MiRx Protocol: Amazing Treatment Results (video) after SPG Blocks.

MiRx Protocol: Amazing Treatment Results (video) after SPG Blocks.

Sphenopalatine Ganglion Block for Sympathetically maintained pain, Migraine & Headache Relief

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https://www.youtube.com/watch?v=n7fQKStzAUo
Additional Videos:
https://www.youtube.com/channel/UCk9Bfz6pklC7_UluWFHzLrg/videos

The sphenopalatine ganglion (SPG) is known by many names including Pterygopalatine ganglion, the nasal ganglion, Meckel's Ganglion and Sluder's Ganglion. The Sphenopalatine Ganglion is a nerve bundle located deep behind the face, at the posterior nasal cavity of the nose. It is part of the autonomic nervous system as well as part of the brain located outside of the calvarium. For over 100 years, the SPG has been a clinical target to treat severe headaches (Sluder 1908). Sluder's early description has often been thought to be the first description of TMD and /or Cluster headaches. Since Sluder first described the application of cocaine or alcohol to the SPG, the SPG has been a site for the treatment of severe headache pain. It was made popular in 1986 after publication of the best selling book, "Miracles on Park Avenue" that described the practice of Miltion Reder, a New York City ENT who was known for Miraculous results of all types of chronic pain problems by utilizing SPG Blocks. Dr Reder utilized liquid cocaine which was first used in medicine as the very first dental anesthetic. Currentl, lidocaine and other agents to the SPG to achieve a nerve block (Kudrow, Kudrow et al. 1995; Maizels, Scott et al. 1996; Maizels and Geiger 1999).

PterygoPalatine Ganglion Blocks (SPG) was tested in patients with migraine (Tepper, Rezai et al. 2009) and cluster headache (Ansarinia, Rezai 2010). which showed acute stimulation of the SPG led to rapid termination of severe headache pain.

The MiRx Protocol utilizes the TX360 device to deliver anesthetic to the area of nasal mucosa that overlies the Sphenopalatine ganglion.

There are currently three FDA approved devices for delivering SPG Blocks. Only the TX360 can be called MiRx protocol due to trademark issues. The Sphenocath and the Allevio devices also are catheter deliveries of anesthetic over the area of the SPG.

The Sphenopalatine ganglion nerve block has been made is easier to preform in some patients with these new devices. They are all, in effect, highly effect "SQUIRT GUNS" that shoot anesthetic of any type to the area of the Spheonpalatine Ganglion. All three require the patient to lie Supine (on Back) for 20-30 minutes with each application.
This procedure is relatively quick and easy quickly and usually not uncomfortable.. SPG Blocks safe cost effective methods of treating and preventing migraines, cluster headaches and chronic daily headaches.

Sphenopalatine Ganglion Blocks can often offer Immediate or almost instantaneous relief. he results are immediate. Blocks of the sphenopalatine ganglion nerve are extremely effective and with repeated applications can dramatically increased the duration of migraine and headache relief.

Older techniques for doing the Sphenopalatine Ganlion (SPG) often have many advantages over these new "SQUIRT GUN" DEVICES.

The headache relief associated with older procedures can be good, excellent and even miraculous. Some patients experience instant relief regardless of the technique used but repeated applications over time increase he effectiveness regardless of the type of application.

https://www.youtube.com/watch?v=nqfLLwZpCo0

https://www.youtube.com/watch?v=DCPLDRJ2twg

Transnasal Technique:is the one originally utilized by Sluder and by Dr Milton Reder. The original procedure was done in physicians offices. Currently, the nasal catheter with cotton tipped applicator is probably the best method available for treating patients. The trans-nasal technique utilized capillary action to steadily and continually deliver anesthetic to the area of the Sphenopalatine Ganglion. This technique does not require the patient to lay supine for long periods but works even while the patient is upright and moving around. You can talk on the phone, use your computer or even cook and eat breakfast while utilizing one of the most effective treatments known.
While all this seems too good to be true the real advantage to the trans-nasal technique is that it is available to the patient whenever necessary even at the very first signs of discomfort. It can be used prophylactically by the patient. It does not require a visit to the physician's office and doesn't cost $750.00 to $1200.00.

https://www.youtube.com/watch?v=IOJTPQEGr1w

https://www.youtube.com/watch?v=B4ZjUM6jeAM

https://www.youtube.com/watch?v=c8fzoKa0agE

Once a patient is taught the trans-nasal SPG Block the cost per application is as little as $1.00 per application. In my office I charge $650-$750 for initial application, teaching of the technique and giving the patient supplies for up to 100 bilateral blocks

The nasal catheter continuous capillary feed action method is by far the best route of administration for most patients but does have one disadvantage if the patient has very narrow tortuous nasal cavities. This can usually be easily overcome by application or Afrin Nasal Spray (Oxymetazoline). This shrinks the nasal tissues significantly making cotton-tipped nasal catheter insertion very easy.

