Have you ever had a Migraine attack that continued for weeks or months with no relief? One available option to break a stubborn cycle of pain may be a nerve block of the sphenopalatine ganglion (SPG).
What is the SPG?
According to the American Migraine Foundation3, the sphenopalatine ganglion (SPG) is a cluster of nerve fibers located inside the skull, behind the nose. It is responsible for the autonomic (involuntary) reflexes that cause nasal congestion and discharge, plus tearing of the eyes. It also has connections to the trigeminal nerve and brain stem, which are both involved in the Migraine attack process.
Numbing the SPG with a local anesthetic has been shown to reduce head and facial pain. In the past, doctors had two options for SPG blocks. Neither was particularly pleasant and both had big disadvantages3.
Long cotton-tipped swabs placed inside each nostril took time to absorb, leaving a patient lying down for at least 30 minutes.
Injection by needle through the cheek required x-ray guidance. There was often pain from the injection site. Patients had to lie very still, too.
In recent years, improved delivery methods have spawned a renewed interest in SPG blocks as treatment option for intractable Migraine attacks. A November 15, 2016 article from the American Migraine Foundation explains how these newer options work. Using a thin catheter guided through the nostril, medication can be applied precisely within seconds. While it may still not feel pleasant to have medication delivered through the nose, these newer options offer a more comfortable solution2.
Sphenocath is a sterile, semi-rigid device that is place inside the nostril until it reaches the nasal bone. A thin catheter is then advanced further into the nasal cavity where a local anesthetic is delivered via the attached syringe. Patients must lie flat for the procedure and remain still for five to ten minutes afterward. A similar device, Allevio, is also available.
Tx360 is a sterile plastic device that is placed just inside the nostril. The device contains a thin catheter that is slowly advanced into the nasal cavity. Once the catheter is in place, a local anesthetic is delivered via the attached syringe. Patients may remain seated for the procedure with no need to remain still post-treatment.
What to expect2
- SPG blocks can be done at an office visit.
- Your doctor may recommend pre-treatment with a nasal decongestant.
- Pre-treatment anesthetic nasal spray may also be used.
- Depending on the applicator used, you may be asked to lie down or remain seated.
- Application takes just a few seconds per nostril.
- You may feel numbness in throat or experience a metallic taste after the procedure.
- Pain reduction may occur within minute or hours
SPG blocks are safe enough to be repeated as often as needed for acute treatment. Long-term benefit is still uncertain. A March 2015 study1 in Headache concluded that repeated use of the Tx360 for chronic Migraine may result in long-term reduction of attack frequency. Treatments were administered twice weekly for six weeks. Follow-up appointments at one and six months demonstrated a reduction in Migraine attack frequency and subsequent reduction in acute medication use. More studies are needed to determine the long-term benefit of all SPG block application methods.
Are SPG blocks right for you?
SPG blocks may be an option for the acute treatment of Migraine when other interventions fail. More studies are needed to determine if it can be successful as a preventive. If you have intractable Migraine, check with your doctor about adding SPG blocks to your treatment plan.
See more helpful articles:
1Cady, R., Saper, J., Dexter, K., et al. (2015), Long-Term Efficacy of a Double-Blind, Placebo-Controlled, Randomized Study for Repetitive Sphenopalatine Blockade With Bupivacaine vs Saline With the Tx360® Device for Treatment of Chronic Migraine. Headache: The Journal of Head and Face Pain, 55: 529–542. doi:10.1111/head.12546
2Charleston, L, MD and Halker, R, MD. (2016, September 4). Sphenopalatine Ganglion Blocks in Headache Disorders. Retrieved August 09, 2017, from https://americanmigrainefoundation.org/understanding-migraine/sphenopalatine-ganglion-blocks-in-headache-disorders/
3Jion, Y, MD and Robbins, M, MD. (2016, November 15). The Sphenopalatine Ganglion (SPG) and Headache. Retrieved August 09, 2017, from https://americanmigrainefoundation.org/understanding-migraine/the-sphenopalatine-ganglion-spg-and-headache/
Headache disorders counselor and advocate Tammy Rome maintains a private practice specializing in treating clients with Migraine and other headache disorders. She also volunteers as vice chair of the American Headache and Migraine Association and as president of The Cluster Headache Support Group. You can read more of Tammy’s work on her website and follow her on Facebook, Twitter, StumbleUpon, Pinterest, LinkedIn, and Google+.