial Pain Caused by Temporal Arteritis

Pain Medicine

Volume 14, Issue 3, pages 392–397, March 2013

1. Noboru Noma DDS, PhD^1,2,*, 
2. Hiroshi Kamo DDS, PhD^1,2, 
3. Yuka Nakaya DDS^1,2,
4. Ko Dezawa DDS^1,2, 
5. Andrew Young DDS, MSD³, 
6. Junad Khan BDS, MSD, MPH, DAAOP⁴, 
7. Yoshiki Imamura DDS, PhD^1,2

Article first published online: 17 JAN 2013

DOI: 10.1111/pme.12040

Introduction.

We report a case of temporal arteritis with a sympathetic component in the orofacial region, which responded to stellate ganglion blocks (SGBs).

Case.

An 81-year-old woman with limited mouth opening and pain upon chewing was referred to the Orofacial Pain Clinic at Nihon University Dental Hospital. The patient also presented with blurred vision and a burning sensation on the right side of her face. On clinical examination, the temporal artery was tender to palpation, and there was increased sensitivity in the temporal region bilaterally. The patient reported jaw pain and limited mouth opening. Laboratory examination showed elevations in erythrocyte sedimentation rate and C-reactive protein. The burning sensation was due to a sympathetic component, and SGBs substantially reduced both the burning sensation and right temporal pain. Blocking the sympathetic chain on the ipsilateral side also improved jaw movement. The patient was referred to a rheumatologist, after which she was admitted to hospital with a tentative diagnosis of temporal arteritis. Treatment with oral prednisone 30 mg daily was initiated, and the dose was tapered as her symptoms resolved.

Discussion.

The reason for the gradual pain relief after SGB is unclear, but we believe it was effective for ischemia in temporal arteritis because it led to dilation of affected arteries or suppression of inflammation/edema of the vascular wall.

Conclusion.

This case demonstrates that SGB may relieve pain related to temporal arteritis and sympathetically maintained headache and orofacial pain by reducing noxious stimulation peripherally and decreasing central pain transmission centrally.

Diffuse noxious inhibitory control evoked by tonic craniofacial pain in humans

P.F. Sowmanab, K. Wangbc, P. Svenssond, L. Arendt-Nielsenb
Received 7 April 2010; received in revised form 2 June 2010; accepted 8 June 2010. published online 08 July 2010.
Abstract

Tonic pain in one body segment can inhibit the perception of pain in another body segment. This phenomenon is mediated by diffuse noxious inhibitory controls (DNIC), and its efficacy in craniofacial regions is investigated in this study. A compressive device that evoked a tonic, moderate/severe, headache-like, conditioning pain (∼8/10 on a visual analogue scale) was applied for 15min. Eleven males participated in the study. Pressure pain threshold (PPT) and pressure pain tolerance (PPTol) at multiple heterosegmental body sites (right masseter, splenius capitis, second intermediate phalange, brachioradialis and tibialis anterior) were measured before, during and at multiple time points (5, 20 and 35min) after the termination of the conditioning pain. PPTs and PPTols were compared within participants across two experimental sessions; one that included painful conditioning stimulation, and a separate control session on a different day. Painful conditioning increased PPT significantly during pain over the masseter (p<0.05) and over the tibialis anterior (p<0.01). PPTol was unchanged. In the period after the painful conditioning stimulation PPT was depressed compared to control. This study shows that pain evoked from the craniofacial region evokes DNIC-like mechanisms on segmental as well as heterosegmental sites.

Corresponding author. Address: Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7 D-3, DK-9220, Aalborg, Denmark. Tel.: +45 99 40 88 30; fax: +45 98 15 40 08.
PII: S1090-3801(10)00142-4
doi:10.1016/j.ejpain.2010.06.009
© 2010 European Federation of International Association for the Study of Pain Chapters. Published by Elsevier Inc. All rights reserved.