Continuous stellate ganglion block for neurovascular headache and associated anxiety and depression

Table 1 Baseline characteristics and clinical features, mean ± SD/n (%)/median (interquartile rage)

Characteristic	Total (n = 126)	Statistics
Demographic characteristics
Age (years)	42.3 ± 11.8	Range: 18-68
Gender
Female	94 (74.6)
Male	32 (25.4)
Body mass index (kg/m2)	23.6 ± 3.2
Headache type
Migraine	82 (65.1)
Tension-type vascular headache	31 (24.6)
Cluster headache	13 (10.3)
Disease duration (years)	3.5 (1.5-7.0)	Range: 3 months to 20 years
Previous treatment history
Received preventive medication	118 (93.7)
Number of preventive medications	2.8 ± 1.3
Medication overuse	38 (30.2)
NSAIDs	28
Triptans	10
Baseline headache characteristics
Headache frequency (times/month)	12.3 ± 4.5
Single episode duration (hours)	8.7 ± 5.2
VAS score	6.8 ± 1.2
Psychological assessment
SAS score	52.4 ± 8.3
Anxiety symptoms (SAS ≥ 50)	61 (48.4)
SDS score	55.1 ± 9.2
Depressive symptoms (SDS ≥ 53)	73 (57.9)
Treatment completion
Follow-up completion rate (%)	92.1	126/137
Completed full SGB treatment (5 days left + 5 days right, total 10 days)	126 (100)
Serious complications	0

NSAID: Non-steroidal anti-inflammatory drugs; VAS: Visual Analog Scale; SAS: Self-Rating Anxiety Scale; SDS: Self-Rating Depression Scale; SGB: Stellate ganglion block.

Table 2 Dynamic changes in pain intensity and clinical outcomes, mean ± SD

Outcome measure	Baseline	1 week	1 month	3 months	F value	P value
VAS score	6.8 ± 1.2	3.2 ± 1.5b	2.8 ± 1.4a,b	3.1 ± 1.6b	486.32	< 0.001
Headache frequency (times/month)	12.3 ± 4.5	6.8 ± 3.2b	5.2 ± 2.8a,b	5.6 ± 3.1b	312.45	< 0.001
Episode duration (hours)	8.7 ± 5.2	4.9 ± 3.1b	3.6 ± 2.4a,b	3.9 ± 2.7b	128.67	< 0.001
SAS score	52.4 ± 8.3	46.8 ± 7.6b	43.2 ± 7.1a,b	44.1 ± 7.5b	156.89	< 0.001
SDS score	55.1 ± 9.2	48.6 ± 8.4b	44.8 ± 7.9a,b	45.9 ± 8.2b	142.34	< 0.001
HIT-6 score	64.5 ± 6.8	56.2 ± 7.2b	52.3 ± 6.5a,b	53.8 ± 6.9b	287.91	< 0.001
Acute medication use (times/month)	9.8 ± 4.2	4.6 ± 2.8b	3.1 ± 2.1a,b	3.5 ± 2.4b	268.73	< 0.001

^aP < 0.05 vs 1-week post-treatment.

^bP < 0.001 vs baseline.

VAS: Visual Analog Scale; SAS: Self-Rating Anxiety Scale; SDS: Self-Rating Depression Scale; HIT-6: Headache Impact Test-6.

