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Have you heard of the sphenopalatine ganglion block? It is often a forgotten, yet effective treatment for migraine. In fact, the sphenopalatine ganglion block (SPG block) is used to treat migraine, cluster headaches, facial pain syndromes, and other facial neuralgias. 
The sphenopalatine ganglion is a group of nerve cells located deep in the face behind the nose. The SPG is associated with the trigeminal nerve, which is the main nerve involved in headache disorders. Blocking these nerves is effective in reducing frequency and severity of cluster and migraine headaches.
You have probably heard us discuss other procedures to treat and manage migraine disease, such as occipital nerve blocks and Botox. The SPG block is emerging as an effective and safe option for management of acute migraine attacks. 
While Migraine Strong writes about the latest in migraine treatments, this is not medical advice. We are patient educators and all information you read should be discussed with your doctor.
What Is the SPG Block?
The SPG block is a short and simple procedure during which an anesthetic is administered to the collection of nerves in the ganglion to block the pain. SPG nerve blocks are most successful when done as part of a comprehensive headache treatment plan. 
To assess SPG block device use for the treatment of primary headache disorders among headache specialists, Jessica Ailani, MD, and colleagues conducted a survey of American Headache Society members and published their results in Neurology Clinical Practice. The most commonly treated headache disorder with sphenopalatine ganglion blocks was chronic migraine, which was also rated as the most likely type to respond to this treatment. 
Three Methods of SPG Blocks
The least invasive way to access the SPG is through the nose (a transnasal approach).  However, here are the three approaches for the SPG blocks:
- Transnasal Approach – There are three available devices, approved by the FDA, which allow this procedure to be completed in a few minutes.   These devices are: SphenoCath, Allevio, and Tx360. Generally during the SPG block, a physician inserts a thin plastic tube, a catheter, into the nose, one nostril at a time. He injects an anesthetic to numb the SPG and the area around it through an attached syringe. Even once the numbness wears off, the patient should still experience relief for some time.
- Transoral Approach – this approach is performed by dentists. SPG is reached by passing a needle through the mouth. This approach can be very painful and is technically difficult. It is more unpredictable in terms of making sure the anesthetic reaches the ganglion. The side effects include orbital hematoma or infection.  
- Lateral Infratemporal Approach – The clinician uses fluoroscopy to direct a needle through a fissure in the skull where an anesthetic is delivered. This technique allows for the anesthetic to be delivered precisely. A rare side effect is infection. 
Transnasal SPG Block
Transnasal sphenopalatine ganglion block is emerging as is an attractive and effective treatment modality for acute migraine headaches, cluster headache, trigeminal neuralgia, and several other conditions.  Accordingly, a study done on a transnasal SPG block, using the Sphenocath device, showed that it was an effective and safe treatment for acute migraine headaches. 
The Day of the Procedure
On the day of the procedure you should be able to travel to the office and drive yourself home afterwards. You will not need to be sedated for this procedure. The SPG block procedure is often done in an exam room by your physician. You may ask your physician if you can use a decongestant prior to the procedure to help reduce irritation in the nose.
The SPG Block Procedure
The physician usually administers a nasal numbing spray to reduce discomfort during catheter placement. The applicator is then placed in a nostril and the catheter is advanced to the back of the nasal cavity. After the anesthetic is pushed through the syringe, the catheter is removed. The procedure is repeated in the other nostril. The entire procedure takes just minutes.
No matter the device used, during the procedure you may feel mild pressure, like you have to sneeze, a brief mild discomfort or irritation like “something is in my nose.” 
Here is a video of Dr. Michael Teixedo demonstrating sphenopalatine ganglion block procedure.
After The Procedure
Patients usually experience instant relief; or relief within 15 minutes to a few hours. Relief typically lasts for a period of time. 
Common side effects include discomfort during and after the procedure, numbness while swallowing, a bitter taste from the anesthesia, bleeding from the nose and lightheadedness. These effects are temporary and will resolve in a few hours or less. 
How Often Can the SPG Block Be Administered?
SPG block can be repeated as often as needed to reduce pain. One study on one of the devices reports reduced frequency and severity of chronic migraine pain over a six month period if the procedure was done twice a week for six weeks (a total of 12 procedures). 
SPG Block For Status Migrainosus
Status migrainosus (SM) is a debilitating migraine attack which lasts more than 72 hours in migraine patients. Typically, these attacks fail to respond to over the counter and prescription medications.
An SPG block using a suprazygomatic injection approach was determined to be a safe and effective option to abort or alleviate pain and autonomic symptoms in status migrainosus patients.  The suprazygomatic injections are done into the zygomatic arch area which is located above the cheekbone.
Is the SPG Block Right For You?
The sphenopalatine ganglion block may be an effective option for you when other interventions fail. If you suffer from chronic migraine check with your doctor about adding SPG block to your treatment plan.
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