Chronic Daily Headaches, Migraines, Cluster Headaches & Rebound Headaches . SPG Blocks Spell Relief and Prevention

Originally posted as a Blog on www.ThinkBetterLife.com

The SPG Block or Sphenopalatine Ganglion Block can be extremely effective at preventing and eliminating migraines. The Sphenopalatine Ganglion is part of the Autonomic Nervous System. It is the Largest Parasympathetic Ganglion and treatment with lidocaine has been shown to be very effective for treating a wide variety of chronic and acute pain syndromes including Migraine, Cluster Headache, Chronic Daily Headache, New Persistent headache, Rebound Headache, Sinus Pain, Trigeminal Neuralgia, Autonomic Cephalgias and many other disorders.  It is frequently used for medically refractory headaches where all other treatments have failed.  SphenoPalatine Ganglion Blocks are probably grossly undrutilized based on safety and cost effectiveness.

There are multiple routes of administration including through the nose and by intra-oral or suprazygomatic injection.

There are several new FDA approved devices for delivering SPG blocks intranasally. These include the Sphenocath, the Allevio and the TX360. The MiRX protocol is specifically designed to prevent and eliminate migraines. The use of cotton tipped applicators saturated with lidocaine, cocaine or other anesthetic has been utilized for many years.

The use of hollow tipped applicators allow a continual feeding mechanism for anesthetic that can easily be accomplished by most patients. This method is extremely cost effective and convenient for patients.

Self administration of SPG Blocks is the key to putting chronic pain patients back in control of their lives.

The injection techniques are most effective in turning off an acute attack. I recently taught a hands on course to neuromuscular dentists at the ICCMO meeting in San Diego several methods of delivering anesthetic to the Sphenopalatine Ganglion.

Self administered Sphenopalatine blocks have been used for multiple conditions including CRPS, Complex Regional Pain Syndrome of the lower extremity (PubMed abstract below), Post Dural Puncture Headache, to treat Tension Headache in pregnant patients, and for OroFacial Pain (PubMed abstract below).  The usefulness has been described of SPG blocks in Pain clinics as well (PubMed Abstract below)

Arch Phys Med Rehabil. 2005 Feb;86(2):335-7.

Complex regional pain syndrome involving the lower extremity: a report of 2 cases of sphenopalatine block as a treatment option.

Quevedo JP1, Purgavie K, Platt H, Strax TE.

Author information

Abstract

We report 2 cases of complex regional pain syndrome (CRPS) involving the lower extremity; in both, a sphenopalatine ganglion (SPG) block was performed as part of a pain management program. In the first case, a woman in her late twenties presented with CRPS in the left lower extremity that was inadequately controlled with typical oral medications. Sympathetic block of the extremity did not provide significant pain relief. However, a noninvasive sphenopalatine block with 4% tetracaine resulted in a 50% reduction in pain level. The patient was shown how to self-administer the sphenopalatine block and was provided with exercises and therapy to help improve her functional status. The second case involved a woman in her mid forties with CRPS in the right lower extremity that was partially controlled with oral medications. The patient experienced a 50% reduction in pain level when SPG block with 4% tetracaine was given. Further study is needed to determine the effects of SPG blocks on symptoms related to chronic regional pain syndrome.

PMID:

15706564

[PubMed – indexed for MEDLINE]

Cranio. 1995 Jul;13(3):177-81.

Int J Obstet Anesth. 2014 Aug;23(3):292-3. doi: 10.1016/j.ijoa.2014.04.010. Epub 2014 May 10.

Transnasal topicalsphenopalatine ganglion block to treat tension headache in a pregnant patient.

Grant GJ1, Schechter D2, Redai I2, Lax J2.

Sphenopalatine ganglion block: a safe and easy method for the management of orofacial pain.

Peterson JN1, Schames J, Schames M, King E.

Author information

Abstract

The sphenopalatine ganglion (SPG) block is a safe, easy method for the control of acute or chronic pain in any pain management office. It takes only a few moments to implement, and the patient can be safely taught to effectively perform this pain control procedure at home with good expectations and results. Indications for the SPG blocks include pain of musculoskeletal origin, vascular origin and neurogenic origin. It has been used effectively in the management of temporomandibular joint (TMJ) pain, cluster headaches, tic douloureux, dysmenorrhea, trigeminal neuralgia, bronchospasm and chronic hiccup.

PMID:

8949858

[PubMed – indexed for MEDLINE]

Clin J Pain. 1990 Jun;6(2):131-6.

Am J Emerg Med. 2015 Nov;33(11):1714.e1-2. doi: 10.1016/j.ajem.2015.03.024. Epub 2015 Mar 14.

Transnasalsphenopalatine ganglion block for the treatment of postdural puncture headache in the ED.

Kent S1, Mehaffey G2.

Sphenopalatine ganglion block: clinical use in the pain management clinic.

Lebovits AH1, Alfred H, Lefkowitz M.

Author information

Abstract

Clinical experience with the sphenopalatine ganglion (SPG) block combined with a review of prior studies led to conducting a retrospective evaluation of four patients with chronic pain treated with the SPG block. The review of case reports suggests the usefulness of SPG blocks in the pain management clinic.

Comment in

• Sphenopalatine block. [Clin J Pain. 1991]

Headache. 2013 Jul-Aug;53(7):1183-90. doi: 10.1111/head.12148. Epub 2013 Jun 28.

