Reprinted from “I Hate Headaches website” http://wwwihateheadaches.org
Authored by: Ira L Shapira DDS, D,ABDSM, D,AACFP, D,ABIPM
A new 2021 three-year retrospective study of the use of Sphenopalatine Ganglion Blocks (SPG Blocks) showed that this minimally invasive procedure had excellent results in a pediatric migraine population. (abstract below)
The Sphenopalatine Ganglion (SPG) also supplies innervation to the Pineal Gland and may help control Circadian Rhythm. Abnormal Circadian Rythym are often seen in chronic headache and migraine patients. Acccording to an article in Stat Pearls(May 4, 2020) the SPG supplies the Parasympathetic innervation while the Sympathetic innervation is from the Superior Sympathetic Ganglion. It is well established that post-ganglionic fibers from the Stellate Ganglion to the Superior Cervical Sympathetic Ganglion travel thru the Sphenopalatine Ganglion. SPG Blocks may be a way to correct Circadian Rhythym issues in headache patients in addition to treating pain. According to the article “The epiphysis cerebri is supplied by the adrenergic nerves. The neurons are sensitive to epinephrine. The sympathetic innervation is from the superior cervical ganglion while the parasympathetic innervation is from the optic and pterygopalatine ganglia. The pineal stalk of the gland also has nerve fibers along with innervation from neurons from the trigeminal ganglion. The neurons from the trigeminal ganglion have nerve fibers that contain the PACAP which is a neuropeptide.” The Pterygopalatine Ganglion is another name for the Sphenopalatine Ganglion. The Trigeminal nerve involvement is expected as the sympathetic and parasympathetic fibers are carried along the Trigeminal nerves. Link to article https://www.ncbi.nlm.nih.gov/books/NBK525955/#article-27230.s8
This study included 489 patients 6-26 years of age diagnosed with migraine or status migrainous which can be devastating to pediatric patients. This study utilized 4% lidocaine delivered by a Sphenocath device. Excellent news for parents of children suffering from migraines but prevention of these issues is also extremely important and possible. (see below)
Self-Administered SPG Blocks or SASPGB are an excellent approach to older children and adults allowing them to turn off and prevent their migraines by self-administered lidocaine via a cotton-tipped catheter. This study was not designed to teach self-care but rather to see a historical view of how SPG blocks worked in a clinical environment.
The results were truly impressive! “With 100% technical success, statistically significant pain reduction, and no complications, we support SPG block in the pediatric population as a simple, efficacious, and safe treatment option for refractory headaches. It is routinely performed in less than 10 minutes and commonly negates the need for inpatient headache pain management. Given its minimal invasivity, we support the use of SPG blockade as a therapeutic treatment in refractory pediatric migraines as it reduces the need for intravenous medications, prolonged pain control, or hospital admission.”
According to the introduction “Persistent headaches and migraines are common in the pediatric population, occurring in 3% to 8% of 3-year-old children, increasing to 57% to 82% in 8- to 15-year-olds. The prevalence in boys is higher than in girls pre-puberty, but the trend reverses post puberty. With headaches being the most common cause of pain in pediatrics, chronic pain has been shown to decrease quality of life through decreased participation in school and social activities. Preventive approaches should always be considered when young children are having this type of issue.
A decreased quality of life in children is unacceptable and a lifetime of issues is a significant failure of pediatric medicine. Sphenopalatine Ganglion Blocks have been safely used for a wide variety of disorders since 1908 when first described by Dr Greenfield Sluder, an Otorhinolaryngologist who wrote 2 medical textbooks on the subject while Chair of the Otolaryngology Department at Washington University School of Medicine.
It is incredibly important to understand that almost 100% of headaches and migraines are Trigeminal nerve related in nature. The trigeminal nervous system accounts for about 50% of all input to the brain after amplification in the Reticular Activating System of the brain.
Having a method to treat Pediatric Migraine safely and quickly with Sphenopalatine Ganglion Blocks is enormous. The Sphenopalatine Ganglion lies in the Pterygopalatine Fossa along with the Maxillary Division of the Trigeminal Nerve. The SPG is the largest of the four Parasympathetic Ganglions of the head. In addition to Parasymmpathetic fibers the Ganglion also has post-synaptic Sympathetic Fibers that travel up from the Stellate Ganglion and entire Cervical Sympathetic Chain through the Superior Cervical Ganglion and Somatosensory nerves of the Trigeminal nervous system.
The Trigeminal Nerve also called “The Dentist Nerve” goes to the jaws, the jaw joints or TMJoints (TMJ), the teeth, the gums, the periodontal ligaments, the lining of the nose and sinuses, the anterior 2/3 of the tongue and controls blood flow to the anterior 2/3 of the meninges of the brain. It also supplies the muscles of the mouth used for talking and eating, as well as control to the veli tensor tympani muscle that goes to the ear drum and the veli tensor palatine muscle that opens and closes the eustacian tubes.
Treatment of pediatric migraines is critically important to quality of life however it is often possible to actually cure or prevent these problems in a great percentage of children by correcting an underlying growth problem that has been occurring for the last 400+ years. This problem is discussed in a recent article from Stanford.
JULY 21, 2020
A hidden epidemic of shrinking jaws is behind many orthodontic and health issues, Stanford researchers say
“The shrinking of the human jaw in modern humans is not due to genetics but is a lifestyle disease that can be proactively addressed”, according to Stanford researchers.
These are often called Epigenetic Changes or changes due to all aspects of developing in the modern world.
