The SPG Block or Sphenopalatine Ganglion Block can be extremely effective at preventing and eliminating migraines. The Sphenopalatine Ganglion is part of the Autonomic Nervous System. It is the Largest Parasympathetic Ganglion and treatment with lidocaine has been shown to be very effective for treating a wide variety of chronic and acute pain syndromes including Migraine, Cluster Headache, Chronic Daily Headache, New Persistent headache, Rebound Headache, Sinus Pain, Trigeminal Neuralgia, Autonomic Cephalgias and many other disorders. It is frequently used for medically refractory headaches where all other treatments have failed. SphenoPalatine Ganglion Blocks are probably grossly underutilized based on safety and cost effectiveness. Frequently, SPG Blocks are not used because practitiones do not understand the anatomy of the autonomic nervous system. Occipital neuralgia and /or occipital migraines are not considered to be directly related to the rigeminal nervous system. In truth, sympathetic fibers from the superior sympathetic ganglion pass theru the pterygopalatine fossa and the Sphenopalatine ganglion and travel on trigeminal nerve. Many occipital issues can be addressed with SPG Blocks.
There are multiple routes of administration including through the nose and by intra-oral or suprazygomatic injection.
There are several new FDA approved devices for delivering SPG blocks intranasally. These include the Sphenocath, the Allevio and the TX360. The MiRX protocol is specifically designed to prevent and eliminate migraines. The use of cotton tipped applicators saturated with lidocaine, cocaine or other anesthetic has been utilized for many years.
The use of hollow tipped applicators allow a continual feeding mechanism for anesthetic that can easily be accomplished by most patients. This method is extremely cost effective and convenient for patients.
Self administration of SPG Blocks is the key to putting chronic pain patients back in control of their lives.
These are videos of patients utilizing these amazing blocks:
The injection techniques are most effective in turning off an acute attack. I recently taught a hands on course to physiologic dentists at the ICCMO meeting in San Diego several methods of delivering anesthetic to the Sphenopalatine Ganglion.
Self administered Sphenopalatine blocks have been used for multiple conditions including CRPS, Complex Regional Pain Syndrome of the lower extremity (PubMed abstract below), Post Dural Puncture Headache, to treat Tension Headache in pregnant patients, and for OroFacial Pain (PubMed abstract below). The usefulness has been described of SPG blocks in Pain clinics as well (PubMed Abstract below)
This link will take you to the Power Point of Dr Shapiras Sphenopalatine Ganglion Block Lecture:
Complex regional pain syndrome involving the lower extremity: a report of 2 cases of sphenopalatine block as a treatment option.
We report 2 cases of complex regional pain syndrome (CRPS) involving the lower extremity; in both, a sphenopalatine ganglion (SPG) block was performed as part of a pain management program. In the first case, a woman in her late twenties presented with CRPS in the left lower extremity that was inadequately controlled with typical oral medications. Sympathetic block of the extremity did not provide significant pain relief. However, a noninvasive sphenopalatine block with 4% tetracaine resulted in a 50% reduction in pain level. The patient was shown how to self-administer the sphenopalatine block and was provided with exercises and therapy to help improve her functional status. The second case involved a woman in her mid forties with CRPS in the right lower extremity that was partially controlled with oral medications. The patient experienced a 50% reduction in pain level when SPG block with 4% tetracaine was given. Further study is needed to determine the effects of SPG blocks on symptoms related to chronic regional pain syndrome.
- [PubMed – indexed for MEDLINE]
Transnasal topical sphenopalatine ganglion block to treat tension headache in a pregnant patient.
Sphenopalatine ganglion block: a safe and easy method for the management of orofacial pain.
The sphenopalatine ganglion (SPG) block is a safe, easy method for the control of acute or chronic pain in any pain management office. It takes only a few moments to implement, and the patient can be safely taught to effectively perform this pain control procedure at home with good expectations and results. Indications for the SPG blocks include pain of musculoskeletal origin, vascular origin and neurogenic origin. It has been used effectively in the management of temporomandibular joint (TMJ) pain, cluster headaches, tic douloureux, dysmenorrhea, trigeminal neuralgia, bronchospasm and chronic hiccup.
- [PubMed – indexed for MEDLINE]
Transnasal sphenopalatine ganglion block for the treatment of postdural puncture headache in the ED.
Sphenopalatine ganglion block: clinical use in the pain management clinic.
Clinical experience with the sphenopalatine ganglion (SPG) block combined with a review of prior studies led to conducting a retrospective evaluation of four patients with chronic pain treated with the SPG block. The review of case reports suggests the usefulness of SPG blocks in the pain management clinic.
- Sphenopalatine block. [Clin J Pain. 1991]
Headache. 2013 Jul-Aug;53(7):1183-90. doi: 10.1111/head.12148. Epub 2013 Jun 28.
Cluster headache: potential options for medically refractory patients (when all else fails).
The most evidence exists for mixed anesthetic/steroid occipital nerve blocks (which are also useful in non-refractory patients), deep brain stimulation, sphenopalatine ganglion (SPG) blocks, SPG radiofrequency ablation, and SPG stimulation with the Autonomic Technologies, Inc (ATI) SPG Neurostimulator, the latter approved in the European Union and reimbursed in several countries.
© 2013 American Headache Society.
LSD; cluster headache; neuromodulation; occipital nerve block; sphenopalatine ganglion stimulation; vagal nerve stimulation