Treating Anxiety / Headache and TMJ Disorders Associated with COVID 19 with Self-Administered Sphenopalatine Ganglion Blocks (SASPGB).
We are living in a period of very high stress and anxiety due to the Corona virus outbreak. Unfortunately, there is excellent research that chronic levels of stress and anxiety and associated sleep disruptions tend to decrease our immune responses.
Sphenopalatine Ganglion (SPG) Blocks are excellent for treating many types of pain including Chronic Headaches, Sinus Pain, Migraine and TMJ Disorders. SPG Blocks can also eliminate about 1/3 of Essential Hypertension that is secondary to Sympathetic Overload. They can also be extremely helpful with stressed induced insomnia, both sleep onset insomnia and sleep maintenance insomnia.
Many medical mental health specialists expect that we will see widespread Post Traumatic Stress Disorder (PTSD) problems secondary to this epidemic, both from the general public as especially from members of our healthcare community. Please see 3/12/2021 update of a clinical study currently underway: ‘The Effect of Ganglion Sphenopalatine Block (SPG-block) Versus Placebo on Persistent Headache Following COVID-19 Infection: a Randomised, Blinded, Clinical Trial” The clinical study page is included at the bottom of this article!
Chronic anxiety will also affect many when this crisis is over. This is a disease / condition of Sympathetic Overload (SO).
The use of Self-Administered Sphenopalatine Ganglion Blocks (SASPGB) are ideal for dealing with this type of stress, anxiety and PTSD disorders. The concept of Self-Care and active patient participation is well known to increase medical outcomes. Self-Administered Sphenopalatine Ganglion Blocks are a perfect adjunct for self care.
SASPGB are done with 2% lidocaine which has natural anti-inflammatory properties. There are other anesthetics that can be utilized but Lidocaine has multiple advantages especially safety and minimal toxicity.. Longer acting anesthetics are appealing if patients must go to the physician or Emergency Department but are not needed when utilizing self administration.
More importantly is that Self-Administered SPG Blocks (SASPGB) take effect almost immediately with virtually no negative side effects. Like all treatments different individuals will have unique responses. There are two available commercial products for doing SPG Blocks, the Sphenocath and the TX 360 and both are modified “squirt guns” for depositing anesthetic over the mucosa covering the medial wall of the pterygoid fossa behind which is the SP Ganglion. Swabs dipped in anesthetic are sometimes utilized but I personally utilize the Cotton Tipped Sterile Nasal Catheters the give continual capillary feed of anesthetic for greatly improved efficacy, convenience and cost effectiveness.
Some individuals respond almost instantly and seemingly magically to their first Trans-Nasal SPG Block (TNSPGB) while others respond best to a series of blocks.
Injection therapy is frequently utilized for severe patients who do not respond initially to a trans-nasal SPG Block. The Chronic Daily Headache and Status Migraine or continuous Migraine patient often respond fastest initially to an injection which can be done intra-orally through the Greater Palatine Foramen or extra-orally by the Supra-Zygomatic approach through the Pterygopalatine Fissure. This is the most direct approach to the Pterygopalatine fossa where the Sphenopalatine Ganglion resides on at the Maxillary Division of the Trigeminal Nerve.
The Sphenopalatine Ganglion Block has been called “The Miracle Block” and has over a hundred year history of safety and efficacy. Originally described by Greenfield Sluder MD in 1908 it faded in use as the pharmaceutical industry created quick cure drugs for almost every ailment. It may have been lost until the book “MIRACLES ON PARK AVENUE” was published in 1986. That book started the revival of the miracle block.
The Sphenopalatine Ganglion is the largest Parasympathetic Ganglion of the cranium . The SPG also has Somatosensory nerves and carries sympathetic nerves from the Cervical Sympathetic Chain. The Stellate Ganglion (SG) is at the bottom of this chain. The Stellate Ganglion Block (SGB) has been called the Miracle Block as well and in some veterans one block to the Ganglion can cure PTSD. This is under study by the military. The Stellate Ganglion Block (SGB) will have a significant place in psychological treatments but is usually administered for Complex Regional Pain Syndromes (CRPS) also called Reflex Sympathetic Dystrophy(RSD) or Causalgia. The SPG Block will serve as an Indirect Stellate Ganglion Block (ISGB)
The Sympathetic response is known to cause many medical issues related to chronic stress. The “Fight or Flight” reflex is a powerful reflex to insure safety or survival of an individual. If you run into Grizzly bear you get ready to run like crazy or fight for your life. While important for survival in Acute stress dangerous conditions the ongoing Sympathetic overload causes multiple diseases and dysfunction including headaches, migraines and anxiety.
The Parasympathetic Reflex is the “Feed and Breed” reflex or “Rest and Digest” reflex. The Parasympathetic reflex is primary in Romantic Love. It comes out when we play with puppies, kittens or babies and is a natural anti-anxiety response.
