The Zygomatic approach is what I use for SPG blocks during and acute pain attack when I cannot get relief with intranasal approach. It is extremely effective in terminating Cluster and Migraines of Trigeminal Nerve origin.

This new study (see PubMed Abstract below) discusses the use of a neurolytic block for neuropathy and extremely successful results.

These were all patients who failed medical treatment. An excellent question is the best treatment for this type of trigeminal Neuropathy, Migraines, Cluster Headaches and related pain syndromes medical management or Sphenopalatine Ganglion Blocks.

When should SPG Blocks be done vs SPG neurolysis. Pain relief lasted for as long as nine years. Is a patient better off taking multiple medications for nine years or doing SPG Neurolysis. The article states some patients (outside study) had pain relief for up to 18 years.

SPG Blocks are far less expensive and safer than the use of Botox. Should SPG Block trial always be attempted prior to Botox?

Is there an advantage to Zygomatic approach to intra-oral approach to Sphenopalatine Ganglion Blocks? Can the intranasal approach for Sphenoplatine Ganglion Blocks that are minimally invasive yield similar or superior results to injection techniques.

Are the “Squirt Gun” SPG Blocks with TX360, Sphenocath or Allevio equal to or superior to intranasal swabs. Are intranasal swabs the most effective method?

Should all chronic head and neck pain patients have diagnostic SPG Blocks to determine if they have a primary autonomic nervous system problem?

Does anyone in Chicago oher than Dr Shapira offer a choice of intra oral, zygomatic , Nasal Swab or nasal canula approaches to SPG Blocks.  Can my doctor learn how to do SPG Blocks?

Neurol Neurochir Pol. 2015 Nov-Dec;49(6):389-394. doi: 10.1016/j.pjnns.2015.08.010. Epub 2015 Sep 19.
The effectiveness of neurolytic block of sphenopalatine ganglion using zygomatic approach for the management of trigeminal neuropathy.
Malec-Milewska M1, Horosz B2, Kosson D2, Sekowska A2, Kucia H2.
Author information
This study was performed to present the outcomes of trigeminal neuropathy management with the application of neurolytic block of sphenopalatine ganglion. This type of procedure is used in cases where pain is not well controlled with medical treatment. Twenty patients were treated with sphenopalatine ganglion neurolysis after their response to pharmacological management was not satisfactory. Significant pain relief was experienced by all but one patient and they were able to reduce or stop their pain medication. The time of pain relief was between a few months and 9 years during the study period. Number of procedures implemented varied as some of the patients have been under the care of our Pain Clinic for as long as 18 years, satisfied with this type of management and willing to have the procedure repeated if necessary. It appears that neurolytic block of sphenopalatine ganglion is effective enough and may be an option worth further consideration in battling the pain associated with trigeminal neuropathy.
Copyright © 2015 Polish Neurological Society. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.
Neurolytic block; Neuropathic pain; Sphenopalatine ganglion; Trigeminal neuropathy