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Ganglion Blocks of the Head and Face

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Deer's Treatment of Pain

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Abstract

Interventional pain procedures have been shown to be effective at managing a variety of headache disorders and facial pain, both typical and atypical, in the acute and chronic setting. The sphenopalatine ganglion has an important role in unilateral headache disorders that are classified as trigeminal autonomic cephalgias (TACs), such as cluster headaches, and can be intervened upon in several fashions to help alleviate the condition. Facial pain associated with trigeminal neuralgia has also been successfully managed with a gasserian ganglion block that can be quickly performed with the aid of either fluoroscopy or ultrasound.

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Recommended Reading

  1. Bolash R, Tolba R. Sphenopalatine ganglion. In: Pope J, Deer T, editors. Treatment of chronic pain conditions. New York: Springer; 2017.

    Google Scholar 

  2. Candido KD, Germanovich A, Ghaly RF, Gorelick GH, Knezevic NN. Computed tomography scan-guided Gasserian ganglion injection of dexamethasone and lidocaine for the treatment of recalcitrant pain associated with herpes simplex type 1 infection of the ophthalmic division of the trigeminal nerve. Anesth Analg. 2011;112:224–7.

    Article  Google Scholar 

  3. Cohen S, Ramos D, Grubb W, Mellender S, Mohiuddin A, Chiricolo A. Sphenopalatine ganglion block: a safer alternative to epidural blood patch for postdural puncture headache. Reg Anesth Pain Med. 2014;39:563.

    Article  Google Scholar 

  4. D’Alessio DJ. Trigeminal neuralgia: a practical approach to treatment. Drugs. 1982;24(3):248.

    Article  Google Scholar 

  5. Day M. Sphenopalatine ganglion analgesia. Curr Rev Pain. 1999;3(5):342–7.

    Article  CAS  Google Scholar 

  6. Edvinsson L. Innervation and effects of dilatory neuropeptides on cerebral vessels. Blood Vessels. 1991;28:35–45.

    CAS  PubMed  Google Scholar 

  7. Felisati G, Arnone F, Lozza P, et al. Sphenopalatine endoscopic ganglion block: a revision of a traditional technique for cluster headache. Laryngoscope. 2006;116:1447–50.

    Article  Google Scholar 

  8. Guyatt G, Gutterman D, Baumann MH, Addrizzo-Harris D, Hylek EM, Phillips B, Raskob G, Lewis SZ, Schunemann H. Grading strength of recommendations and quality of evidence in clinical guidelines: report from an American college of chest physicians task force. Chest. 2006;129(1):174–81.

    Article  Google Scholar 

  9. Hawkins K, Wang S, Rupnow MF. Indirect cost burden of migraine in the United States. J Occup Environ Med. 2007;49:368–74.

    Article  Google Scholar 

  10. Huang J, Zhongge N, Finch P. Gasserian ganglion and retrobulbar nerve block in the treatment of ophthalmic postherpetic neuralgia: a case report. Pain Pract. 2017;17(7):961–7. https://doi.org/10.1111/papr.12547. Epub 2017 Feb 25.

    Article  PubMed  Google Scholar 

  11. Jusino E, Guirguis M. Trigeminal nerve block. In: Pope J, Deer T, editors. Treatment of chronic pain conditions. New York: Springer; 2017.

    Google Scholar 

  12. Khonsary SA, Ma Q, Villablanca P, Emerson J, Malkasian D. Clinical functional anatomy of the pterygopalatine ganglion, cephalgia and related dysautonomias: a review. Surg Neurol Int. 2013;4:S422–8.

    Article  Google Scholar 

  13. Kittrelle JP, Grouse DS, Seybold ME. Cluster headache. Local anesthetic abortive agents. Arch Neurol. 1985;42:496–8.

    Article  CAS  Google Scholar 

  14. Maizels M, Scott B, Cohen W, Chen W. Intranasal lidocaine for treatment of migraine: a randomized, double-blind, controlled trial. JAMA. 1996;276:319–21.

    Article  CAS  Google Scholar 

  15. Maksymowicz W. Treatment of trigeminal neuralgia by glycerol gangliolysis of the trigeminal ganglion. Neurol Neurochir Pol. 1987;21:45–8.

    CAS  PubMed  Google Scholar 

  16. Mohammadkarimi N, Jafari M, Mellat A, Kazemi E, Shirali A. Evaluation of efficacy of intra-nasal lidocaine for headache relief in patients refer to emergency department. J Res Med Sci. 2014;19:331–5.

    CAS  PubMed  PubMed Central  Google Scholar 

  17. Moiseiwitsch J, Irvine T, Hill C. Clinical significance of the length of the pterygopalatine fissure in dental anesthesia. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001;92:325–8.

    Article  CAS  Google Scholar 

  18. Nader A, Kendall MC, De Oliveria GS, Chen JQ, Vanderby B, Rosenow JM, Bendok BR. Ultrasound-guided trigeminal nerve block via the pterygopalatine fossa: an effective treatment for trigeminal neuralgia and atypical facial pain. Pain Physician. 2013;16(5):537–45.

    Google Scholar 

  19. Nappi G, Moskowitz MA. Cluster headache and trigeminal autonomic cephalgias: general aspects. Handbook of clinical neurology. 2011;97(3rd series):387–8.