I have had a few patients that cannot utilize the nasal catheter delivery device and I have taught them to utilize the Spenocath Device at home. The Sphenocath is easy enough for patients to utilize at home. The cost of any of the new the devices is approximately $75.00 per device.

There are multiple injection approaches that can be done relatively easily. The Greater Palatine Foramen is located at the back of the hard palate and can be easily reached by a small gauge needle. Usually, dentists and ENT's are the only health care professionals capable of doing these blocks via the intra-oral approach. These blocks are routinely utilized during extractions of maxillary teeth as a routine method of numbing the palate. Once the palate is numb it is ver easy for the dentist to deliver a highly effective and therapeutic dose through the canal.

https://www.youtube.com/watch?v=7U11_-bl_og

https://www.youtube.com/watch?v=31mpCl7lReM

The Supra-Zygomatic injection is probably the most comfortable and easies method of doing SPG blocks and are so effective due to direct application over the ganglion.

The lateral approach can be done by injecting through the space between the condylar neck of the mandible and the coronoid process or through the masseter muscle. There are advantages to these approaches in specific patients.

The use of fluoroscopy to guide the blocks is sometimes utilized by interventional radiologists but rarely is necessary. Fluoroscopy would be the best approach to implant neurostimulator electrodes or laser stimulaters.

https://www.youtube.com/watch?v=Uzb9dB0JbT8

https://www.youtube.com/watch?v=hpB2FxVyb5c

Ira L Shapira DDS, D,ABDSM, D,AAPM, FICCMO
Chair, Alliance of TMD Organizations
Diplomat, American Academy of Pain Management
Diplomat, American Board of Dental Sleep Medicine
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
www.ThinkBetterLife.com
www.DelanyDentalCare.com
www.IHateCPAP.com
www.iHateHeadaches.org
www.SleepandHealth.com
www.SphenopalatineGanglionBlocks.com


#MiRX,  #MiRXprotocol ,  #allevio , #spenocath , #TX360 ,  #SPG ,  #SPGBlock ,  #pterygopalatineganglion block, #sphenopalatineganglionblock ,  #Sluder 'sganglion,  #nasalganglion ,  #miraclesonParkAvenue ,  #miraculousmigrainerelief ,  #miraculousmigraineprevention ,  #migraineprophylaxis ,  #sludersneuralgia ,  #sphenopalatineganglionneuralgia ,  #pterygopalatineganglionneuralgia ,#migrainespgblock, 

Quality of Life Considerations in Migraine and Chronic Daily Headache Treatment

This was originally published as a Blog for www.ThinkBetterLife.com and my Highland Park Illinois office that serves Highland Park, Lake Forest, Dererfield, The entire North Shore, Chicago, Lake County and Cook County. The office is conveniently located on the Metra line North at the Fort Sheridan stop.  The office is dedicated to treatment of Chronic pian, TMJ disorders and sleep disorders including migraines, trigeminal neuralgia, and chronic daily headaches.

Migraines, Chronic Daily Headaches, Tension Headaches and the Trigeminal Autonomic Cephalgias are all extremely invasive and disruptive to overall quality of life.

Medications to treat these disorders are often dangerous and have multiple side effects that range from minor to life threatening.

Medication Overuse Headaches and Rebound Headaches can actually be worse than the original problem the medications are used to treat. Even ubiquitous drugs like Ibuprofen are responsible for thousands of deaths on a yearly basis and a host of GI problems.

The two ways to approach headaches treatment is to prevent the onset or to treat the actual headache when it occurs.

Preventing the onset can be the avoidance of headache triggers and /or drug treatment.

I am not discussing drugs for treating migraines in this paper but rather alternative to stand drug therapies.