Patients suffering from Trigeminal Neuralgia (TN) often get the most lasting relief by utilizing a combination of injections initially followed by Self Administered SPG Blocks.
Recently I have worked with a Dynatronics iontophoresis unit to utilize iontophoresis to increase the effect of Self-Administered SPG Blocks.
Nomenclature is important and I suggest that the following will be extremely helpful in dealing with Covid 19 Stress Disorders (CV19SD)
SPG= Sphenopalatine Ganglion
SPGB= Sphenopalatine Ganglion Block
SASGPB = Self-Administered Sphenopalatine Ganglion Block
SG = Stellate Ganglion
SGB = Stellate Ganglion Block
ISGB =Indirect Stellate Ganglion Block
SO = Sympathetic Overload
SR = Sympathetic Reflex
PR = Parasympathetic Reflex
SPGN = Sphenpalatine Ganglion Neuralgia also known as Sluder’s Neuralgia
PPG = Pterygopalatine Ganglion is the same as Sphenopalatine Ganglion named by location in Pterygopalatine Fossa
NG = Nasal Ganglion Same as Sphenopalatine Ganglion, Pterygopalatine Ganglion and Sluder’s Ganglion
SSPGB = Suprazygomatic Spehnopalatine Ganglion Block
IOSPGB = Intra-Oral Sphenopalatine Ganglion Block
GPFSPGB = Greater Palatine Foramen Sphenopalatine Ganglion Block
TNSPGB = Trans-Nasal Sphenopalatine Ganglion Block
The Effect of Ganglion Sphenopalatine Block Versus Placebo on Persistent Headache Following COVID-19 Infection
|The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.|
|ClinicalTrials.gov Identifier: NCT04636034|
Recruitment Status : Recruiting
First Posted : November 19, 2020
Last Update Posted : January 14, 2021
- Study Details
- Tabular View
- No Results Posted
- How to Read a Study Record
|Condition or disease||Intervention/treatment||Phase|
|HeadacheCovid19Sphenopalatine Ganglion BlockPersistent Headache Following COVID-19||Procedure: Sphenopalatine Ganglion Block with Local AnestheticProcedure: Sphenopalatine Ganglion Block with Placebo (Isotone NaCl)Procedure: “Sham”-block with Placebo (Isotone NaCl)||Phase 3|
Adult patients with persistent headache following COVID-19 infection will be enrolled in the study. The patients will be randomised into three groups; bilateral SPG-block withto receive local anesthetic (lidocaine + ropivacaine), bilateral SPG-block with placebo (isotone NaCl) or bilateral “sham”-block with placebo (isotone NaCl).
Primary outcome is hyperactivity in the sphenopalatine ganglion assessed by pain intensity (0-100mm on a visual analogue scale, VAS) of the headache in standing position 30 minutes after block in the group Ropicavain-Lidocain and “sham”.
|Study Type :||Interventional (Clinical Trial)|
|Estimated Enrollment :||60 participants|
|Intervention Model:||Parallel Assignment|
|Masking:||Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)|
|Official Title:||The Effect of Ganglion Sphenopalatine Block (SPG-block) Versus Placebo on Persistent Headache Following COVID-19 Infection: a Randomised, Blinded, Clinical Trial|
|Actual Study Start Date :||January 12, 2021|
|Estimated Primary Completion Date :||August 2021|
|Estimated Study Completion Date :||November 2021|
How and with which agents does one administer this nlock
Typically local anesthetic is utilized. I prefer use of 2% lidocaine without vasoconstrictor. Self-Administration is trans-nasal or thru the nose.
I had an spg block done to try to treat severe anxiety, panic attacks and ptsd, it only seemed to work until the lidocaine wore off, then my anxiety and hypervigalence was back to normal, the Dr prescribed me the lidocaine to take home and do the procedure myself when needed but again it only works until the lidocaine wears off. Do you think a stellate ganglion block might be better for me?
Dr Shapira response: The effects of SPG Blocks are additive over time. I suggest doing the 2 times daily for the first couple of weeks for severe patients.
Over time frequecy can be decreased.
Did I teach you my protocol?
I have a deviated septum and have trouble doing the self treatment at home. I am wondering if you have any suggestions?
These SPG blocks done in the office were life changing but my provider retired and I can’t find another one willing to do it.
Dr Shapira’s Response:
You experience is typical of the amazing results seen with SPG Blocks.
I like SASPGB or Self-Administration of SPG Blocks. The cotton-tipped catheter is the best approach but you can learn to utilize a sphenocath is your nose is extremely tight.
Many patients find utilizing Afrin or generic oxymetazoline 20 minutes ahead of time make the process easier.
Use of Cotton-tipped cathetr tends to get easier with time. Did your original provider teach you Self-Administration?