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

CONTINUOS HEADACHE FOR MONTHS!

DEBBIE: i have had a headache non stop for 21 months. i need help now!!!!!!
The doctdors can not tell me what is causing thsi, they just keep giving me drugs.

DR SHAPIRA RESPONSE: Debbie, I frequently hear stories like yours. The fact that the physicians cannot find a cause is good news. It means there isn't a brain tumor or similar organic disorder. The majority of headaches are neuromuscular in orgin and you are probably an excellent canidate for diagnostic blocks, trigger pint deactivation and a neuuromuscular orthotic that addresses the trigeminal nerve and the muscles it feeds.

You did not discuss what tests you have had or your history prior to the headache. I advise that you continual to lookfor the underlying causes of your pain.

Long term like you are experiencing can creat permanent brain changes thru central sensitization.

Glycerol injections of the Trigeminal Nerve for Cluster Headaches

Orville : I have suffered with episodic cluster migraines for years they usually come every other fall. the only thing that has helped me besides oxygen is zomig but I have to take more than the manufacturer recomends. What are the possible complications associated with Glycerol facial injections

Dr Shapira response: Glycerol injections are usually safe and effective but can have advers effects.

I have quoted a reference below that discusses adverse effects such as refractory pain that becomes non-remitting and possibly worse and unresponsive to treatment.

I would recommend utilizing Sphenopalatine Ganglion Blocks (SPG), an autonomic block that can be done transnasaly with no risk almost no risk. Patients can do SPG blocks at home to turn off or prevent attacks. Oxygen is obviously an excellent therap and can be used alone or with SPG blocks. SPG blocks before bed can often prevent an attack if they occur primarily in the night.

Taking more than rx dose of ZOMIG should be discussed with your physician.


Trigeminal Cistern Glycerol Injections for Facial Pain†
Thomas A. Waltz M.D., Donald J. Dalessio M.D., Kenneth H. Ott M.D., Brian Copeland M.D., Gaye Abbott C.M.A.-C.Article first published online: 22 JUN 2005


Headache: The Journal of Head and Face Pain
Volume 25, Issue 7, pages 354–357, October 1985
Dalessio, D. J., Ott, K. H., Copeland, B. and Abbott, G. (1985), Trigeminal Cistern Glycerol Injections for Facial Pain. Headache: The Journal of Head and Face Pain, 25: 354–357.
Publication History Issue published online: 22 JUN 2005
Article first published online: 22 JUN 2005

SYNOPSIS
The treatment of paroxysmal facial pain is often easily accomplished. At times, however, the converse occurs; the pain becomes more refractory, and unresponsive to therapy. This is especially the case when trigeminal neuralgia, cluster headache, and atypical facial pain become chronic. This report will summarize our experience with injection of glycerol into the region of the trigeminal cistern for intractable facial pain in 71 patients; 58 with trigeminal neuralgia, 5 with chronic cluster headache, and 8 with atypical facial pain.