An excellent alternative that is more effective than most drugs for most people is the Sphenopalatine Ganglion Block. There are several methods of preforming SPG Blocks some of which require a visit to the doctor and others that can be preformed by the patient in the comfort of their own homes. The Sphenopalatine Ganglion is the largest parasympathetic ganglion in the head. The block turns off sympathetic overload often called the Fight or Flight reflex that can be a major headache/migraine trigger.

The best method is the intranasal approach by the patient to be reviewed later in this article.

There are multiple methods of injection. The injection thru the Greater Palatine foramen is an intraoral injection that is routinely used in dentistry. Oral Surgery procedures often require this block for removing wisdom teeth. Many patients who have maxillary wisdom teeth removed experience a respite from migraines often for an extended time. More often than not the migraine relief is from the block not the removal of the teeth. The block can be done just to turn off a severe headache or as a migraine preventive. It is often accompanied by temporary facial numbness and numbness of the palate.

Injection can also be done extraorally either from above the zygomatic arch or through the masseter muscle. I prefer the approach that avoids the muscle. It is a relatively easy injection and can be done in the office. It is also done by some doctors using video fluoroscopy but that gratly increases the cost. This method of injection is the most effective and fastest onset often relieving the headaches in a minute or two.

This is ideal SPG approach for headaches that would put patients in the ER, migraines or severe headaches of several days duration, and especially headaches related to anxiety, stress and worry.

There are also three devices that can deliver local anaesthetic to the nasal mucosa that overlies the Sphenopalatine Ganglion. The three devices are the TX360 nasal applicator using the MiRX protocol. Its is intended for use for Trigeminal Neuralgia, Migraines, Cluster Headaches and Tension Headaches. It is essentially a high tech double barreled squirt gun that is designed to deliver anesthetic solution over the area covering the Ganglion.

The Sphenocath and the Allevio devices are simpler to use and may deliver the anaesthetic solution in a slightly superior position. The Sphenocath is the original device and the Allevio is a copy made by the Sphenocath ‘s original manufacturer.

My preferrd method when nasal passages are large enough is to utilize hollow cotton tipped applicators that use a capillary action to continually deliver anaesthetic over a longer period of time.

The beauty of this approach is that patients can self apply the block in minutes at an extremely low cost. They can turn off the headache faster than any drugs take effect and Lidocaine or other anesthetic can be used.

Side effects are feeling relaxed, turning off fight or flight response, reduced anxiety, increased parasympathetic actiity such a digestion, feelings of warmth and comfort, increased sexual desire and responsiveness, lower blood pressure and other positive effects.

The most effective method of eliminating triggers is through a diagnostic neuromuscular orthotic that can be created to decrease noxious input to the trigeminal nervous system that causes headache. The diagnostic appliance allows evaluation of the effect in a safe and cost effective approach prior to comencine and dental, orthodontic or orthopedic interventions.

The combination or SPG Blocks and Neuromuscular Dentistry may be the closest we will ever come to curing migraines and other trigeminal type headaches.

Drug treatments are directed at changing neurotransmitter and neuropeptide levels by drug interaction. Neuromuscular Dentistry and SPG Blocks do it by restoring homeostasis and eliminating noxious input to the trigeminal nervous system.

The noxious input causes the ultimate release of neuropeptides by the TrigeminoVascular System like CGRP or Calcitonin gene Related Peptide in the meninges in the anter two thirds of the brain which cause vascular headaches,

It also corrects input to the trigeminal cervical complex that is responsible ofr occipital headaches, while at the same time postural corrections of the head reduce excess cervical muslce activity and makes the spine, especially C1 and C@ or the Atlas and Axis more stable. The mechanics have been well explained in the Quadrant Theorem of Guzay.

LAKE FOREST: TENSION HEADACHES, CHRONIC DAILY HEADACHE, MIGRAINE, CLUSTER HEADACHE AND CHRONIC MIGRAIN

Diagnosis of a particular type of headache is often the worst event for a headache patient.  All headaches are multifactorial and there are many aspects to prevention and treatment.  Unfortunately once the headaches are labeled many patients experience their doctors wearing Blinders and all diagnosis and treatment decisions are outside of the blinders are never considered.  At my new office in Highland Park I take an open approach to chronic pain.  The labels do not help and often interfere with treatment. Visit www.thinkbetterlife.com the website for my HighlandPark office.

