Sphenopalatine ganglion block in primary headaches

Abstract

BackgroundThe sphenopalatine ganglion (SPG), in the pterygopalatine fossa, is a known current and historical target for therapeutic intervention in headache disorders because of its role in cranial autonomics and vasodilation. There remains an overall lack of well-established SPG treatment protocols, particularly with the advent of newer commercial devices.MethodsA 22 multiple-choice question survey was created to evaluate clinical practice patterns with SPG block and sent to members of the American Headache Society (AHS). Questions focused on determining indications, preferred applicators, medications applied, perceived efficacy, tolerability, and reimbursement.ResultsOne hundred seventy-two of 1,346 (12.8%) AHS members participated. Ninety-three respondents (56.3%) had performed SPG blocks on 50 or fewer patients. The SphenoCath (42.4%) and the Tx360 (41.8%) were the most common methods of application. Ease of use was the top reason for provider preference in applicator type. SPG blocks were mostly used as an as-needed one-time procedure. When a scheduled protocol was used, twice weekly for 6 weeks was most common. Chronic migraine was the most commonly treated headache disorder and rated the most likely to respond to SPG block. Experienced clinicians found SPG more helpful as a stand-alone treatment and tended to report that acute relief was not predictive of enduring response.ConclusionsThe variety of responses strongly suggests that clinicians would benefit from formalized protocols for SPG blocks. More experienced clinicians may have developed individualized protocols that they feel are more effective. The lack of evidence-based protocols contribute to clinicians not performing SPG blocks more frequently.

Intranasal Lidocaine Administration via Mucosal Atomization Device: A Simple and Successful Treatment for Postdural Puncture Headache in Obstetric Patients

“…Numerous case reports suggest positive outcomes with intranasal lidocaine in headache patients. While a significant percentage of patients respond well, there is also a substantial proportion of non-responders [43]. Although topical lidocaine to the sphenopalatine ganglion has been considered promising for treating acute cluster headache attacks, only one-third of patients seem to benefit.…”

Clinic-based Procedures for Headache

“…Headache specialists surveyed do not seem to have a consensus for the most effective and feasible technique. 59 Intranasal sphenopalatine ganglion blocks do not specifically require any imaging guidance and are generally safe to perform. However, they should be avoided in any patient with a history of any local bone or sinus defect, including a history of sinus surgery.…”

“…No evidence suggests which technique may be more effective. Headache specialists surveyed do not seem to have a consensus for the most effective and feasible technique 59 …”

Midterm Clinical Outcomes of Repetitive Transnasal Sphenopalatine Ganglion Blockade in Chronic Migraine

“…It has also been emphasized that those benefiting most from the blockade are the patients with chronic migraine. On the other hand, headache specialists prefer the procedure less frequently due to the lack of evidence-based protocols related to the SPG blockade (7). There is currently a limited number of studies demonstrating that the SPG blockade may have a prophylactic efficacy in chronic migraine (8)(9)(10).…”