Sphenopalatine ganglion spg blocks spg blocks chicago. Sphenopalatine ganglion spg blocks are a proposed treatment option for chronic migraines. The earliest example of spg blockade was by sluder in 1909. The sensory and autonomic fibers that travel through the spg provided the scientific rationale for symptoms associated with these head and neck syndromes. Preganglionic fibers reach the ganglion from the facial nerve through the greater superficial petrosal nerve and the nerve of the pterygoid canal. The nerve bundle is linked to the trigeminal nerve, the primary nerve involved in. Pdf sphenopalatine block for treatment of migraine headache. The sphenopalatine ganglion spg the spg is a small concentrated structure containing the largest group of neurons outside the brain. It is largely innervated by the greater petrosal nerve a branch of the facial nerve. However, most of the controlled studies were small and without replications. Sphenopalatine ganglion block for relieving postdural puncture.
Pdf sphenopalatine ganglion block in the management of. Sphenopalatine ganglion block infrazygomatic approach what is the purpose of this procedure. Safety and efficacy of sphenopalatine ganglion stimulation. The spg is a group of nerve cells that is located behind the bony structures of the nose. Sphenopalatine ganglion block for postdural puncture headache. A sphenopalatine ganglion block is a relatively quick procedure that offers patients rapid pain relief. He successfully aborted symptoms of ch with intranasal application of varying concentrations of cocaine. The spg is located behind the bony structures of the.
A sphenopalatine block involves the insertion of either cotton buds soaked in a local. Cluster headache, radiofrequency ablation, sphenopalatine ganglion block. Sphenopalatine ganglion block a jack of all trades block medcrave. Sphenopalatine ganglion block sphenopalatine ganglion spg blocks are a proposed treatment option for chronic migraines and some severe nonmigraine headaches. Kent s, mehaffey g 2015 trans nasal sphenopalatine ganglion block for the treatment of postdural puncture headache in the ed. Spg blocks may be used to treat headaches and other forms of pain with local anesthetics in low concentrations which can block the sensory fibers and thereby reduce pain while maintaining function. It is located at the posterior attachment of the middle turbinate above the ethmoidal crest.
Sphenopalatine ganglion spg block has been used by clinicians in the treatment of a variety of headache disorders, facial pain syndromes, and other facial neuralgias. Medical coverage policy sphenopalatine ganglion block. This blocks the pain messages thereby reducing the pain. Yet, despite the elucidation of this pathogenic target, the. The sphenopalatine ganglion block has been associated with alleviation of the frequency and intensity of headaches, specifically cluster headache and migraine, which are poorly controlled with conventional drugs such as betablockers. A new option for self administration of sphenopalatine ganglion spg blocks may 4, 2020 pterygopalatine ganglion block for treatment of chronic and episodic chronic headache, severe headache, tension headache, migraine, cluster headache, trigeminal autonomic cephalgias april 28. In the early part of this century the late greenfield sluder first directed attention to a syndrome which he called sphenopalatine ganglion neuralgia, or lower half headache. Sphenopalatine ganglion block cluster headache migraine headache bupivacaine functional endoscopic sinus.
The sphenopalatine ganglion may be accessed via the nostrils of the nose and blocked with a topical application of local anesthetic. The pterygopalatine ganglion aka meckels ganglion, nasal ganglion, spg or sphenopalatine ganglion is a parasympathetic ganglion found in the pterygopalatine fossa. Sphenopalatine ganglion spg blocks are a proposed treatment option for chronic migraines and some severe nonmigraine headaches. The modified cotton swab applicator assembled from ubiquitous components found in most operating rooms is an alternative to costly commercial devices tx360 tian medical, llc, grayslake, illinois and sphenocath dolor technologies, llc, salt lake city, utah for sphenopalatine ganglion nerve blocks. Sphenopalatine ganglion spg block has been used by clinicians in the treatment of a variety of headache disorders, facial.
It is in or close to the foramen that connects the pterygopalatine fossa to the nasal cavity. The flow of blood to the nasal mucosa, in particular the venous plexus of the. Sphenopalatine ganglion blocks are considered investigational for all indications, including but not. Please refer to the members plan document for specific coverage information.