Full article: https://news.stanford.edu/2020/07/21/toll-shrinking-jaws-human-health/
Chicagoland parents are blessed to have one of the world’s leading experts on early diagnosis of pediatric airway in Chicago, Dr Kevin Boyd. I treat teens and adults with Trigeminal nerve related headaches and migraines that often present with TMJ Disorders (TMD) and Sleep Disordered Breathing in my office in Highland Park, Illinois. www.Thinkbetterlife.com
Dr Kevin Boyd a pediatric dentist is actually correcting these growth disorders in children as young as three. This can prevent a lifetime of issues including headaches and migraines, ADD, ADHD, Learning Disabilities, behavioral disorders and more. Typical orthodontic treatment provided by orthodontists is too little / too late to prevent changes in how the brain and airway develops.
According to Dr David Gozal’s work at the University of Chicago the cut off age to return to normal growth is 8 years old. Correction allowing for optimal brain growth often begin with release of tongue ties at birth to promote proper development and improve quality of breastfeeding experiences for both infants and their mothers. The field or Oral Myofunctional Therapy or Oral Myology trains children and adults to correct harmful oral habits and idealize growth and development of infants and young children.
It is possible to grow larger healthier airways in older teens and adults by use of Epigenetic Orthopedics and the DNA and MRNA Appliance which I have utilized for the past 10+ years but early intervention and prevention is always the best approach! I refer the children of my patients with TMJ disorders, Headaches, Migraines and Sleep Apnea and Snoring to Dr Kevin Boyd for early intervention which can forever change these young lives.
Sphenopalatine Ganglion Blocks and Neuromuscular Dentistry are routinely used in adults with chronic headaches, migraines and TMJ disorders. There are over 200 of my patient testimonial videos at: https://www.youtube.com/channel/UCk9Bfz6pklC7_UluWFHzLrg/videos
A 1998 study by Shimshak showed patients with TMJ disorders had a 300% increase in utilization of medical insurance in all fields of medicine except obstetrics. A paper on the subject of Sphenopalatine Ganglion Blocks and Neuromuscular Dentistry can be found at:
Neuromuscular dentistry and the role of the autonomic nervous system: Sphenopalatine ganglion blocks and neuromodulation. An International College of Cranio Mandibular Orthopedics (ICCMO) position paper
Sphenopalatine Ganglion Nerve Block for the Treatment of Migraine Headaches in the Pediatric Population
Mohammad A Mousa 1, David J Aria 2, Abeer A Mousa 1, Carrie M Schaefer 2, M Hamed H Temkit 3, Richard B Towbin 2
Background: Persistent headaches and migraines are common in pediatrics with various treatment options. The sphenopalatine ganglion (SPG) has been identified as communicating with the parasympathetic autonomic nervous system and pain receptors. In adults, SPG block is an established treatment but there is no published literature in pediatrics.
Objectives: The purpose of this study is to analyze the SPG block in pediatrics.
Study design: Retrospective, single-center study.
Setting: This study was conducted at Phoenix Children’s Hospital in Phoenix, Arizona.
Methods: A comprehensive review of patient charts from 2015-2018 of all pediatric SPG blockades performed by interventional radiology were included in the analysis. Utilizing fluoroscopic guidance, a SphenoCath was inserted into each nostril and after confirming position, and 4% lidocaine injected. Pre- and postprocedural pain was assessed using the Visual Analog Scale (VAS). Immediate and acute complications were documented.
Results: A total of 489 SPG blocks were performed in patients between ages 6 and 26 years who were diagnosed with migraine or status migrainosus. One hundred percent technical success was achieved with mean reduction of pain scores of 2.4, which was statistically significant (P < 0.0001). There were no immediate or acute complications.
Limitations: Results of this study were based on retrospective study. The use of VAS may be subjective, and the need of a prospective study may be necessary.
Conclusions: With 100% technical success, statistically significant pain reduction, and no complications, we support SPG block in the pediatric population as a simple, efficacious, and safe treatment option for refractory headaches. It is routinely performed in less than 10 minutes and commonly negates the need for inpatient headache pain management. Given its minimal invasivity, we support the use of SPG blockade as a therapeutic treatment in refractory pediatric migraines as it reduces the need for intravenous medications, prolonged pain control, or hospital admission.
References from the article:
Kristjansdottir G, Wahlberg V. Sociodemographic differences in the prevalence of self-reported headache in Icelandic school-children. Headache 1993; 33:376-380.
2. Sillanpää M. Prevalence of headache in prepuberty. Headache 1983; 23:10-14.
3. Abu-Arafeh I, Razak S, Sivaraman B, et al. Prevalence of headache and migraine in children and adolescents: A systematic review of population-based studies. Dev Med Child Neurol 2010; 52:1088-1097.
4. Gold JI, Mahrer NE, Yee J, et al. Pain, fatigue and health-related quality of life in children and adolescents with chronic pain. Clin J Pain 2009; 25:407-412.
5. Binfalah M, Alghawi E, Shosha E, Alhilly A, Bakhiet M. Sphenopalatine ganglion block for the treatment of acute migraine headache. Pain Res Treat 2018; 2018:2516953.
6. Cohen S, Levin D, Mellender S, et al. Topical sphenopalatine ganglion block compared with epidural blood patch for postdural puncture headache management in postpartum patients: A retrospective review. Reg Anesth Pain Med 2018; 43:880-884.
7. Lee SH, Kim Y, Lim TY. Efficacy of sphenopalatine ganglion block in nasal mucosal headache presenting as facial pain. Cranio 2020; 38:128-130.
8. Dance L, Aria D, Schaefer C, Kaye R, Yonker M, Towbin, R. Safety and efficacy of sphenopalatine ganglion blockade in children: Initial experience. J Vasc Interv Radiol 2017; 28:2(Supplement S8)? R