Benefits, side effects, how it works

Migraine is a medical condition that affects more than 1 out of 10 people around the world, according to the National Institute of Neurological Disorders and Stroke. It is best known for causing debilitating, throbbing headaches on one side of the head.

Migraine is usually treated with a combination of preventative drugs and painkillers.

The sphenopalatine ganglion (SPG) is a group of neurons that sits behind your nose and above your mouth. Nerve block can be applied to SPG as a treatment for migraines.

Read on to learn more about SPG blocks as migraine treatments and whether they might be useful for you.

The SPG is also called the pterygopalatine ganglion, nasal ganglion or Meckel’s ganglion. All of these names refer to the same structure of nerve cells.

For more than a century, SPG is thought to play a role in certain types of headaches and facial pain. This is due to its location, which is close to many other neurological structures involved in pain perception, such as the trigeminal nerve.

A common type of headache thought to be caused by PGS is sphenopalatine ganglioneuralgia. You might know it best as a brain freeze or an ice cream headache.

The SPG plays a role in mediating the usual variation of widening and narrowing of cranial blood vessels. In migraine, some research shows that the blood vessels in the brain are enlarged. This has long been considered a contributing factor to migraine attacks. A small study 2017 found evidence to support the theory that dilation of blood vessels is linked to migraine, but more research is still needed.

Getting an SPG nerve block means having a drug injected near your SPG. Several types of drugs can be used.

There are three common procedures for getting medicine to the SPG. Let’s look at these in detail.

Medications

Local anesthetics are the most commonly used drugs for SPG block. According to a 2017 reportNearly a dozen anesthetics have been used for SPG block, but the most common are lidocaine and bupivacaine.

Other drugs are sometimes used instead of local anesthetics. These include steroids, phenol and ethanol.

These drugs help reduce inflammation or excessive activation of the SPG. This prevents the SPG from sending pain sensations and causing changes in blood vessels and the brain that cause pain.

Procedures

There are three common methods a doctor can use to perform an SPG blockade. They are the transnasal approach, the transoral approach and the infrazygomatic approach.

Transnasal approach

The transnasal approach is the one that has existed the longest. This involves inserting a cotton swab or specialized catheter into your nose. The instrument travels down your nasal floor, which is above the roof of your mouth, until it reaches your SPG.

According to a 2019 review, the transnasal approach is the simplest and fastest procedure. In fact, a study 2017 cancer pain patients found transnasal SPG blocks could be applied at home post-workout. Self-injection is not used for the treatment of migraine.

Transoral approach

The transoral approach uses a dental needle to reach your SPG through your greater palatine foramen. This is a small opening in the roof of your mouth towards the back.

A 2019 review found that the transoral approach was less comfortable and technically more difficult than the transnasal approach, while being more invasive.

Infrazygomatic approach

The infrazygomatic approach is the most specialized. Using this method, a doctor will achieve the SPG by inserting a needle under your cheekbone. A specialized type of X-ray called a fluoroscope is used during the procedure.

This approach is the most invasive and using the fluoroscope means you will be exposed to radiation. The advantage is that it offers the most direct access to the SPG.

Research on SPG blocks generally agrees that they are an effective treatment for migraine pain. But experts also tend to point out that most of the studies done to date have small sample sizes and would benefit from further testing.

For example, a 2021 review found a lack of studies that directly compare the effectiveness of various SPG block drugs against each other. The studies that do exist have not determined whether a drug gives the best results.

Most research agrees that SPG blocks can relieve pain during a migraine attack. Pain relief is obtained between 10 minutes and 24 hours.

A small study 2020 found that regular SPG block treatments can lead to structural changes in the brain. Participants reported less severe headaches and fewer headaches per month. This suggests that SPG blocks may work as a preventive treatment for migraines, but more research is still needed.

SPG blocks can also be an effective treatment for children with migraine. A study 2021 found SPG blocks to reduce pain in children without immediate complications.

Getting an SPG block does come with some risks, but they are generally slight. The procedure itself can cause local effects in some cases. These include:

  • nose bleeds
  • numbness
  • tearing in one or both eyes
  • bitter taste

Getting an SPG block can lead to infection or hematoma (bleeding), but these risks are not common.

A study 2017 found that home-based SPG blocks for cancer pain sometimes caused:

  • temporary difficulty breathing and swallowing
  • stunning

The cost of an SPG block can vary from practice to practice. You can expect them to cost over $100, and sometimes over $500. The cost may vary depending on the SPG blocking procedure you receive.

Some insurance companies will cover SPG blocks for migraine, but not all companies or policies.

If you have insurance and want to know if your policy covers SPG blocks for migraine, contact your insurance company before scheduling your procedure. The doctor’s office will likely be experienced in billing SPG blocks and should be able to help you determine what your policy covers and what your cost will be.

SPG blocks may be an option for treating migraines that do not improve with standard treatment, but the lasting impact of this treatment has not been well established at this point.

Most studies agree that SPG blocks are effective in treating migraine pain. More research is needed to find out if they can also prevent migraine attacks.

In addition to migraine, SPG block has been used to treat other conditions related to headaches and facial pain, such as:

Just as with the SPG block for migraine, more research is needed to better understand when and how this treatment should be used for these conditions.

It has also been used as a pain management technique for various head and neck cancers, including cancer of:

SPG blocks are a promising treatment for migraine pain and may also have preventive potential.

If you get an SPG block, a doctor will apply medication to your SPG, most often by entering your nose with a catheter or cotton swab. Pain relief usually occurs within 1 hour.

If you think an SPG block might be an effective migraine treatment for you, make an appointment with a doctor.

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