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Advantages of radiofrequency trigeminal gangliorhizolysis include:

• It is safe for elderly people
• Associated with low headache recurrence rate and low mortality rate
• Provides relief for many patients suffering from refractory cluster headache

The adverse effects of radiofrequency trigeminal gangliorhizolysis may include:

• Moderate or severe reduced abnormal sensation in the face
• Corneal sensory loss
• Anesthesia dolorosa - damage to the trigeminal nerve results in reduction or elimination of facial sensation but the sense of pain remains.

Approximately 50% of the patients who fail radiofrequency thermocoagulation benefit from subsequent trigeminal nerve root section.

Glycerol Trigeminal Rhizotomy

This procedure is similar to radiofrequency rhizotomy except that instead of using radiofrequency waves, glycerol is injected into the trigeminal ganglion where it acts as a denerving (destroys the nerve) agent. Glycerol trigeminal rhizotomy has good results in terms of pain free periods but it has a higher rate of recurrence of cluster headaches (approximately 40% of cases) than does radiofrequency rhizotomy.

The advantages of glycerol trigeminal rhizotomy include:

• Safe for elderly
• No general anesthesia is needed
• Less complicated technically than radiofrequency
• Fewer incidences of complications than radiofrequency rhizotomy (e.g., corneal anesthesia and keratitis)

Disadvantages of this procedure include:

• High rate of initial failure which requires a second treatment
• Highly skilled surgeon is required since correct needle placement is crucial
• Higher recurrence rate of cluster headache than with radiofrequency rhizotomy
• Multiple treatments may potentially damage the area of needle placement and reduce the efficacy of further injections

Trigeminal Nerve Root Section

With this procedure, a lesion is created in the trigeminal nerve at the root entry zone. Complete or near-complete pain relief was reported in 12 out of 14 patients who participated in one study for the period of observation (5.5 years). One patient developed cluster headache on the opposite side. Complete resection of the trigeminal nerve is more likely to offer complete relief as compared to partial trigeminal nerve root section.

Gamma Knife Radiosurgery

Gamma knife radiosurgery, also known as stereotactic radiosurgery, is a type of radiation therapy in which the trigeminal nerve is injured with a beam of radiation. This procedure can be done on an outpatient basis and typically only takes several hours to complete. At present only a limited number of medical institutions have gamma knife capabilities. A study performed in 1998 evaluated the use of gamma knife in cluster headaches and results were promising. Four men and two women with cluster headache were treated. Five of the patients had chronic cluster headache (daily cluster headaches without periods of remission) and one had episodic cluster headache (daily attacks for weeks or months and then headache free time for weeks or months). Four patients experienced pain relief after gamma knife radiosurgery, which was judged excellent. Of the two remaining patients, one had pain relief judged as good and the other fair. Five of the six patients had relief within a few days to a week following gamma knife. None of the patients treated developed significant post-radiation side effects during a follow-up period of 8 or 14 months.