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Monday, March 19, 2012

cluster headache and SPG (sphenopalatine Ganglion block) Block

I have been a strong advocate of utilizing sphenopalatine ganglion blocks to treat cluster headaches, acute and chronic daily migraines, sinus headaches and chronic daily headaches. The following Pub Med abstract is a case report on utilizing lidocaine (an extremely safe drug) to do SPG blocks for cluster headaches.

The Ptsosis (wikipedia...Ptosis (from Greek Ptosis or πτῶσις, to "fall") is a drooping or falling of the upper or lower eyelid ) as well as the pain responded to the block. It is important to note that SPG blocks are more effective at preventing attacks than stopping them. I have many patients who use the blocks prophylactically to prevent headaches or migraines as well as avert them when there is the first onset of symptoms.

SPG blocks with lidocaine are probably the safest and most effective drug therapy for migraines, cluster headaches and other autonomic cranial facial pain syndromes, unfortunately very few physicians teach their patients this valuable technique .

Sphenopalatine Neuralgia or Sluders Neuralgia respond to topical blockage of the SPG ganglion. The second abstract discusses phenolization of the ganglion. I have always been more comfortable utilizing non-toxic lidocaine for SPG Blocks. In Sever cases I will do a block with Marcaine through the palate but I prefer to let the patient avoid attacks with a cotton applicator and lidocaine.


J Med Case Reports. 2012 Feb 15;6(1):64. [Epub ahead of print]

Cluster headache with ptosis responsive to intranasal lidocaine application : a case report.

Abstract

ABSTRACT: INTRODUCTION: The application of lidocaine to the nasal mucosal area corresponding to the sphenopalatine fossa has been shown to be effective at extinguishing pain attacks in patients with a cluster headache. In this report, the effectiveness of local administration of lidocaine on cluster headache attacks as a symptomatic treatment of this disorder is discussed. Cases presentation: A 22-year-old Turkish man presented with a five-year history of severe, repeated, unilateral periorbital pain and headache, diagnosed as a typical cluster headache. He suffered from rhinorrhea, lacrimation and ptosis during headaches. He had tried several unsuccessful daily medications. We applied a cotton tip with lidocaine hydrochloride into his left nostril for 10 minutes. The ptosis responded to the treatment and the intensity of his headache decreased. CONCLUSION: Intranasal lidocaine is a useful treatment for the acute management of a cluster headache. Intranasal lidocaine blocks the neural transmission of the sphenopalatine ganglion, which contributes to the trigeminal nerve as well as containing both parasympathetic and sympathetic fibers.

PMID:
22335966
[PubMed - as supplied by publisher]
Free full text
Otolaryngol Pol. 2007;61(3):319-21.

[Atypical facial pains--sluder's neuralgia--local treatment of the sphenopalatine ganglion with phenol--case report].

[Article in Polish]

Source

Poradnia Chorób Nosa Uniwersyteckiego Szpitala Klinicznego im. WAM Uniwersytetu Medycznego w Lodzi.

Abstract

AIM:

Chronic reccuring head and facial pain can be very difficult for successful treatment. Such a pain can be in some rare cases Sluder's sphenopalatine ganglion neuralgia. The aim of the study was to obtain the pain relief by local treatment in patients with Sluder's sphenopalatine ganglion neuralgia.

METHODS:

We described three cases of Sluder's neuralgia among all the seventeen patients with reccuring head and face pain that were seen in our department. In all these cases 4% Xylocaine was applied intranasally, into the region of shenopalatine ganglion, behind the posterior tip of the middle turbinate four times for ten minutes. According to Kern, the diagnosis of Sluder's neuralgia was confirmed only in cases where local anesthetic block of the sphenopaltine ganglion was successful. It means the patients were pain-free for at least an hour after application of Xylocaine, so they were qualified for phenolization and 88% phenol was applied on the cotton carriers (number of the applications depended on the patient).

RESULTS:

The total relief of pain of different duration was obtained in all the presented cases.

CONCLUSION:

The relief of pain obtained by intranasal phenolization of sphenopalatine ganglion in three patients shows it could be the effective treatment of Sluder's neuralgia. The patients were totally free from the pain and accompanying symptoms like nasal obstruction, rhinorrhea, epiphora or conjunctivitis. The relief period was different but the patients were satisfied with the effectiveness and simplicity of the treatment. They did not need to take the additional medications for months and were able to continue work.

PMID:
17847789
[PubMed - indexed for MEDLINE]

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posted by Dr Shapira at 5:22 PM

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