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 Ganglion) is 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, M; Demesticha, T; Troupis, T; Vlasis, K; Skandalakis, P; Makri, A; Mazarakis, A; Lappas, D;Piagkos, G; Johnson, EO. "The pterygopalatine ganglion and its role in various pain syndromes: from anatomy to clinical practice." Pain Pract. 2012;12(5):399-412.

Jenkin,s B; Tepper, SJ. "Neurostimulation for Primary Headache Disorders, Part 1: Pathophysiology and Anatomy, History of Neuromodulation in Headache Treatment, and Review of Peripheral Neuromodulation in Primary Headaches." Headache 2011;51:1254-1266.

Martelletti, P; Jensen, RH; Antal, A; Arcioni, R; Brighina, F’ de Tommaso, M; Franzini, A; Fontaine, D;Heiland, M; Jürgens, TP; Leone, M; Magis, D; Paemeleire, K; Palmisani, S; Paulus, W; May, 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, J; Jensen, RH; Lantéri-Minet, M; Láinez, MJ; Gaul, C; Goodman, AM; Caparso, A; May, 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. 

CHICAGO MIGRAINE CURE: Treatment and Prevention of Migraine Headaches

Migraines can be avoided, eliminated and cured with a combination of treatments designed to reduce noxious input into the Trigeminal nervous system.  It is universally accepted that migraines are mediated by the trigeminal input to the brain in conjunction with the trigeminal nerve control of blood flow to the anterior two thirds of the meninges of the brain.

There has long been a controversy whether migraine was a vascular headache or a neurogenic headache or a combination of the two.  Ther has never been a question over mediation of migraine by the trigeminal nerves.

Noxious input from the trigeminal nerve can be eliminated.  There is actually an appliance that has been FDA approved as a migraine preventive, the NTI -TSS appliance.  NTI-TSS stands for Nociceptive trigeminal inhibition tension suppression system.  It uses noxious input into the trigeminal nervous system to suppress bruxism.  The original appliance was Dr Peter Neff's  appliance that the NTI  concept was taken from.   There are many problems and risks associated with the NTI but there is a place for it in patients with migraines that occur in the night or upon awakening and who do not have sleep disordered berthing including apneas, hypopneas, RERAs, UARS, and/or snoring.

Patients with these problems should have their nocturnal breathing corrected which can often cure these same migraines.  The TAP appliance actually treats the breathing and simultaneously creates the same effect as the NTI simultaneously.

CURING MIGRAINES goes beyond the NTI and sleep disordered breathing to idealizing the cranial cervical physiology.  Neuromuscular Dentistry as part of a comprehensive program can cure many migraines by removing the noxious input to the CNS from the trigeminal nerve.  Correction of posture is important to eliminate myofascial pain and trigger points that also cause headaches.

Upper cervical spinal problems can also create migraines but the combination of neuromuscular dental orthotics and atlas orthoganol correction creates long term stability.

The first step is always diagnosis and trial reversible treatment.  A diagnostic neuromuscular orthotic shold always be the first step in neuromuscular treatment and prevention of migraines. Correction of upper cervical probles is easier when the orthotic is worn and adjustments hold better.  It is important to understand that changes to orthotic and upper cervical areas must be balanced carefully to achieve homeostasis.

Curing migraines depends on maintaining this homeostasis.  There are migraine triggers that are chemical in nature that must be controlled by diet and avoidance.  Many patients find that over time these migraine triggers have less effect.

There are no migraine cures that work for everyone but neuromuscular dentistry offers many patients near miraculous results.  The combination of neuromuscular dentistry with upper cervicsal stabilization is even more powerful.  SphenoPalatine Ganglion Blocks can be used on more difficult cases to turn off and prevent migraines.  These were discussed in a popular book "Miracles on Park Avenue".  In my office we teach patients to self administer SPG blocks with cotton tipped swabs and lidocaine delivery.   Learn more about treatment of headaches and migraines at
www.thinkbetterlife.com.