Cluster Headache Relief With Sphenopalatine Ganglion Block. Controlling Chronic Daily Headaches with Neuromuscular Orthotic.

Originally posted on on Sunday, June 10, 2012
Cluster Headache Relief With Sphenopalatine Ganglion Block
A recent article reported on the treatment of cluster headaches with Sphenopalatine Ganglion Blocks. While neuromuscular diagnostic orthotics may relieve or eliminate cluster headaches they may still require treatment on occasion. I frequently teach my patients how to self administer the blocks intranasally with cotton tip applicators. The PubMed abstract is at the end of the blog. J Med Case Rep. 2012 Feb 15;6:64:e23-27 Cluster headache with ptosis responsive to intranasal lidocaine application: a case report.

Dr Shapira practices in Highland Park, Il 60035

Another recent article discussed use of sphenopalatine ganglion blocks when doing sinus endoscopic surgery and showed a 50% reduction in time in recovery. What the paper did not mention was that frequently chronic sinus pressure, pain and/or headaches can be treated or eliminated with SPG (sphenoalatine ganglion) Blocks without surgery. J Med Case Rep. 2012 Feb 15;6: Cluster headache with ptosis responsive to intranasal lidocaine application: a case report.

Neuromuscular Dentistry as part of a comprehensive treatment of TMJ (TMD) disorder treatment is extremely effective in eliminating chronic daily migraine and tension headaches and chronic sinus and facial pain. It frequently eliminates or r lessens the frequency of episodic pain. SPG blocks are an easily self administered technique that patients accept and that has a very high margin of safety.

J Med Case Rep. 2012 Feb 15;6:64.
Cluster headache with ptosis responsive to intranasal lidocaine application: a case report.

Bakbak B, Gedik S, Koktekir BE, Okka M.

Department of Ophthalmology, Selcuk University Selcuklu Medical Faculty, Konya, Turkey. [email protected].


The application of lidocaine to the nasal mucosal area corresponding to the sphenopalatine fossa has been shown to be effective at extinguishing pain attacks in patients with a cluster headache. In this report, the effectiveness of local administration of lidocaine on cluster headache attacks as a symptomatic treatment of this disorder is discussed. CASES

A 22-year-old Turkish man presented with a five-year history of severe, repeated, unilateral periorbital pain and headache, diagnosed as a typical cluster headache. He suffered from rhinorrhea, lacrimation and ptosis during headaches. He had tried several unsuccessful daily medications. We applied a cotton tip with lidocaine hydrochloride into his left nostril for 10 minutes. The ptosis responded to the treatment and the intensity of his headache decreased.

Intranasal lidocaine is a useful treatment for the acute management of a cluster headache. Intranasal lidocaine blocks the neural transmission of the sphenopalatine ganglion, which contributes to the trigeminal nerve as well as containing both parasympathetic and sympathetic fibers.

Am J Rhinol Allergy. 2012 Jan-Feb;26(1):e23-7.
Bilateral sphenopalatine ganglion blockade improves postoperative analgesia after endoscopic sinus surgery.
DeMaria S Jr, Govindaraj S, Chinosorvatana N, Kang S, Levine AI.

Department of Anesthesiology, The Mount Sinai Medical Center, One Gustave L. Levy Place, New York, NY 10029, USA. [email protected]

Endoscopic sinus surgery (ESS) is a common procedure preferably done with an anesthetic technique ensuring effective postoperative analgesia while speeding discharge home. Although anesthesia administered locally in conjunction with vasoconstricting agents is known to minimize intraoperative bleeding, its usefulness in providing postoperative analgesia has not been well characterized. The results supporting the use of regional anesthesia for sinus surgery have also been limited. Using a randomized, double-blinded and placebo-controlled design, we evaluated recovery times, opioid consumption, and nausea and vomiting after ESS when patients were randomized to either general anesthesia (GA) alone or with regional blockade.

Subjects were 70 adults scheduled for sinus surgery. All participants underwent propofol/remifentanil/nitrous oxide anesthesia and similar intraoperative care. Patients received either GA alone or with sphenopalatine ganglion (SPG) blocks in a double-masked study design. Independent observers recorded readiness for discharge, incidence of nausea/vomiting, and pain scores every 15 minutes until discharge. Overall opioid use in the recovery area was also a secondary end point. Twenty-four hours later, patients were called and asked to rate their pain and overall satisfaction with their pain control.

Block group participants were considered ready for discharge after 45 minutes and discharged from the hospital ∼40 minutes sooner than GA group participants. The block group required less total fentanyl in the recovery room than did the GA group. The incidences of nausea and vomiting did not differ significantly. Data at 24 hours postoperatively did not differ significantly between groups but trended toward increased satisfaction in the block group. No lasting adverse events were observed.

Regional anesthesia using targeted nerve blocks is effective in ESS. The combination of GA and SPG blockade appears to shorten hospital stay and reduce narcotic requirements in the recovery area. No demonstrable benefits were observed after 24 hours regarding pain management.