Re-Emerging Therapy in Headache Management: Efficacy of Transnasal Sphenopalatine Ganglion

Background and Purpose: According to the Global Burden of Disease Study 2017, headache disorders are the second highest cause of disability worldwide in all patient ages and the number one cause of disability in patients under age 50. The 2017 results reflect no improvement in headache disability trends since 1990 when the first study was conducted making headache disorders the most common and disabling condition globally. The purpose of this article is to update providers on the phenomenology underlying headache disorders and discuss one treatment modality with high efficacy rates and minimal safety concerns or side effects. Description and Methodology: PubMed, MEDLINE, and Cochrane databases were accessed through EBSCOHost. A literature search was conducted using the Boolean operator “AND” to combine the search terms sphenopalatine ganglion block, headache, and migraine. The articles were reviewed for relevancy. Articles were excluded if the sphenopalatine ganglion block was not administered through the transnasal approach. Nineteen articles were included in the final selection and serve as the basis for this clinical review. Procedure A cotton-tipped swab is soaked in either 2% or 4% lidocaine and inserted parallel to the bridge of the nose while the patient is lying supine. The applicator is inserted until resistance is felt and the tip is touching the superior aspect of the upper middle turbinate. The cotton tip can be further saturated with lidocaine by dripping medication down the hollow tube or along the length of the swab. The patient should remain in the supine position for 10-15 minutes to allow the medication to be absorbed through the mucosa into the area of the sphenopalatine ganglion. Results: Sphenopalatine ganglion (SPG) blocks have a high efficacy rate for acute and intractable migraine headaches, cluster headaches, tension headaches, trigeminal neuralgia, postdural puncture headaches, and headaches caused from head and neck cancer. Conclusions: SPG blockade is an effective, safe treatment for headaches from multiple etiologies. Administration is easy, noninvasive and has limited side effects or contraindications. Further research is needed to determine the efficacy of SPG block in comprehensive pain management protocols for headache disorders. Keywords: Sphenopalatine ganglion block, headache, migraine