Sphenopalatine Ganglion Block in the Management of Chronic Headaches
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Purpose of Review
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. The sensory and autonomic fibers that travel through the SPG provided the scientific rationale for symptoms associated with these head and neck syndromes. Yet, despite the elucidation of this pathogenic target, the optimal method to block its pain-producing properties has not been determined. Clinicians have developed various invasive and non-invasive techniques, each of which has shown variable rates of success. We examined the available studies of sphenopalatine ganglion blockade and its efficacy in the treatment of cluster headaches, migraines, and other trigeminal autonomic cephalalgias.
Studies have demonstrated that SPG blockade and neurostimulation can provide pain relief in patients with cluster headaches, migraines, and other trigeminal autonomic cephalalgias. Patients with these conditions showed varying levels and duration of pain relief from SPG blockade. The efficacy of SPG blockade could be related to the different techniques targeting the SPG and choice of therapeutic agents.
Based on current studies, SPG blockade is a safe and effective treatment for chronic headaches such as cluster headaches, migraines, and other trigeminal autonomic cephalalgias. Future studies are warranted to define the optimal image-guided technique and choice of pharmacologic agents for SPG blockade as an effective treatment for chronic headaches related to activation of the sphenopalatine ganglion.
KeywordsSphenopalatine ganglion block Trigeminal autonomic cephalalgias Cluster headache Paroxysmal hemicrania Hemicrania continua Migraine headache
Compliance with Ethical Standards
Conflict of Interest
Jeffery Mojica, Bi Mo, and Andrew Ng declare that they have no conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
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- 3.Moore KL, Dalley AF, Agur AM. Clinically oriented anatomy. Lippincott Williams & Wilkins; 2013.Google Scholar
- 4.Robbins MS, Robertson CE, Kaplan E, Ailani J, Charleston L, Kuruvilla D, Blumenfeld A, Berliner R, Rosen NL, Duarte R, Vidwan J. The sphenopalatine ganglion: anatomy, pathophysiology, and therapeutic targeting in headache. Headache: J Head Face Pain. 2015.Google Scholar
- 6.•• Piagkou M, Demesticha T, Troupis T, Vlasis K, Skandalakis P, Makri A, Mazarakis A, Lappas D, Piagkos G, Johnson EO. The pterygopalatine ganglion and its role in various pain syndromes: from anatomy to clinical practice. Pain Practice. 2012;12(5):399–412. This article highlights the pathophysiology of headaches related to sphenopalatine ganglion activation and different techniques of sphenopalatine ganglion blocks.Google Scholar
- 12.Headache classification committee of the international headache society (IHS). The international classification of headache disorders, (beta version). Cephalalgia. 2013;33(9):629–808.Google Scholar
- 16.Michelle Androulakis X, Krebs KA, Ashkenazi A. Hemicrania continua may respond to repetitive sphenopalatine ganglion block: a case report. Headache: J Head Face Pain. 2016.Google Scholar
- 17.Devoghel JC. Cluster headache and sphenopalatine block. Acta Anaesthesiol Belg. 1980;32(1):101–7.Google Scholar
- 32.•• Cady R, Saper J, Dexter K, Manley HR. A double-blind, placebo-controlled study of repetitive transnasal sphenopalatine ganglion blockade with Tx360® as acute treatment for chronic migraine. Headache: The Journal of Head and Face Pain. 2015;55(1):101–16. This article demonstrates the efficacy of sphenopalatine ganglion block with bupivacaine. CrossRefGoogle Scholar
- 33.•• Bratbak DF, Nordgård S, Stovner LJ, Linde M, Dodick DW, Aschehoug I, Folvik M, Tronvik E. Pilot study of sphenopalatine injection of onabotulinum toxin A for the treatment of intractable chronic migraine. Cephalalgia. 2016. It is a novel approach to utilize onabotulinum toxin A as a pharmacologic agent for sphenopalatine ganglion block.Google Scholar
- 34.Sluder G. The anatomical and clinical relations of the sphenopalatine (Meckel’s) ganglion to the nose and its accessory sinuses. AR Elliott Publishing Company; 1909.Google Scholar