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Sphenopalatine Ganglion Block in the Management of Chronic Headaches

  • Anesthetic Techniques in Pain Management (D Wang, Section Editor)
  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

A Correction to this article was published on 20 November 2017

This article has been updated

Abstract

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.

Recent Findings

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.

Summary

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.

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Change history

  • 20 November 2017

    The original version of this article contains an error in an author’s first name. The spelling of Dr. Mojica’s first name should read “Jeffrey” instead of “Jeffery.”

References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Rusu MC, Pop F, Curcă GC, Podoleanu L, Voinea LM. The pterygopalatine ganglion in humans: a morphological study. Annals of Anatomy-Anatomischer Anzeiger. 2009;191(2):196–202.

    Article  CAS  Google Scholar 

  2. Rusu MC, Pop F. The anatomy of the sympathetic pathway through the pterygopalatine fossa in humans. Annals of Anatomy-Anatomischer Anzeiger. 2010;192(1):17–22.

    Article  CAS  Google Scholar 

  3. Moore KL, Dalley AF, Agur AM. Clinically oriented anatomy. Lippincott Williams & Wilkins; 2013.

  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.

  5. Ruskell GL. Distribution of pterygopalatine ganglion efferents to the lacrimal gland in man. Exp Eye Res. 2004;78(3):329–35.

    Article  CAS  PubMed  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.

  7. Tubbs RS, Menendez J, Loukas M, Shoja MM, Shokouhi G, Salter EG, Cohen-Gadol A. The petrosal nerves: anatomy, pathology, and surgical considerations. Clin Anat. 2009;22(5):537–44.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  PubMed Central  Google Scholar 

  9. May A, Goadsby PJ. The trigeminovascular system in humans: pathophysiologic implications for primary headache syndromes of the neural influences on the cerebral circulation. J Cereb Blood Flow Metab. 1999;19(2):115–27.

    Article  CAS  PubMed  Google Scholar 

  10. Goadsby PJ, Edvinsson L. Human in vivo evidence for trigeminovascular activation in cluster headache neuropeptide changes and effects of acute attacks therapies. Brain. 1994;117(3):427–34.

    Article  PubMed  Google Scholar 

  11. Yarnitsky D, Goor-Aryeh I, Bajwa ZH, Ransil BI, Cutrer FM, Sottile A, Burstein R. 2003 Wolff Award: possible parasympathetic contributions to peripheral and central sensitization during migraine. Headache: The Journal of Head and Face Pain. 2003;43(7):704–14.

    Article  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.

  13. Matharu MS, Goadsby PJ. Trigeminal autonomic cephalgias. J Neurol Neurosurg Psychiatry. 2002;72(suppl 2):ii19–26.

    PubMed  PubMed Central  Google Scholar 

  14. May A, Leone M, Afra J, Linde M, Sandor PS, Evers S, Goadsby PJ. EFNS guidelines on the treatment of cluster headache and other trigeminal-autonomic cephalalgias. Eur J Neurol. 2006;13(10):1066–77.

    Article  CAS  PubMed  Google Scholar 

  15. Morelli N, Mancuso M, Felisati G, Lozza P, Maccari A, Cafforio G, Gori S, Murri L, Guidetti D. Does sphenopalatine endoscopic ganglion block have an effect in paroxysmal hemicrania? A case report. Cephalalgia. 2010;30(3):365–7.

    Article  CAS  PubMed  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.

  17. Devoghel JC. Cluster headache and sphenopalatine block. Acta Anaesthesiol Belg. 1980;32(1):101–7.

    Google Scholar 

  18. Barre F. Cocaine as an abortive agent in cluster headache. Headache: The Journal of Head and Face Pain. 1982;22(2):69–73.

    Article  CAS  Google Scholar 

  19. Kittrelle JP, Grouse DS, Seybold ME. Cluster headache: local anesthetic abortive agents. Arch Neurol. 1985;42(5):496–8.

    Article  CAS  PubMed  Google Scholar 

  20. Robbins L. Intranasal lidocaine for cluster headache. Headache: The Journal of Head and Face Pain. 1995;35(2):83–4.

    Article  CAS  Google Scholar 

  21. Costa A, Pucci E, Antonaci F, Sances G, Granella F, Broich G, Nappi G. The effect of intranasal cocaine and lidocaine on nitroglycerin-induced attacks in cluster headache. Cephalalgia. 2000;20(2):85–91.