The sphenopalatine ganglion block can be useful to treat migraine headaches, cluster headaches, and a variety of facial pain conditions. Pain messages from these areas are sent along these nerves to the brain where the pain is interpreted. Sphen ala angli w the sphenopalatine ganglion is a littleknown region in the face that transmits pain signals from the head and face. Sphenopalatine ganglion block for headache sphenopalatine ganglion block sphenopalatine ganglion spg blocks are a proposed treatment option for chronic migraines and some severe nonmigraine headaches. The sphenopalatine ganglion spg, in the pterygopalatine fossa, is a known current and historical target for therapeutic intervention in headache. Anesthetizing the sphenopalatine ganglion is both diagnostic and therapeutic.
Pterygopalatine ganglion an overview sciencedirect topics. In the sphenopalatine ganglion stimulator group, pain relief at 15 min was experienced in 67% of attacks, compared with 7% of attacks in both the sham and subperception treatment groups. The sphenopalatine ganglion is a group of nerve cells. Sphenopalatine ganglion block in the management of chronic headaches article pdf available in current pain and headache reports 216 june 2017 with 702 reads how we measure reads. Kent s, mehaffey g 2016 trans nasal sphenopalatine ganglion block for the treatment of postdural puncture headache in obstetric patients. Surgical decompression of second cervical nerve root and ganglion surgical decompression of the greater occipital nerve. Sphenopalatine ganglion block is known for its efficacy in otorhinolaryngological surgeries in which the sinuses are approached by transnasal endoscopy, as an important part of postoperative analgesia. Sphenopalatine ganglion blocks are considered investigational for all indications. Sphenocath sphenopalatine ganglion block what is the purpose of this procedure. Epidural bloodpatch ebp is the gold standard treatment when conservative therapy fails, but has significant risks associated. The block is usually temporary but the benefit can sometimes.
Sphenopalatine ganglion blocks in headache disorders amf. Sphenopalatine ganglion block and radiofrequency ablation. The sphenopalatine ganglion spg is a group of nerve cells that is linked to the trigeminal nerve, the main nerve involved in headache the spg, located behind the nose, carries information about sensation, including pain, and also plays a role in autonomic functions, such as tearing and nasal congestion. By placing a small amount of local anesthetic on it, pain. Sphenopalatine ganglion block infrazygomatic approach. Kent s, mehaffey g 2016 transnasal sphenopalatine ganglion block for the treatment of postdural puncture headache in obstetric patients. Sphenopalatine ganglion block treatments pain doctor. The rest of the available literature was case reports and case series.
Trial eligibility criteria include meeting international classification of. Sphenopalatine ganglion block for the treatment of acute migraine. Sphenocath, sphenopalatine ganglion block, sphenopalatine ganglion, headache, migrane, facial pain. Sphenopalatine ganglion block injections for conditions other than chronic headache are also considered investigational, and therefore, not medically necessary. Sphenopalatine ganglion block for headache and pain. The spg is a group of nerve cells located behind the bony structures of the nose. Sphenopalatine ganglion block is a procedure and therefore does not require fda approval.
Cinicalstudy sphenopalatine ganglion block for the treatment of acute migraine headache mohamedbinfalah,1 emanalghawi,2 eslamshosha,3 alialhilly,4 andmoizbakhiet 5 universitymedicalcenter,kingabdullahmedicalcy,p. Sphenopalatine ganglion block in the management of chronic. The sphenopalatine ganglion is a group of nerve cells located deep in. Sphenopalatine ganglion block for the treatment of. Treatment of postdural puncture headache in postpartum. The strongest evidence lies in using sphenopalatine ganglion block, radiofr equency ablation and neurostimu lation for cluster headache. The sphenopalatine ganglion block has been utilized over the last century for a wide variety of maladies. Sphenopalatine ganglion block also has some evidence supporting its use in a few other conditions. Cohen s, sakr a, katyal s, chopra d 2009 sphenopalatine ganglion block for postdural puncture headache. In a sphenopalatine ganglion spg block, an anesthetic is administered to the collection of nerves in the ganglion to stop pain transmission.
