The least invasive way to access the SPG is through the nose.
What is the sphenopalatine ganglion?
The sphenopalatine ganglion (or SPG) consists of a bundle of nerve cells located just behind the bony structures of the nose. It contains autonomic nerves and sensory nerves. Autonomic nerves are specialized nerve that control organ functions.
In the SPG, autonomic nerves supply the lacrimal glands (which produces tears) and the inner lining of the nose and sinuses (which produces nasal discharge or congestion). The main sensory nerve of the face is the trigeminal nerve. The trigeminal nerve is the primary nerve involved in headache disorders and when activated, this nerve transmits pain signals to the brain via the ophthalmic branch to the meninges.
When activated, the blood vessels in the meninges become dilated causing a sterile inflammatory cascade. This vasodilation and inflammation signals pain signals back to the brain.
The SPG has connections to the brainstem (where cluster and migraine attacks may be generated) and to the meninges (coverings of the brain) by the trigeminal nerve (through the ophthalmic branch). Pain receptors are activated when the blood vessels become dilated and inflamed. Pain impulses are then transmitted through the trigeminal nerve, eventually to the sensory areas of the brain, and are perceived as pain. In migraine and cluster headache, nerves carrying these pain signals pass through the SPG, with some making connections to the autonomic nerves.
This explains why in cluster headache, and sometimes in migraine, we see autonomic features including tearing of the eyes and nasal congestion or discharge. We call this the trigeminal autonomic reflex. This is also why many people that suffer from migraines, mistakenly think they have "sinus" headaches instead.
What medication is used?
Local anesthetic such as lidocaine, the same or similar medication that is injected by a dentist or used to anesthetize a laceration before stitches.
About the procedure:
- The day of the procedure you should be able to travel to the office and drive home afterwards.
- The procedure is done in the clinic and takes only about 15 minutes. After the procedure, about 15-30 minutes of recovery/monitoring is suggested.
- No sedating medications are needed for the procedure. The procedure is often done in an exam room by your provider. Prior to the procedure, your blood pressure and heart rate, and possibly your cheek temperature may be checked.
- The patient is instructed to lie on his/her back with the head tilted back. A nasal anesthetic gel may be applied with a long cotton tip beforehand to lessen any discomfort during the procedure.
- New catheters have been developed which enable a faster, more comfortable procedure. The device (or catheter) is more effective in reducing head and facial pain than the technique using cotton swabs and is less invasive than the injection techniques historically utilized.
- The device involves placing a very thin plastic tube into the nose to insert numbing medication in and around the SPG. The catheter is inserted through the nostril to the very back of the nasal cavity. At this point, a syringe is used to deliver the anesthetic agent onto the back of the nasal cavity through the catheter. The medication is absorbed through the bone and into the ganglion. The procedure is then repeated on the opposite side, if indicated.
- Tearing and a brief temperature change are likely to occur and may indicate the procedure was successful. You may experience an immediate reduction in head and/or facial pain, but results can take anywhere from 15 minutes to a few hours to occur.
- After the procedure is completed on each side, the patient is instructed to lay in the same position for 15-30 minutes.
The duration of pain relief is highly variable. Some patients receive no benefit from the procedure while others report a drastic reduction in the amount of medications taken to relieve headache attacks over the 4-6 weeks following the procedure.
What are the potential side effects or risks?
The risks of the procedure are typically minimal and temporary. Discomfort during and after the procedure, a numb sensation when swallowing, bitter taste from the anesthesia, low blood pressure, nausea and/or light-headedness are the most common side effects reported. These side effects typically resolve within minutes to a few hours. There is a very small risk of nasal bleeding, seizures, infection and allergic reactions.
SPG blocks have been reported to treat the following conditions:
• Cluster headache
• Trigeminal neuralgia
• Herpes zoster
• Paroxysmal hemicrania
• Cancer of the head or neck
• Facial pain that is atypical
• Complex regional pain syndrome (CRPS)
• Temporomandibular disorder
• Nasal contact point headache
• Vasomotor rhinitisWill insurance cover this procedure?
Most insurance carries cover SPG block for a variety of headache disorders, but you should speak with your insurance representative to ensure it is covered if your provider performs it.
How often can I have this procedure done?
SPG block can be repeated as often as needed to reduce pain.
The Sphenopalatine Ganglion (SPG) is a group of nerve cells that is linked to the trigeminal nerve, the main nerve involved in headache.
The link between the SPG and the trigeminal nerve is important in head pain. If you apply local anesthetics (or numbing medications) to block or partially block the SPG, this can be helpful in reducing head and facial pain.
SPG block is a safe, quick, and effective way to reduce severity and frequency of various headache disorders for a period of time. Like many other procedures in headache medicine, SPG block is likely to work best when combined with a comprehensive headache treatment plan.