There is one common thread to almost 100% of all chronic headaches, the involvement of the Trigeminal Nerve. There is no universal agreement on the sequence or causes of headaches but there is agreement that there are various triggers to most headaches.

Effective Treatment to Prevent, Treat and Eliminate the spectrum of headaches should include a primary Trigeminal Component.

Our nervous system has a Somatic Division which is divided into Sensory and Motor Nerves and an Autonomic component which has a Smpathetic and Parasympathetic components.

Before discussing more common headaches and migraines lets consider a special group of headaches called the Trigeminal Autonomic Cephalgias that includes Cluster Headaches, Paroxysmal Hemicrania and the SUNCT / SUNA headaches or Short Unilateral Neuralgiaform Headache with Conjuctival Injection. All of these often present with severe sudden onsets and initially should be evaluated with either/or CAT Scans and MRI’s to rule out tumors and/or vascular bleeds. I will discuss these special autonomic headaches in more detail in a future post. These headaches frequently can be prevented and allieved in many cases by Neuromuscular Dentistry and by changing Trigeminal Input with a Diagostic Orthotic. More information can be found at www.ihateheadaches.org and http://www.neurology.org/content/74/11/e40.full

Another special type of headache or cranial pain disorder is Trigeminal Neuralgia or Tic Douloureux known for sudden stabbing pain usually unilaterally in the face. Tic Doulourex is considered one of the most severe types of pain a person can experience earning it the name “The Suicide Pain” because of patients taking their life. Trigeminal Neuralgia will also respond to initial treatment with a Neuromuscular Diagnostic Orthotic though radical (and dangerous) therapy may be required.

Tension headaches, muscle spasm headaches, chronic daily headaches, cervicalgia headaches, sinus headaches, TMJ headaches are some of the names given to pain coming primarily from muscles. I would characterize this group of headaches as MPD or Myofascial Pain and Dysfunction in nature. It is associated with taut muscle band and trigger points. The primary cause of all of these in the head and neck is repetitive strain injuries and are ideally treated with Neuromuscular Diagnostic Orthotics as The First Line of treatment. Correction of underlying orthopedic and functional conditions can lead to a lifetime of better health. This treatment is often called TMJ treatment but that is always an oversimplification.
The postural train goes from the jaws to the feet (or hips when sitting) and changes in one area affect all areas. The terms Cranial Sacral Therapy, Sacral Occipital Therapy, and the fields of Chiropractic Medicine, Osteopathic Medicine Physiatry, Physical Therapy, and Naprapathy are all about treating problems between the reset points. Correction of end points are necessary for long term results.

The three endpoints are the bite including the upper and lower jaws including the TMJoints, the feet when standing and the hips when sitting. It is incredibly important to stabilize end points.

The Jaw is the single most important end-point in regards to headaches. This is because it is home to the majority of Trigeminal Nerve input to the brain. The Trigeminal nerve accounts for over 50% of all input to the brain after amplification by the Reticular Activating System. If Nociceptive (painful) inputs are brought into the brain chronic headaches is a frequent outcome. In computer lingo “Garbage in….Garbage Out” where Garbage is pain. The Trigeminal nerve innervates the teeth, the periodontal ligaments, the jaw joints, the jaw muscles, the tongue, soft palate, uvula, the tensor of the ear drum, the muscle that opens and closes the eustachian tube, the lining of the sinuses and MOST IMPORTANT, the Trigeminal Nerve controls the blood flow to the anterior two thirds of the meninges of the brain. This is the connection to all vascular and neurogenic headaches including previously discussed Autonomic Trigeminal Cephalgias and Trigeminal Neuralgia.

All headaches are basically primary or secondary results of input-output errors of the information the Trigeminal Nerve brings into the brain. This input causes chemical changes in the brain through the synapses. This changes blood flow and muscle function, posture, breathing and more.

The NHLBI of the NIH published a report”The Cardiovascular and Sleep -Related Consequences of TemporoMandibular Disorders"  discussing the wide spread affects of TMJ disorders. www.nhlbi.nih.gov/files/docs/workshops/tmj_wksp.pdf
This should be read by all headache patients.