Blocking the sphenopalatine ganglion is useful in the treatment of migraine and cluster headaches. The sphenopalatine ganglion is made up of a large number of nerves which relay various messages from the face, head and neck to the brain. Sphenopalatine ganglion block in primary headaches neurology. The sphenopalatine ganglion spg is associated with the trigeminal nerve, the major nerve involved in headache ha disorders see figure 1. The patient is placed in the supine position with the cervical spine extended over a foam wedge. The sphenopalatine ganglion is a group of nerve cells located deep in the face behind the nose.
The infrazygomatic technique can be used to directly. The spg is a fivemm triangular shaped parasympathetic ganglion, located superficially and anterior to the pterygoid canal in the pterygopalatine. Occipital neuralgia and headache treatment page 1 of 21. Nerve blocks for the treatment of headaches or neuralgia. Sphenopalatine ganglion block what is a sphenopalatine ganglion block and why is it helpful. Pdf sphenopalatine ganglion block for postdural puncture. The pterygopalatine or sphenopalatine ganglion ppg, spg is one in all four tiny parasympathetic ganglia found within the head. The nerve bundle is linked to the trigeminal nerve, the primary nerve involved in headache disorders.
The block is carried out on a daily basis for 5 to 7 days, using topical application of local anesthetic to the. A sphenopalatine ganglion block is an established treatment method for a wide varie of pain syndromes. Sphenopalatine ganglion block for the treatment of acute. A doubleblind, placebocontrolled study of repetitive. The novelty of this disease drew considerable attention, and the enthusiasm continued for several years, reaching a maximum in the early twenties. Sphenopalatine ganglion block riverhills neuroscience. Sphenopalatine ganglion block sphenopalatine ganglion spg nerve blocks are a proposed treatment option for chronic migraines and some severe non migraine headaches. Transnasal sphenopalatine ganglion block is emerging as is an attractive and effective treatment modality for acute migraine headaches. Sphenopalatine ganglion spg blockade or lesioning can offer significant pain relief for cluster headaches chs and a variety of other pain syndromes involving the head and face. If you apply local anesthetics or numbing medications to block or partially block the spg, this can be helpful in reducing head and facial pain. The sphenopalatine ganglion spg is a parasympathetic ganglion, located in the pterygopalatine fossa. The sphenopalatine ganglion block can be useful to treat migraine headache, cluster headaches, and a variety of facial pain conditions. Postdural puncture headache pdph is a relatively common complication associated with neuraxial anesthesia and unintentional dural puncture. Four cc of 2% viscous lidocaine is placed to the level of the sphenopalatine ganglion with a 20 gauge angiocatheter along sterile swabs which were placed carefully into the patients nostrils bilaterally and lateral to the middle turbinate.
However, in a neurosurgical environment, specifically in the treatment of tumors of the sella turcica, the use of the blockade of the referred. The pterygopalatine ganglion is a parasympathetic ganglion located in the pterygopalatine fossa just beneath the maxillary nerve. Recently, bilateral sphenopalatine ganglion block spgb has emerged as an alternative and safe technique in patients with pdph. Rhinitis, sphenopalatine ganglion block, bupivacaine introduction vasomotor rhinitis is a nonallergic, nonin fectious disease characterized by congestion of the nasal mucosa, intermittent rhinorrhea, paroxysmal sneezing, and nasal obstruction. Patients usually report pain relief between 15 and 30 minutes after the procedure.
The risks associated with a sphenopalatine ganglion block are very low. Transnasal sphenopalatine ganglion block is emerging as is an attractive and effective treatment modality for acute migraine headaches, cluster headache, trigeminal neuralgia, and several other conditions. Sphenopalatine ganglion, trigeminal nerve, occipital nerve, supraorbital nerve blocks are considered. The sphenopalatine ganglion spg and headache the link between the spg and the trigeminal nerve is important in head pain. Sphenopalatine ganglion block via the greater palatine foramen approach is accomplished by the injection of local anesthetic onto the ganglion. These services may or may not be covered by all medica plans.