Ganglion Blocks of the Head and Face

  • Reda Tolba
  • Tyler NixEmail author


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.


Sphenopalatine Gasserian Ganglion Trigeminal neuralgia Cluster headaches 

Recommended Reading

  1. 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. 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.CrossRefGoogle Scholar
  3. 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.CrossRefGoogle Scholar
  4. 4.
    D’Alessio DJ. Trigeminal neuralgia: a practical approach to treatment. Drugs. 1982;24(3):248.CrossRefGoogle Scholar
  5. 5.
    Day M. Sphenopalatine ganglion analgesia. Curr Rev Pain. 1999;3(5):342–7.CrossRefGoogle Scholar
  6. 6.
    Edvinsson L. Innervation and effects of dilatory neuropeptides on cerebral vessels. Blood Vessels. 1991;28:35–45.PubMedGoogle Scholar
  7. 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.CrossRefGoogle Scholar
  8. 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.CrossRefGoogle Scholar
  9. 9.
    Hawkins K, Wang S, Rupnow MF. Indirect cost burden of migraine in the United States. J Occup Environ Med. 2007;49:368–74.CrossRefGoogle Scholar
  10. 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. Epub 2017 Feb 25.CrossRefPubMedGoogle Scholar
  11. 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. 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.CrossRefGoogle Scholar
  13. 13.
    Kittrelle JP, Grouse DS, Seybold ME. Cluster headache. Local anesthetic abortive agents. Arch Neurol. 1985;42:496–8.CrossRefGoogle Scholar
  14. 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.CrossRefGoogle Scholar
  15. 15.
    Maksymowicz W. Treatment of trigeminal neuralgia by glycerol gangliolysis of the trigeminal ganglion. Neurol Neurochir Pol. 1987;21:45–8.PubMedGoogle Scholar
  16. 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.PubMedPubMedCentralGoogle Scholar
  17. 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.CrossRefGoogle Scholar
  18. 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. 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. 20.
    Narouze SN. Role of sphenopalatine ganglion neuroablation in the management of cluster headache. Curr Pain Headache Rep. 2010;14(2):160–3.CrossRefGoogle Scholar
  21. 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.CrossRefGoogle Scholar
  22. 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.CrossRefGoogle Scholar
  23. 23.
    Ruskin AP. Sphenopalatine (nasal) ganglion: remote effects including “psychosomatic” symptoms, rage reaction, pain, and spasm. Arch Phys Med Rehabil. 1979;60:353–9.Google Scholar
  24. 24.
    Rusu MC, Pop F. The anatomy of the sympathetic pathway through the pterygopalatine fossa in humans. Ann Anat. 2010;192:17–22.CrossRefGoogle Scholar
  25. 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.CrossRefGoogle Scholar
  26. 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. 27.
    Sluder G. Nasal neurology, headaches and eye disorders. St. Louis: CV Mosby; 1927.CrossRefGoogle Scholar
  28. 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.CrossRefGoogle Scholar
  29. 29.
    Talman WT, Corr J, Dragon DN, Wang D. Parasympathetic stimulation elicits cerebral vasodilation in rat. Auton Neurosci. 2007;133(2):153–7.CrossRefGoogle Scholar
  30. 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.CrossRefGoogle Scholar
  31. 31.
    Tsui BC. Ultrasound imaging to localize foramina for superficial trigeminal nerve block. Can J Anaesth. 2009;56:704–6.CrossRefGoogle Scholar
  32. 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.CrossRefGoogle Scholar
  33. 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. 34.
    Waldman SD. Sphenopalatine ganglion block – 80 years later. Reg Anesth. 1993;18(5):274–6.PubMedGoogle Scholar
  35. 35.
    Yang I, Oraee S. A novel approach to transnasal sphenopalatine ganglion injection. Pain Physician. 2006;9:131–4.PubMedGoogle Scholar
  36. 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.CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Wake Forest Baptist Medical CenterWinston SalemUSA
  2. 2.Anesthesiology DepartmentOchsner Health SystemNew OrleansUSA

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