Decreasing Burdens of Migraine: Medical Costs, Economic Losses and Suffering Can Be Reduced With SPG Blocks.

Migraine affects 39 million men, women and children in the US and over 1 billion world-wide.

A treatment that could reduce suffering and prevent lost days of work and massive costs of Emergency visits would be a game changer for patients.

Almost everyone knows of a family member or friend who suffers from migraine or suffer from them personally. Migraine is the 3rd most prevalent illness in the world.

Nearly 1 in 4 U.S. households includes someone with migraine.  This accounts for approximately 12% of the population,  including children who suffer from migraine.  Almost 1 in 5 American women  and 1 in 10 children experience migraines.  Migraine is most commonly affects adults between the ages of 25 and 55.

Migraine is the 6th most disabling illness in the world.  On avcrage approximately every 10 seconds an emergency room occurs for patients with chief complaints of head pain.

At least 4 million people have chronic daily headaches with at least 15 migraine days per month.

More than 90% of sufferers are unable to work or function normally during their migraine. There has been a blurring of diagnosis and the number of headaches currently classified as migraines, atypical migraines and many other types migraines were once  classified as headaches, tension headaches, referred Myofascial pain headaches.

As this has occurred the amount of money spent spent on drugs, medications and emergency room visits has continually increased.  Patients who come in to the ER with a migraine often leave with a migraine.

A new trend in Emergency care is for resistant migraines that don’t respond well to other treatment protocols is to utilize Sphenopalatine Ganglion Blocks which can be extremely effective.  They are an old technique originally described in 1908 by Sluder.

Aliem:  Academic Life in Emergency Medicine  recently published a paper (online) on the use of SPG Blocks for ER patients with migraine.  They reported on the technique and stated;

“In our anecdotal experience with performing SPG blocks in patients presenting to the ED (Emergency Department) with primary headaches, we have found an overwhelminging positive response, with the vast majority of patients reporting significant improvement of their symptoms.

The same month they reported this several Blue Cross policies (Ma, NC and PREMERA) came out with new medical policy which will deny treatment for this 100 year old procedure because it is “Experimental”.  This is the same procedure that was featured in the 1986 book “MIRACLES ON PARK AVENUE” which documented the amazing medical practice of Dr Milton Reder in NYC.  The entire article can be read at

The real advantage to SPG Blocks is that they are relatively easy for patients to learn to self-administer.  Self Administration is a game changer if patients can skip the trip to the hospital and eliminate their headache while staying in the comfort of their home.

Blue Cross is being very short sighted in the decision to not cover SPG Blocks.  Ideally they would not only cover SPG Blocks but insist that all patients be taught to self administer SPG Blocks.  Blue Cross should cover the costs of teaching patients how to self-administer the blocks which could save enormous costs and dramatically improve the quality of life for their patients.  The cost of self-administration after initial expense is about $1.00 per bilateral block.  The cost of an Emergency Room Visit for migraine is between $1800 and $3500 per visit.

Self Administration would result in patients and families have an improved quality of life and less days of work are lost which is an advantage to employers who purchase these health benefits.  A 20 year old study on PubMed discussed the safety and efficacy of Self-Administered SPG Blocks.  The current technique I utilize with patients using transnasal catheters with continuous capillary feed is far more effective from my experience than other techniques.  In those patients which have difficult nasal access a Sphenocath is also effective for home use.

The SPG Block was also shown to be effective in a study in “The Korean Journal of Pain” for Postdural Puncture Headache as an alternative to epidural block patch (EBP)injection into epidural space.  The SPG Block is far less invasive and no risk of accidental misplacement into the CSF in the spinal sack.

There is a great deal of information on this procedure @

There are many patient testimonials on Reddit at:

Dr Shapira practices is Highland Park and Gurnee Illinois.

The Highland Park website:

Gurnee Website:


Reg Anesth. 1996 Jan-Feb;21(1):68-70.

Patient-administered sphenopalatine ganglion block.

Author information

Department of Anesthesiology, University of Florida College of Medicine, Gainesville 32610-0254, USA.



Pain resulting from head and neck cancer can be severe and difficult to manage. Avoiding hospitalization for as long as possible with a reasonable level of comfort requires a number of therapeutic modalities. The usefulness of self-administered sphenopalatine ganglion block was evaluated in a patient with lethal midline granuloma requiring large doses of morphine.


A 30-year-old woman with intractable pain from lethal midline granuloma was taught to self-administer 4% lidocaine, 1.5 mL topically into each nostril three times per day.


A 3-month follow-up examination showed substantial pain relief and reduction in morphine requirement. No adverse side effects or complications developed.


In certain patients, sphenopalatine ganglion block can be effectively self-administered at home to manage chronic pain.



Managing Chronic Migraines with SPG Block (Sphenopalatine Ganglion Block)

Data from Statista:  The Statistics Portal

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