The National Institute for Health and Care Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Implantation of a sphenopalatine ganglion stimulation device for chronic cluster headache, in June 2015.


Cluster headaches are characterised by episodes of unilateral periorbital pain, conjunctival injection, lacrimation and rhinorrhoea. This form of neurovascular headache most commonly affects middle-aged men. Headache attacks can last from a few minutes to several hours and can occur many times a day, over several days. Chronic cluster headaches can be separated by headache-free periods of less than 1 month, or not separated at all.

The usual treatments for acute cluster headache attacks are oxygen inhalation and/or with or without medications such as triptans. Medications such as corticosteroids, verapamil and occipital nerve blocks are used to prevent or reduce the number of attacks. Surgical treatments are reserved for patients with distressing symptoms that are refractory to medical treatments. They include deep brain stimulation to modulate central processing of pain signals and radiofrequency ablation to interrupt trigeminal sensory or autonomic pathways.

Coding recommendations

A33.4 Insertion of neurostimulator electrodes into the cranial nerve

Z04.8 Specified cranial nerve NEC

In addition the ICD-10 code G44.0 Cluster headache syndrome would be recorded.

The Clinical Classifications Service has advised NICE that currently these are the most suitable OPCS-4 codes to describe this procedure. The OPCS-4 classification is designed to categorise procedures for analysis ant it is not always possible to identify a procedure uniquely.

G44.0 Cluster headache syndrome

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