Sphenopalatine Ganglion Block

Sphenopalatine Ganglion Blockade- an exciting new device for performing an once complicated procedure.

New hope for facial pain and migraine headache patients

Recent research has highlighted the important role of the sphenopalatine
ganglion (SPG) in cerebrovascular autonomic physiology and in the pathophysiology of cluster and migraine headaches . The relatively accessible location of the SPG within the pterygopalatine fossa and the development of a new device(sphenocath.com) for minimally invasive approaches to the SPG make it an attractive target for anesthetic neuromodulation approaches. The obvious advantage of SPG anesthetic modulation when compared to ablative procedures on the SPG such as radiofrequency destruction and stereotactic radiosurgery is its reversibility and adjustable features.

The postsynaptic fibers of the pterygopalatine or sphenopalatine ganglion (PPG or SPG) supply the lacrimal and nasal glands. The PPG appears to play an important role in various pain syndromes including migraine and other types of headaches, trigeminal and sphenopalatine neuralgia, atypical facial pain, muscle pain, vasomotor rhinitis, eye disorders, and post herpetic neuralgia. Clinical trials have shown that these pain disorders can be managed effectively with sphenopalatine ganglion blockade (SPGB). In addition, regional anesthesia of the distribution area of the SPG sensory fibers for nasal and dental surgery can be provided by SPGB via a transnasal, transoral, or lateral infratemporal approach.

The patient testimonial below is fairly typical of the results seen in my practice.

The SPG Block has given me incredible relief from migraine pain, when no other meds have worked.  Generally, there has been a 2 week period between each treatment, but a little more when I changed sides of face.  Here’s my story:

“My History:  3 year plus history of migraines not resolved after medication treatment and had side effects from many medications that were tried.  Normal MRI and sinus xrays.  Started with extreme sensitivity and pain in left central incisor without any dental-related problems.  Pain then radiated to left eye with increased sensitivity to light, including florescent light, sound, and smell.  First symptom of migraine was usually nasal congestion and stuffiness.

First (left side) SPGB Procedure:  Very little pain during procedure.  Post-op, I looked at the flourescent light, and didn’t feel the pain.  It was amazing!  I told the nurse, and she said, “That’s good.”  I had hope for the first time that the pain will be more manageable.   
In the days following the procedure, I noticed the swelling in the left side of my face was substantially reduced, and my nasal stuffiness was gone.  The back side of my left jaw felt strange, like the knot that was back there pushing on my jaw was going away.  Having that pressure and pain relieved really felt wonderful!  The sensitivity to light in the left eye was also reduced.  I was extremely pleased with the results because I had less chronic pain and less major migraine episodes. 
 
Other people started noticing that I was acting differently.  They said I talked and looked different.  I realized then how much being in chronic pain changed my personality, besides every other aspect of my life.  And that was just after the FIRST procedure!!!
 
Second (left side) SPGB Procedure:  Before this procedure, My Doctor asked me about how I was feeling since the first one.  I told him I had one word for him — “life-changing”.  He was very happy to hear that.  Similar complete pain relief immediately following the procedure, and increased permanent effects.  Feeling more like normal (my old, pre-migraine normal), but still having pain on the right side of my face that has not been treated and in a new area, the top of my head.  This reminded me that I needed to be in for the long haul, to get all of the areas treated, to be patient, to follow through with the entire course of treatment.
 
Third (left side) SPGB Procedure:  Before this procedure, my Doctor asked me about how I was feeling since the second one.  I told him I couldn’t find a better word for him than the last time – ”life-changing”.  He was very pleased.  By this point, I’m familiar with staff and the procedure.  Even so, I was excited about the results.  I am having very little pain in the left side of the face that was treated, and I hope to continue to get all areas treated.”

Treatment Information

What is a sphenopalatine ganglion block?

A sphenopalatine ganglion block is located in the pterygopalatine fossa, which is located behind the nasal passages. The sphenopalatine ganglion block is the application of a local anesthetic onto the ganglion.

Why would a sphenopalatine ganglion block be performed?

A sphenopalatine ganglion block may be performed if you are experiencing pain as a result of an acute or chronic migraine headache, acute cluster headache, and a variety of facial neuralgias including Sluder’s, Vail’s and Gardner’s syndrome.

What are reasons NOT to do a sphenopalatine ganglion block?

A sphenopalatine ganglion block will NOT be performed if you have an active infection particularly involving the upper respiratory tract, fever, bleeding problems, allergy to the local anesthetic, and/or pregnancy.

What are the preparations for the procedure?

You must have someone of age to drive you home following your procedure. Otherwise, no special preparations are required before a sphenopalatine ganglion block is performed.

What are possible complications from the procedure?

There are few minor risks and potential complications of the procedure. Complications that can occur include but not limited to local anesthetic toxicity, orthostatic hypotension, nosebleed, infection, numbness of the hard palate, numbness of the teeth and reaction to the local anesthetic. Complications are actually very rare and the procedure is very safe. Performed with the Sphenocath device(sphenocath.com) the procedure is essentially painless and more consistently effective than with older techniques. 

What will occur during the sphenopalatine ganglion block?

First, an informed consent paper, (giving permission for the procedure), must be signed by the patient. Then the patient is placed on the bed lying on your back. The inside of your nose will be inspected first. Dr Goltra will then insert a small , soft and flexible plastic catheter(sphenocath) which has been designed for this purpose, into the back of your nasal cavity. A very brief xray picture is taken to confirm position and then the local anesthetic medication, ( usually lidocaine 4%, 2ml ) is injected into the back of the nasal cavity. Sometimes steroids are added to the lidocaine and sometimes a longer acting anesthetic is used. The procedure is then repeated on the other side.

How long is the procedure?

Usually this procedure takes approximately 5 minutes to complete.

What happens after the procedure?

After the procedure is completed, you will lay quietly in that position for about 10-15 minutes. You will be observed for the effectiveness of the block. Then you may come to a sitting position. Then you may come to standing position once you are ready. Remember, you may experience numbness or a bitter taste in the back of the throat and light-headedness.

Do I need to have the procedure repeated?

There are protocols for treatment which involve repeat injections. The frequency of the injection will be determined by your individual circumstances.