Sphenopalatine Ganglion block is an important treatment option for those experiencing chronic headaches, migraines and atypical facial pain. The nonsurgical procedure is found to be a superior alternative to medication and conventional therapy. Patients with acute and chronic face and head pain and neuralgias prefer sphenopalatine ganglion blocks for faster and longer relief of their symptoms.
What is a sphenopalatine ganglion block?
Sphenopalatine ganglion blocks refers to the nerve block performed on the Sphenopalatine Ganglion located behind the nostrils. The plexus is a hub of sympathetic, parasympathetic, and sensory nerves feeding out various facial glands, including lacrimal gland, paranasal sinuses, nasal cavity, gingival, upper pharynx and the hard palate. When infection, trauma or any other medical condition impacts glands or organs in the face, neck, nose or mouth innervated from the ganglion, it receives sympathetic responses from connected nerve fibers and channels the pain signal to the brain.
Sphenopalatine ganglion blocks helps prevent transmission of sympathetic sensation to the brain and patients experience relief of their symptoms.
What is used during sphenopalatine block?
A numbing medication is used to perform sphenopalatine block. When the procedure was first introduced in 1908, alcohol or cocaine was used for years as the numbing agent. Local anesthetics, such as lidocaine and marcaine, have now replaced it.
How does sphenopalatine block work?
The blocking of the sphenopalatine ganglion results in suppressing pain sensation coming from face, neck, mouth, nose or other organs connected to the plexus. While pain signals are not allowed to pass through it to the brain, non-painful sensory signals continue to be transmitted. This ensures significant relief from facial pain and headache for patient for weeks or months at a stretch.
What conditions are treated using sphenopalatine block?
Sphenopalatine ganglion block is beneficial for relieving headache and facial pain associated with following conditions.
- Migraine
- Short-term, throbbing cluster headache
- Head, neck and facial pain associated with cancer
- Trigeminal, Sluder’s and sphenopalatine neuralgias
- Chronic pain in the mouth and tongue
- Atypical facial pain
- Paroxysmal hemicranias pain
- Acute, worsening headaches
- Pain originating in temporomandibular joint between the skull and lower jaw
- Complex regional pain syndrome leading to facial pain
- Pain due to severe spasmodic condition impacting the nose, neck, shoulders and face
- Pain from frequent inflammation of nasal membrane
- Pain around the eye
- post-traumatic headache
When is a sphenopalatine block required?
A sphenopalatine block is performed with three important objectives.
- Diagnose the of cause of headache and facial pain
- Prevent recurrence of sympathetic facial pain
- Manage chronic headaches associated with sphenopalatine innervations
The procedure is performed first as a diagnostic block to examine if the patient has particular pan condition responsive to the block. A therapeutic block follows.
How beneficial is sphenopalatine block?
- Sphenopalatine block is the most potent method to control pain linked to head and neck cancer. (Journal of Laryngology & Otology, 2001)
- When combined with radiofrequency ablation, the block offers complete head and facial pain relief up to two years. (Acta Neurochirurgica)
- Sphenopalatine block provides relief from facial pain and chronic headaches to 86 percent users. (Pain Practice, 2005)
- A meta-analysis found the procedure significantly effective in managing pain related to neck cancer and cluster headache. (Chest, 2006)
- In 2006, the Chest journal published a meta-analysis that suggested significant relief offered by the treatment for neck cancer pain, tooth pain, and chronic cluster headache.
How is sphenopalatine block performed?
A sphenopalatine ganglion block can be performed in three different ways.
- Transoral delivery of local anesthetic through a needle place via the gum line.
- Lateral delivery of numbing medication through an injection on the cheek. Patients lie down on their back and the process is performed under fluoroscopic guidance. IV sedations or local anesthesia are used.
- Transnasal method involves administration of the numbing medication via the nose. Patients remain in a supine position and lidocaine gel is put into the nostril. The gel, when inhaled, anesthetizes the mucosa. Then, a small catheter is inserted to reach out to the sphenopalatine ganglion at the back of the throat. The medication is delivered through the catheter. Often an applicator is used during the transnasal procedure. Tipped with cotton dipped in numbing medication, it is kept there for 20 to 30 minutes ensuring direct absorption of local anesthetic.
- Another transnasal procedure involves a new revolutionary device for medication delivery known as the Tx360. Similar to the cotton tip applicators noted above, this device delivers the local anesthetic via the nasal pathway. However, using this device dramatically reduces the procedure time to less than a Dr. Gershon has been successfully performing both types of transnasal procedures.
How long does it take?
Depending on the approach the procedure can take one minute or 20-30 minutes.
What should I expect after the procedure?
Patient can go home after brief monitoring. Nasal congestion and tears may occur soon after the procedure. Rest is advised for a few hours after the patient discharged. The patient is instructed not to eat until the numbing medication wears off. Regular work can be resumed from the next day.
When will I have pain relief?
Pain relief is instant and patients experience it within 15 to 30 minutes. However, it takes 3 to 7 days before the block shows its semi-permanent effect.
How many sphenopalatine block injections should I have?
The frequency of sphenopalatine block and time gap between two sittings are decided according to pain relief experienced and condition of a patient.
How long does the pain relief last?
Pain relief lasts between a few weeks and a few years. The least benefit reported by our patients is eight weeks. There are many who have experienced pain relief between 10 to 24 months. Radiofrequency ablation combined with sphenopalatine block assures pain relief up to two years. A study showed that 60 percent of cluster headache patients treated with the block continued to have benefits for six years.
What are the side effects of sphenopalatine block?
There is no major side effect, except rarely seen nasal bleeding. Patients may experience dizziness, nasal congestion, bitter taste, and numbness in the throat for a few hours after sphenopalatine block is performed.
References
Guyatt G., Gutterman D., Bauman M., et al: Grading strength of recommendations and quality of evidence in clinical guidelines: report from an American college of chest physician’s task force. Chest 2006; 129:174-181.
Levin M. Nerve blocks in the treatment of headache. Neurotherapeutics. 2010; 7(2):197-203.
Khan, S; Schoenen, J; Ashina, M. “Sphenopalatine ganglion neuromodulation in migraine: What is the rationale?” Cephalalgia 2014;34(5:382–391.
Varghese BT, Koshy RC. Endoscopic transnasal neurolytic sphenopalatine ganglion block for head and neck cancer pain. J Laryngol Otol. 2001 May;115(5):385-7.
Bayer E., Racz G., Day M., et al: Sphenopalatine ganglion pulsed radiogrequency treatment in 30 patients suffering from chronic face and head pain. Pain Practice 2005; 5:223.
