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Friday, March 25, 2016

Hemicrania Continua: Successful Treatment with SPG Blocks

New Developments in Improving Quality of Life for Headache and Migraine Patients

A brand new article in Headache (see Abstract below) shows successful treatment of Hemicrania continua with Sphenopalatine Ganglion Blocks.  This is a very exciting development for patients who live with chronic pain of this disorder.

This disorder also responds well to Neuromuscular Dentistry but there is obviously a significant autonomic nervous system involvement in this disorder.  I am pleased to report that I taught a course to approximately 100 dentists at the ICCMO meeting in San Diego and that patients can now see their ICCMO trained Neuromuscular Dentist to treat this disabling disorder.

Top Neuromuscular Dentists can be found at the ICCMO website www.ICCMO.org

Patients with Hemicrania continuam , migraines, cluster headaches and other disorders should visit their local ICCMO Neuromuscular Dentist.


Chair, Alliance of TMD Organizations
Diplomat, American Academy of Pain Management
Regent & Fellow, International College of CranioMandibular Orthopedics
Board Eligible, American Academy of CranioFacial Pain
Dental Section Editor, Sleep & Health Journal
Member, American Equilibration Society
Member, Academy of Applied Myofunctional Sciences

 2016 Mar;56(3):573-9. doi: 10.1111/head.12783. Epub 2016 Mar 1.

Hemicrania continua may respond to repetitive sphenopalatine ganglion block: A case report.



Hemicrania continua (HC) is a chronic headache disorder characterized by a continuous, strictly unilateral head pain accompanied by cranial autonomic symptoms, which completely responds to indomethacin; however, few alternative treatment options exist for the patients with this disorder who cannot tolerate indomethacin. Sphenopalatine ganglion (SPGblock has been used for the treatment of various headaches, with the strongest evidence for efficacy in cluster headache.


A 52-year-old woman with a 7-year history of HC was evaluated in our clinic for management of her headaches after she had stopped using indomethacin due to a bleeding gastrointestinal ulcer. After failing multiple pharmacologic therapies, she was treated with repetitiveSPG blocks using bupivacaine (0.6 mL at 0.5%) twice a week for 6 weeks and followed by maintenance therapy. This treatment protocol resulted in significant improvement in her headaches, mood, and functional capacity.


SPG block using a local anesthetic may be an effective treatment for patients with HC, specifically for those who cannot tolerate indomethacin, or when this drug is contraindicated.
© 2016 American Headache Society.


chronic migraine; cranial autonomic symptoms; hemicrania continua; indomethacin; sphenopalatine ganglion block; trigeminal autonomic cephalagias

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posted by Dr Shapira at 9:10 AM

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