Table 3 Comprehensive clinical outcomes following treatment, mean ± SD

Outcome measure	Baseline	1 week	1 month	3 months	F value	P value
Headache frequency (times/month)	12.3 ± 4.5	7.8 ± 3.6b	5.1 ± 3.2a,b	5.6 ± 3.4b	178.56	< 0.001
Episode duration (hours)	8.7 ± 5.2	5.3 ± 4.1b	4.2 ± 3.6a,b	4.5 ± 3.8b	89.43	< 0.001
VAS pain score	6.8 ± 1.2	3.5 ± 1.4b	2.9 ± 1.3a,b	3.2 ± 1.5b	412.67	< 0.001
Acute medication use (times/month)	9.8 ± 4.2	5.2 ± 3.1b	3.4 ± 2.3a,b	3.8 ± 2.6b	245.89	< 0.001
SAS anxiety score	52.4 ± 8.3	47.6 ± 7.8b	43.8 ± 7.2a,b	44.9 ± 7.6b	134.28	< 0.001
SDS depression score	55.1 ± 9.2	49.8 ± 8.6b	45.3 ± 8.1a,b	46.7 ± 8.4b	121.56	< 0.001
HIT-6 score	64.5 ± 6.8	57.9 ± 7.1b	53.6 ± 6.4a,b	54.8 ± 6.7b	256.34	< 0.001
Sleep quality score (PSQI)	11.8 ± 3.4	9.2 ± 2.9b	7.6 ± 2.5a,b	8.1 ± 2.7b	167.92	< 0.001
Work productivity loss (%)	42.3 ± 12.6	28.7 ± 10.4b	21.5 ± 9.2a,b	23.8 ± 9.8b	198.45	< 0.001

^aP < 0.05 vs 1-week post-treatment.

^bP < 0.001 vs baseline.

VAS: Visual Analog Scale; SAS: Self-Rating Anxiety Scale; SDS: Self-Rating Depression Scale; HIT-6: Headache Impact Test-6; PSQI: Pittsburgh Sleep Quality Index.

Table 4 Pearson correlation analysis between pain relief and psychological improvement

Variables	Correlation coefficient (r)	P value	Correlation strength
VAS decrease% vs SAS decrease%	0.687	< 0.001	Moderate positive
VAS decrease% vs SDS decrease%	0.652	< 0.001	Moderate positive
Headache frequency decrease% vs SAS decrease%	0.594	< 0.001	Moderate positive
Headache frequency decrease% vs SDS decrease%	0.571	< 0.001	Moderate positive
SAS score vs SDS score	0.782	< 0.001	High positive

VAS: Visual Analog Scale; SAS: Self-Rating Anxiety Scale; SDS: Self-Rating Depression Scale.

Table 5 Treatment response by headache subtype at 3 months post-treatment

Headache subtype	n (%)	VAS reduction (%)	SAS score change	SDS score change	Total effective rate (%)
Migraine	89 (70.6)	54.8	15.8	14.6	87.6
Tension-type vascular headache	28 (22.2)	52.1	15.2	14.3	85.7
Cluster headache	9 (7.1)	56.3	15.1	14.8	77.8
Statistical comparison		P = 0.71	P = 0.64	P = 0.58	P = 0.67

Visual Analog Scale reduction represents percentage decrease from baseline. Self-Rating Anxiety Scale and Self-Rating Depression Scale score changes represent percentage reduction from baseline. Total effective rate includes markedly effective and effective cases. Statistical comparisons: One-way ANOVA for continuous variables (Visual Analog Scale, Self-Rating Anxiety Scale, Self-Rating Depression Scale); χ² test for total effective rate. No statistically significant differences were observed among headache subtypes for any outcome measure (all P > 0.05). VAS: Visual Analog Scale; SAS: Self-Rating Anxiety Scale; SDS: Self-Rating Depression Scale.

Table 6 Migraine-Specific Quality of Life Questionnaire scores, mean ± SD

MSQ dimension	Baseline	3 months post-treatment	Change (%)	t value	P value
Total score	43.8 ± 12.6	62.5 ± 14.3	+42.7	13.76	< 0.001
Role function-restrictive	41.2 ± 13.5	60.8 ± 15.2	+47.6	12.89	< 0.001
Role function-preventive	45.6 ± 14.2	63.4 ± 16.1	+39.0	11.24	< 0.001
Emotional function	44.5 ± 11.8	63.2 ± 13.6	+42.0	14.32	< 0.001

All comparisons between baseline and 3 months post-treatment were statistically significant (P < 0.001). MSQ: Migraine-Specific Quality of Life Questionnaire.