Objective: This report describes the effects of ganglionic local opioid application (GLOA) in patients with chronic headache and persistent idiopathic facial pain.

Case Report: We present 2 patients with chronic headaches and 1 patient with persistent idiopathic facial pain who were refractory to medical treatment. These patients responded well to a series of ganglionic local opioid applications (GLOAs) by administration of buprenorphine. The beneficial effect of GLOA was manifested by a decrease in pain intensity, reduction of pain medications, and improvement in quality of life.

Conclusions: These results support the theory of sympathetically mediated pain in the head and face, the presence of opioid receptors on the sympathetic ganglia, and a possible beneficial role of opioids in modulation of this process. To our knowledge, this case series is the first case series in the English literature of the use of GLOA at the stellate ganglion for head-and-face pain.