Sphenopalatine Ganglion Implicated in Migraines and Cluster Headaches via Cerebrovascular Autonomic Physiology

The pathophysiology or cause of almost all headaches, migraines, cluster headaches and tension-type headache involve the Trigeminal Nerve which can effectively be treated in mane headache sufferers through neuromuscular dentistry. Another pathway of relieving chronic headache pain is by utilizing a SPG or Sphenopalatine Ganglion Block which affects the autonomic nervous system and is readily accessible to dentists with either palatal injection or nasal swab.

Newer techniques involving neurostimulation hold promise but the simple use of lidocaine on a nasal swab often produces miraculous relief for patients. When combined with a diagnostic neuromuscular orthotic a 50 - 80% success rate easily achieved in most patients. The following PubMed abstract discusses possible new avenues of addressing the sphenopalatine ganglion. I would advise patients to start with nasal or palatal block. Nasal blocks are easily learned by patients for home administration and can be used to prophylactically to abort migraines similar to triptans or topomax with fewer side effects.

Prog Neurol Surg. 2011;24:171-9. Epub 2011 Mar 21.

Sphenopalatine ganglion interventions: technical aspects and application.

Oluigbo CO, Makonnen G, Narouze S, Rezai AR.

Source

Department of Neurological Surgery, Ohio State University Medical Center, Columbus, Ohio 43210, USA.

Abstract

Recent research has highlighted the important role of the sphenopalatine ganglion (SPG) in cerebrovascular autonomic physiology and in the pathophysiology of cluster and migraine headaches as well as conditions of stroke and cerebral vasospasm. The relatively accessible location of the SPG within the pterygopalatine fossa and the development of options for minimally invasive approaches to the SPG make it an attractive target for neuromodulation approaches. The obvious advantage of SPG stimulation compared to ablative procedures on the SPG such as radiofrequency destruction and stereotactic radiosurgery is its reversibility and adjustable features. The on-going design of strategies for transient and continuous SPG stimulation on as needed basis using implantable SPG stimulators is an exciting new development which is expected to expand the clinical versatility of this technique.

Copyright © 2011 S. Karger AG, Basel.

PMID:

21422787

[PubMed - in process]

MIGRAINE PATIENTS UTILIZING TRIPTANS HAVE HIGHER CO2 LEVELS IN SLEEP. IS THIS A DANGEROUS FINDING OR A THERAPEUTIC EFFECT?

An abstract in Sleep abstract supplement "THE EFFECTS OF TRIPTANS ON RESPIRATORY DYNAMICS AND SLEEP ARCHITECTURE IN PATIENTS WHO SUFFER FROM MIGRAINE HEADACHES" found no changes in Polysomnography but did find there was a significant
finding of increased end-tidal CO2. These higher levels of CO2 may fit with the vascular theory of migraines.

On the other hand the high end-tidal CO2 values may be a significant risk factor when considering long term triptan use.

"We noted significant difference in sleep time spent with End-Tidal Co2 (ETCO2) higher than 45mmhg PLMD" ( 35.56/36.8 vs. 13.84/17.34)

Should we be concerned that there is an increasein CO2 and could it lea to long term difficulties? Maybe the higher CO@ is the therapeutic effect of triptans changing the autonomic breathing drive.

This will probably be the start of interesting research on migraine patients.