Created February 22, 2017, last updated 15 days ago.
Collection: 83, Score: 1686, Trend score: 0, Read count: 1686, Articles count: 8, Created: 2017-02-22 08:37:45 UTC. Updated: 2019-11-20 23:44:07 UTC.
First described in 1909, and then used for treatment of various types of headache and facial pain, the sphenopalatine ganglion block may offer a novel, simple and less-invasive treatment for post-dural puncture headache.
Very little has been published, primarily case studies, case series and retrospective audits. This limited data does however suggest that the technique may be as effective as the traditional epidural blood patch, though with significantly fewer risks.
Larger studies are however needed to properly define the block's role in treating PDPH.
Publications describe a trans-nasal approach, either sitting or supine. First topicalising with co-phenylcaine spray, then placing 2%-4% viscous lignocaine-soaked cotton-tipped applicators for 10 minutes, and finally repeated for a further 20 minutes. Success appears to range from 30-70%.
The mechanism of action may result from parasympathetic blockade at the SPG, resulting in reversal of the cerebral vasodilation thought to be associated with post dural puncture headache.
Several videos showing how simple SPG techniques:
- Roger Browning demonstrating one method for performing a topical SPG block.
- SPG Block for chronic migraine.
- SPG demonstration in the ED setting.
- SPG demonstration for family member to perform later at home.
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To demonstrate a possible alternative treatment for postdural puncture headache (PDPH). ⋯ When comparing the risks of a transnasal SPGB, which include bleeding and temporary discomfort, against those of an EBP, which are documented as dural puncture, neurologic complications, bleeding, and infection, it seems reasonable to offer the SPGB before EBP.
The sphenopalatine ganglion (SPG) is a parasympathetic ganglion, located in the pterygopalatine fossa. The SPG block has been used for a long time for treating headaches of varying etiologies. ⋯ Also, since the existing evidence proving the efficacy of the SPG block in PDPH is scarce, the block cannot be offered to all patients. EBP can be still considered if an SPG block is not able to alleviate pain due to PDPH.
Postdural puncture headache (PDPH) is a severe and debilitating complication of unintentional dural puncture. The criterion-standard treatment for PDPH has been epidural blood patch (EBP), but it is an invasive intervention with the potential for severe complications, such as meningitis and paralysis. We believe this is the first ever 17-year retrospective chart review in which we compare the effectiveness of sphenopalatine ganglion block (SPGB) to EBP for PDPH treatment in postpartum patients. ⋯ A greater number of patients experienced a quicker onset of headache relief, without any new complications, from treatment with SPGB versus EBP. We believe that SPGB is a safe, inexpensive, and well-tolerated treatment. We hope that clinical trials will be conducted in the future that will confirm our findings and allow us to recommend SPGB for PDPH treatment prior to offering patients EBP.
Transnasal sphenopalatine ganglion block is emerging as is an attractive and effective treatment modality for acute migraine headaches, cluster headache, trigeminal neuralgia, and several other conditions. We assessed the efficacy and safety of this treatment using the Sphenocath® device. 55 patients with acute migraine headaches underwent this procedure, receiving 2 ml of 2% lidocaine in each nostril. Pain numeric rating scale (baseline, 15 minutes, 2 hours, and 24 hours) and patient global impression of change (2 hours and 24 hours after treatment) were recorded. ⋯ Most patients rated the results as very good or good. The procedure was well-tolerated with few adverse events. This treatment is emerging as an effective and safe option for management of acute migraine attacks.