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Tuesday, July 21, 2015

Migraine Treatment: Sphenopalatine Ganglion (SPG) Blocks are they a Magic Migraine Cure?

The Sphenopalatine Block has been called by some the Miracle Headache Cure after being popularized in the best selling book "Miracles on Park Avenue:  Techniques for Treating Arthritis and Other Chronic Pain" by Albert Benjamin Gerber.

While not a "MIRACLE CURE" it is definitely miraculous treatment for many patients.

The Sphenopalatine Ganglion (SPG)  (also called pterygopalatine ganglion, Meckel's Ganglion or the Nasal Ganglionis the largest parasympathetic autonomic ganglion a group of nerve cells that is linked to the trigeminal nerve.  
The Trigeminal Nerve is the primary nerve involved in all migraines and other headaches.  
The Trigeminal Nerve is usually called the Dentist's Nerve because dentists are considered the experts in most peripheral aspects of the Trigeminal Nerve structures. The Trigeminal Nerve goes to the teeth, the gums (gingiva), the periodontal ligaments, the jaw joints (TMJ, TMJoint) or TemporoMandibular Joints, the lining of the sinuses, the jaw muscles, the tensor of the ear drum and the muscle that opens and closes the eustacian tube, the lacrimal glands (tear ducts) and is responsible for nasal congestion.
The Trigeminal Nerve is also the major control of blood flow to the anterior 2/3 of the meninges of the brain and central to almost 100% of headaches.  The Trigeminal Nerve accounts for over 50% of the total input to the brain after amplification in the Reticular Activating System.

TMJ Disorders are often called "The Great Imposter because the can mimic all types of headaches, migraines, sinus problems and ear problems.  The majority of chronic headache patients have similar myofascial pain at patients with TMJ.  Neuromuscular Dentistry can be the best treatment for many patients with chronic headaches.  Learn more at WWW.ThinkBetterLife.com.  
The SPG is located behind and lateral nose in the pterygopalatine fossa, and carries information about sensation, including pain, and also plays a role in autonomic functions, such as tearing and nasal congestion. 
The application of local anesthetics to the SPG and the trigeminal nerve can be extremely effective in eliminating and/or controlling all types of head pain including tension headaches, chronic daily headache, new persistent daily headache, Cluster headaches, and migraine staticus.  I
SPG blocks can be accomplished by nasal swaps placed intranasally, injections intra-orally or from externally (Most effective) and recently three devices have been FDA approved for performing SPG blocks.  These devices involve placing  anesthetic through a thin cannula that passes through the nasal cavity to insert numbing medication in and around the Sphenopalatine ganglion area where it passes through the mucosa ti the ganglion.  These devices are less invasive than the injection technique but also less effective.  The three devices are the Sphenocath®, the  Allevio®, and the Tx360®.

The nasal swabs have an enormous advantage as they can be self applied by patients on a daily basis and when done with continuos delivery are amazingly effective and very inexpensive.  
Different types of anesthetic solutions can be utilized with any of these techniques.
The nasal swabs are left in place for 20 minutes to 30 minutes if done in my office.  Patients with severe problems can actually leave them in longer and self apply a couple of times a day.   The most common side effects, regardless of how SPG blocks are given are all temporary, including numbness in the throat, low blood pressure, and infrequently nausea. 
References:
Maizels, M; Scott B; Cohen W; Chen W. Intranasal lidocaine for treatment of migraine: a randomized, double blind, controlled trial. JAMA 1996;27:319-21.
Piagkou, MDemesticha, TTroupis, TVlasis, KSkandalakis, PMakri, AMazarakis, ALappas, D;Piagkos, GJohnson, EO. "The pterygopalatine ganglion and its role in various pain syndromes: from anatomy to clinical practice." Pain Pract. 2012;12(5):399-412.
Martelletti, PJensen, RHAntal, AArcioni, RBrighina, F’ de Tommaso, MFranzini, AFontaine, D;Heiland, MJürgens, TPLeone, MMagis, DPaemeleire, KPalmisani, SPaulus, WMay, A. "Neuromodulation of chronic headaches: position statement from the European Headache Federation." J Headache Pain 2013;14(1):86.
Khan, S; Schoenen, J; Ashina, M. "Sphenopalatine ganglion neuromodulation in migraine: What is the rationale?Cephalalgia 2014;34(5:382–391.
Schoenen, JJensen, RHLantéri-Minet, MLáinez, MJGaul, CGoodman, AMCaparso, AMay, A. "Stimulation of the sphenopalatine ganglion (SPG) for cluster headache treatment. Pathway CH-1: a randomized, sham-controlled study." Cephalalgia. 2013 Jul;33(10):816-30. 

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posted by Dr Shapira at 3:20 PM

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