Cluster headache: potential options for medically refractory patients (when all else fails).

Tepper SJ1, Stillman MJ.

Author information

Abstract

The most evidence exists for mixed anesthetic/steroid occipital nerve blocks (which are also useful in non-refractory patients), deep brain stimulation, sphenopalatine ganglion (SPG) blocks, SPG radiofrequency ablation, and SPG stimulation with the Autonomic Technologies, Inc (ATI) SPG Neurostimulator, the latter approved in the European Union and reimbursed in several countries.

Chicago Migraine: Is Neuromuscular Dentistry and Reductions in CGRP the best Migraine Treatment?

Understanding CGRP and Why Neuromuscular Dentistry Relieves and Eliminates Migraines 

Neuromuscular Dentistry can reduce CGRP levels and reduce the number and severity of migraines and possibly eliminate migraines.

Learn more about Neuromuscular Dentistry in the  Chicago area at

 www.ThinkBetterLife.com and at www.NorthShoreSleepDentist.com

At least three  pharmaceutical companies are currently investigating drugs to block CGRP according to: Bloomberg July 21, 2015 in an article by David Wainer titled "The Pharma Industry Thinks It Finally Has A Fix For Migraines"

According to Bloomberg, "Amgen, Alder, Lilly and Teva are developing drugs aimed at erasing those episodes entirely -- at least in some patients -- by blocking CGRPs, or calcitonin gene-related peptides, which play a role in inflammation and transmission of pain.

The Calcitonin Gene-Related Peptide that the pharmaceutical companies are trying to block can be controlled by changing the neural input into the Trigeminal Nervous System.

 CGRP is  released by the Trigemino-Vascular System in the cell bodies of trigeminal nerves located with the Trigeminal Ganglion.  This is the primary source of CRGP related to headaches.  Decreasing of Nociceptive input by utilizing Neuromuscular Dentistry will prove to be a cure for many migraine sufferers.

Utilizing a Diagnostic Neuromuscular Orthotic during phase 1 treatment can determine effectiveness of Neuromuscular Dentistry in alleviating or eliminating migraines in a non-invasive manner.  Treatment is reversible if patients do not experience significant improvement or elimination of migraines.

The way Neuromuscular Dentistry affects CGRP is by removing nociceptive input to the CNS, particularly into the Trigeminal Nervous System and negating the production of CGRP.

CGRP is a potent vasodilator and works by the Trigeminal Nervous system control of blood flow to the anterior two thirds of the meninges of the brain.  This is a primary proposed mechanism in Migraine and other neurovascular pain conditions.

The drug companies want to block CGRP's that play a significant role in inflammation and transmission of pain.    They also want to partake in the estimated 8 billion dollars or more that the migraine market can generate.

According to Wikipedia:

• "In the spinal cord, the function and expression of CGRP may differ depending on the location of synthesis. CGRP is derived mainly from the cell bodies of motor neurons when synthesized in the ventral horn of the spinal cord and may contribute to the regeneration of nervous tissue after injury. Conversely, CGRP is derived from dorsal root ganglion when synthesized in the dorsal horn of the spinal cord and may be linked to the transmission of pain."

If the drug companies treat with CGRP blocking agents will this adversely interfere with healing or could it contribute to Dementia, Alzheimers or other neurological problems.  

Correcting CGRP by changing neural input into the Trigeminal Nervous System via neuromuscular dentistry is probably the safest, most physiologic and efficient means of reducing or eliminating migraines thru reduction in CGRP Levels.

Unfortunately for Migraine patients the value of treatment with drugs is 8 Billion dollars so all research is directed toward the largest financial returns.  Effective and safe migraine alleviation and elimination with SPG Blocks and Neuromuscular Dentistry receive minimal funding for studies in spite of effectiveness.

Chicago Migraine Treatment Center: A Better Approach To The Treatment and Prevention of Migraine

There are numerous medical headache clinics in Chicago.  Diamond Headache Clinic, Robbins Headache Clinic, and the University of Chicago are among the best.  All of them utilize  the  typical medical approach to treatment of migraines and headaches of medications to alter the central nervous system.

There is another way to alter brain chemistry and that is to change the input to the central nervous system.  Changing neuro input changes the ratio of neurotransmitters at various synapses and changes brain chemistry.

The most Holistic approach to correcting brain chemistry is changing neural input to the brain.  This has no toxicities or medication side effects.  Neuromuscular Dentistry offers patients with chronic migraines new hope.

The first step in treatment is a consultation and work-up followed ay a diagnostic neuromuscular orthotic.  Patients frequently report 50-90% improvement after 1 week in the orthotic.  No pain, no meds.  There is additional improvement over time.

Additional procedures such as sphenopalatine Ganglion Blocks, Greater Occipital Nerve blocks are also both diagnostic and increase efficacy of treatment.

Treatment is only continued when patients respond.  The majority of patients show vast improvement.

The only way to find out if this healthy alternative is idel for you is to have the diagnostic orthotic made but it is possible to utilize an Aqualizer as a "Bandaid Appliance" for a short time to feel the effects prior to starting treatment.

My favorite patients are the chronic migraine patients because we know if we can relieve their pain at the first visit we can vastly improve or eliminate their pain.  It is always easier to understand a problem you can see.  Episodic migraine is actually harder to understand in a single visit than is chronic daily pain.

If you ae tired of living with Migraine Pain contact the office and we will begin the process of pain elimination.