    Article  CAS  PubMed  Google Scholar 

  22. Sanders M, Zuurmond WW. Efficacy of sphenopalatine ganglion blockade in 66 patients suffering from cluster headache: a 12- to 70-month follow-up evaluation. J Neurosurg. 1997;87(6):876–80.

    Article  CAS  PubMed  Google Scholar 

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

    Article  Google Scholar 

  24. Loomba V, Upadhyay A, Kaveeshvar H. Radiofrequency ablation of the sphenopalatine ganglion using cone beam computed tomography for intractable cluster headache. Pain Physician. 2016;19:E1093–6.

    PubMed  Google Scholar 

  25. Chua NH, Vissers KC, Wilder-Smith OH. Quantitative sensory testing may predict response to sphenopalatine ganglion pulsed radiofrequency treatment in cluster headaches: a case series. Pain practice. 2011;11(5):439–45.

    Article  PubMed  Google Scholar 

  26. Fang L, Jingjing L, Ying S, Lan M, Tao W, Nan J. Computerized tomography-guided sphenopalatine ganglion pulsed radiofrequency treatment in 16 patients with refractory cluster headaches: twelve- to 30-month follow-up evaluations. Cephalalgia. 2016;36(2):106–12.

    Article  PubMed  Google Scholar 

  27. Van Bets B, Raets I, Gypen E, Mestrum R, Heylen R, Van Zundert J. Pulsed radiofrequency treatment of the pterygopalatine (sphenopalatine) ganglion in cluster headache: a 10 year retrospective analysis: 14AP7-5. European Journal of Anaesthesiology (EJA). 2014;31:233.

    Article  Google Scholar 

  28. Bendersky DC, Hem SM, Yampolsky CG. Unsuccessful pulsed radiofrequency of the sphenopalatine ganglion in patients with chronic cluster headache and subsequent successful thermocoagulation. Pain Practice. 2015;15(5):E40–5.

    Article  PubMed  Google Scholar 

  29. Kudrow L, Kudrow DB, Sandweiss JH. Rapid and sustained relief of migraine attacks with intranasal lidocaine: preliminary findings. Headache: The Journal of Head and Face Pain. 1995;35(2):79–82.

    Article  CAS  Google Scholar 

  30. Maizels M, Scott B, Cohen W, Chen W. Intranasal lidocaine for treatment of migraine: a randomized, double-blind, controlled trial. JAMA. 1996;276(4):319–21.

    Article  CAS  PubMed  Google Scholar 

  31. Maizels M, Geiger AM. Intranasal lidocaine for migraine: a randomized trial and open-label follow-up. Headache: The Journal of Head and Face Pain. 1999;39(8):543–51.

    Article  CAS  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.

    Article  Google 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.

  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.

  35. Felisati G, Arnone F, Lozza P, Leone M, Curone M, Bussone G. Sphenopalatine endoscopic ganglion block: a revision of a traditional technique for cluster headache. Laryngoscope. 2006;116(8):1447–50.

    Article  PubMed  Google Scholar 

  36. Higuchi Y, Nashold BS, Sluijter M, Cosman E, Pearlstein RD. Exposure of the dorsal root ganglion in rats to pulsed radiofrequency currents activates dorsal horn lamina I and II neurons. Neurosurgery-Baltimore. 2002;50(4):850–6.

    Article  Google Scholar 

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Authors and Affiliations

  1. Jefferson Pain Center, Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, PA, 19107, USA

    Jeffery Mojica, Bi Mo & Andrew Ng

Authors
  1. Jeffery Mojica
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  2. Bi Mo
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  3. Andrew Ng
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Corresponding author

Correspondence to Andrew Ng.

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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.

Additional information

This article is part of the Topical Collection on Anesthetic Techniques in Pain Management

A correction to this article is available online at https://doi.org/10.1007/s11916-017-0652-6.

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Mojica, J., Mo, B. & Ng, A. Sphenopalatine Ganglion Block in the Management of Chronic Headaches. Curr Pain Headache Rep 21, 27 (2017). https://doi.org/10.1007/s11916-017-0626-8

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  • DOI: https://doi.org/10.1007/s11916-017-0626-8

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