Background: Herpes zoster is a common disease mainly affect sensory nerves, but in this report sphenopalatine ganglion (SPG), mainly a parasympathetic ganglion was infected by the vesicular-zoster virus, with the performance of cluster headache.
Case presentation: The patient underwent headache on left side orbit, supraorbital and temporal regions after infection of herpes zoster for 8 months, with lacrimation, conjunctival injection and nasal discharge. Pulsed radiofrequency of the SPG under ultrasound guidance was performed, we applied 2 cycles of PRF at 42℃for 120 seconds each time. Partial response lasted 1 month and the pain had recover to its baseline level. Low-temperature plasma radiofrequency ablation (coblation) technology is a relatively new technology that has shown promise in treating neuropathic pain. Then a CT-guided coblation of SPG was performed, used three of intensity for coblation (lasting for 30s, repeat twice) and six of intensity for coagulation (lasting for 30s, once). After coblation, the patient reported completed pain relief and autonomic symptoms disappeared without any side effects. The patient was satisfied with the effect on post-operative telephone follow-up performed on day 7, month 1 and month 3, pain VAS score remained on 0/10.
Conclusions: Our report demonstrates that coblation technology is succeseful treatment for cluster headache in this case, but this finding still needs additional studies for confirmation.
Key words: cluster headache, coblation, herpes zoster