I n the past I have seen patients who have lived with chronic pain for most of their lives only to find out there was treatment that could relieve their pain.  One patient had continuous headaches for over fifty years in spite of being married to a physician.  After two visits she was out of pain but also very angry.  Why did she have to live with constant headache pain when treatment was so simple.  The reason is what I call circle of knowledge.  There are thousands of excellent, well educated physicians and specialists who love helping patients and stay abreast in their knowledge.  Unfortunately, even the best and brightest don't know what they don't know.  Often, they have seen a failure in one patient and assume it applies to all patients.

Each patient is unique as is the source and causes of their pain.  A good physician listens to their patients, hears what they express and believes what their patients tell them.  Many patients feel like their doctors don't believe them about the severity of their pain which is very frustrating. 

Cluster Headaches and Teeth Grinding

Dan:     I have been diagnosed with Chronic Cluster Headaches. I also grind and clench my teeth at night. My pain is on the right side always.

Dr Shapira Response,

Good News, Neuromuscular Dentistry may help control or eliminate your cluster headaches.

Sorry to hear about your headaches.  While the causes of Cluster Headaches are not well understood they are unquestionably related to the Trigeminal Nerve, the same nerve responsible for TMJ disorders and headache, sinus pain, facial pain and related symptoms.

We know that 100% oxygen can relieve classic cluster headaches.  We also know that almost all nocturnal  clenching and grinding of the teeth is related to sleep disordered breathing that causes oxygen desaturation and disturbs hormonal systems.  The connection is critical.

Much of the literature on cluster headaches point to a hormonal link.  When sleep is disturbed most of the bodies hormonal systems go into malfunction.  Especially Growth hormone, melatonin, thyroid, sex hormones, insulin resistance and cortisol.

TMJ disorders and sleep disorders both upset the functions of our circadian clocks that are also implicated in cluster headaches.  

A thorough diagnosis by a trained Neuromuscular Dentist(ideally a Fellow or Master of ICCMO due to advanced  training and commitment to the science) would be an excellent first step.  The use of a Neurmucular Diagnostic Orthotic may by itself eliminate or greatly improve your symptoms. I would strongly suggest you take a broader approach and also seek out a Board certified Diplomat in Dental Sleep Medicine trained in treating sleep disordered breathing and sleep apnea.  Correcting sleep disordered breathing whether it is snoring or sleep apnea or anything between can have dramatic effects on your cluster headaches.

This will address the trigeminal nervous system which contributes over 50% of input to the brain after the reticular activating system.  The sleep treatment will eliminate or minimize circadian disruptions.  It will also allow hormonal systems to be properly regulated and will eliminate the oxidative stress of repeated hypoxias (drops in oxygen).

A doctor trained in Sphenopalatine Ganglion blocks and trigger point injections can offer additional methods of eliminating your cluster headaches.  Diplomats of the American Academy of Pain Management understand the complex nature of chronic pain.  Be wary of doctors who only "throw medications" at the problem because they often only treat the symptoms and not the underlying causes of the disorder.

Good Luck

Ira L Sahpira DDS, D,ABDSM, D,AAPM, FICCMO

This new abstract from PUBMED.gov explains how Trigeminal Nerves can be affected by reactive oxygen, exactly as created by sleep disordered breathing.

Headache. 2014 Mar;54(3):472-84. doi: 10.1111/head.12301. Epub 2014 Feb 11.

Reactive oxygen species induce procalcitonin expression in trigeminal ganglia glia.

Raddant AC1, Russo AF.

Author information

Abstract

OBJECTIVE:

To examine calcitonin gene-related peptide (CGRP) gene expression under inflammatory conditions using trigeminal ganglia organ cultures as an experimental system. These cultures have increased proinflammatory signaling that may mimic neurogenic inflammation in the migraine state.

BACKGROUND:

The trigeminal nerve sends peripheral pain signals to the central nervous system during migraine. Understanding the dynamic processes that occur within the trigeminal nerve and ganglion may provide insights into events that contribute to migraine pain. A neuropeptide of particular interest is CGRP, which can be elevated and play a causal role in migraine. However, most studies have overlooked a second splice product of the Calca gene that encodes calcitonin (CT), a peptide hormone involved in calcium homeostasis. Importantly, a precursor form of CT called procalcitonin (proCT) can act as a partial agonist at the CGRP receptor and elevated proCT has recently been reported during migraine.