    Google Scholar 

  20. Narouze SN. Role of sphenopalatine ganglion neuroablation in the management of cluster headache. Curr Pain Headache Rep. 2010;14(2):160–3.

    Article  Google Scholar 

  21. Narouze S, Kapural L, Casanova J, Mekhail N. Sphenopalatine ganglion radiofrequency ablation for the management of chronic cluster headache. Headache. 2009;49(4):571–7.

    Article  Google Scholar 

  22. Robbins MS, Robertson CE, Kaplan E, Ailani J, Charleston L, Kuruvilla D, Blumenfeld A, Berliner R, Rosen NL, Duarte R, Vidwan J, Halker RB, Gill N, Ashkenazi A. The sphenopalatine ganglion: anatomy, pathophysiology, and therapeutic targeting in headache. Headache J Head Face Pain. 2016;56:240–58.

    Article  Google Scholar 

  23. Ruskin AP. Sphenopalatine (nasal) ganglion: remote effects including “psychosomatic” symptoms, rage reaction, pain, and spasm. Arch Phys Med Rehabil. 1979;60:353–9.

    CAS  Google Scholar 

  24. Rusu MC, Pop F. The anatomy of the sympathetic pathway through the pterygopalatine fossa in humans. Ann Anat. 2010;192:17–22.

    Article  CAS  Google Scholar 

  25. Shah R, Racz G. Long-term relief of posttraumatic headache by sphenopalatine ganglion pulsed radiofrequency lesioning: a case report. Arch Phys Med Rehabil. 2004;85:1013–6.

    Article  Google Scholar 

  26. Sluder G. The anatomical and clinical relations of the sphenopalatine ganglion to the nose. N Y State J Med. 1909;90:293–8.

    Google Scholar 

  27. Sluder G. Nasal neurology, headaches and eye disorders. St. Louis: CV Mosby; 1927.

    Book  Google Scholar 

  28. Stechison MT, Brogan M. Transfacial transpterygomaxillary access to foramen rotundum, sphenopalatine ganglion, and the maxillary nerve in the management of atypical facial pain. Skull Base Surg. 1994;4:15–20.

    Article  CAS  Google Scholar 

  29. Talman WT, Corr J, Dragon DN, Wang D. Parasympathetic stimulation elicits cerebral vasodilation in rat. Auton Neurosci. 2007;133(2):153–7.

    Article  Google Scholar 

  30. Tator CH, Rowed DW. Fluoroscopy of foramen ovale as an aid to thermocoagulation of the Gasserian ganglion; technical note. J Neurosurg. 1976;44:254–7.

    Article  CAS  Google Scholar 

  31. Tsui BC. Ultrasound imaging to localize foramina for superficial trigeminal nerve block. Can J Anaesth. 2009;56:704–6.

    Article  Google Scholar 

  32. Uddman R, Hara H, Edvinsson L. Neuronal pathways to the rat middle meningeal artery revealed by retrograde tracing and immunocytochemistry. J Auton Nerv Syst. 1989;26:69–75.

    Article  CAS  Google Scholar 

  33. van Kleef M, Slujter M, van Zundert J. Radiofrequency treatment. In: Benzon H, Rathmell JP, Wu CL, Turk DC, Argoff CE, editors. Raj's practical management of pain. 4th ed. Philadelphia: Elsevier; 2008. p. 1063–78.

    Google Scholar 

  34. Waldman SD. Sphenopalatine ganglion block – 80 years later. Reg Anesth. 1993;18(5):274–6.

    CAS  PubMed  Google Scholar 

  35. Yang I, Oraee S. A novel approach to transnasal sphenopalatine ganglion injection. Pain Physician. 2006;9:131–4.

    PubMed  Google Scholar 

  36. Yarnitsky D, Goor-Aryeh I, Bajwa ZH, Ransil BI, Cutrer FM, Sottile A, Burstein R. Possible parasympathetic contributions to peripheral and central sensitization during migraine. Headache. 2003;43(7):704–14.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Wake Forest Baptist Medical Center, Winston Salem, NC, USA

    Reda Tolba

  2. Anesthesiology Department, Ochsner Health System, New Orleans, LA, USA

    Tyler Nix

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  1. Reda Tolba
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  2. Tyler Nix
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Correspondence to Tyler Nix .

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Editors and Affiliations

  1. The Spine and Nerve Center of the Virginias, Charleston, WV, USA

    Timothy R. Deer

  2. Evolve Restorative Center, Santa Rosa, CA, USA

    Jason E. Pope

  3. Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA

    Tim J. Lamer

  4. Pain Diagnostics and Interventional Care, Sewickley, PA, USA

    David Provenzano

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Tolba, R., Nix, T. (2019). Ganglion Blocks of the Head and Face. In: Deer, T., Pope, J., Lamer, T., Provenzano, D. (eds) Deer's Treatment of Pain. Springer, Cham. https://doi.org/10.1007/978-3-030-12281-2_37

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  • DOI: https://doi.org/10.1007/978-3-030-12281-2_37

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-12280-5

  • Online ISBN: 978-3-030-12281-2

  • eBook Packages: MedicineMedicine (R0)

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