METHODS:

We used a trigeminal ganglion whole organ explant model, which has previously been demonstrated to induce pro-inflammatory agents in vitro. Quantitative polymerase chain reaction and immunohistochemistry were used to evaluate changes in messenger ribonucleic acid (mRNA) and protein levels of CGRP and proCT.

RESULTS:

Whole mouse trigeminal ganglia cultured for 24 hours showed a 10-fold increase in CT mRNA, with no change in CGRP mRNA. A similar effect was observed in ganglia from adult rats. ProCT immunoreactivity was localized in glial cells. Cutting the tissue blunted the increase in CT, suggesting that induction required the close environment of the intact ganglia. Consistent with this prediction, there were increased reactive oxygen species in the ganglia, and the elevated CT mRNA was reduced by antioxidant treatment. Surprisingly, reactive oxygen species were increased in neurons, not glia.

CONCLUSIONS:

These results demonstrate that reactive oxygen species can activate proCT expression from the CGRP gene in trigeminal glia by a paracrine regulatory mechanism. We propose that this glial recruitment pathway may occur following cortical spreading depression and neurogenic inflammation to increase CGRP nociceptive actions in migraine.

© 2014 American Headache Society.

KEYWORDS:

calcitonin gene-related peptide; migraine; procalcitonin; reactive oxygen species; trigeminal ganglion

PMID:

 

24512072

 

[PubMed - indexed for MEDLINE] 

PMCID:

 

PMC3947709

 [Available on 2015/3/1]

Related citations

Study Shows that Cluster Headaches Mediated By Trigeminal Nerve

This study confirms the role of the trigeminal nerve in cluster headaches. A diagnostic neuromuscular orthotic is a reasonable and positive step in confirming not only trigeminal involvement but may alleviate or eliminate cluster headaches. A negative result from a neuromuscular diagnostic orthotic can be followed by addition of a SPG block with safe lidocaine.

In my experience almost all patients have a positive response to SPG blocks (spenopalatine ganglion blocks) or neuromuscular orthotics. Combination of these treatments brings about almost universal sucess of varying levels.

Neurology. 2012 Mar 14. [Epub ahead of print]

Lateralized central facilitation of trigeminal nociception in cluster headache.

Holle D, Gaul C, Zillessen S, Naegel S, Krebs S, Diener HC, Kaube H, Katsarava Z, Obermann M.

Source

From the Department of Neurology (D.H., C.G., S.Z., S.N., S.K., H.-C.D., Z.K., M.O.), University of Duisburg-Essen, Essen; and Interdisciplinary Pain Center (H.K.), University of Freiburg, Freiburg, Germany.

Abstract

OBJECTIVE:

To investigate whether central facilitation of trigeminal pain processing is part of the pathophysiology of cluster headache (CH).

METHODS:

Sixty-six patients with CH (18 episodic CH inside bout, 28 episodic CH outside bout, 20 chronic CH) according to the International Classification of Headache Disorders-II classification, as well as 30 healthy controls, were investigated in a case-control study using simultaneous recordings of the nociceptive blink reflex (nBR) and pain-related evoked potentials (PREP) following nociceptive electrical stimulation on both sides of the forehead (V1).

RESULTS:

nBR latency ratio (headache side/nonheadache side) was decreased in all CH patients independent from CH subtype compared with healthy controls indicating central facilitation at brainstem level. Area under the curve ratio was increased in patients with episodic CH inside bout only. PREP showed decreased N2 latency ratio in patients with chronic CH indicating central facilitation at supraspinal (thalamic or cortical) level.

CONCLUSIONS:

Asymmetric facilitation of trigeminal nociceptive processing predominantly on brainstem level was detected in patients with CH. This alteration is most pronounced in the acute pain phase of the disease, but appears to persist in remission periods. Only chronic CH patients show additional changes of PREP prompting to supraspinal changes of pain processing related to the chronic state of disease in regard to neuronal plasticity, which exceeds changes observed in episodic CH.

PMID:

22422891

[PubMed - as supplied by publisher]

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.

Bakbak B, Gedik S, Ekinci Koktekir B, Okka M.

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]

Olszewska-Ziaber A, Ziaber J, Rysz J.

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]

Publication Types, MeSH Terms, Substances