Sphenopalatine Nerve Block

Laryngoscope. 2006 Aug;116(8):1447-50.

Sphenopalatine endoscopic ganglion block: a revision of a traditional technique for cluster headache.

University of Milan, Via di Rudini 8, 20100 Milan, Italy. giofel@tiscali.it

The diagnosis of chronic cluster headache (CH), the most painful form of headache, is based on typical clinical features characterized by strictly unilateral pain with no side shift and ipsilateral oculofacial autonomic phenomena. The attacks occur several times a day for periods of 1 to 2 months in the episodic form of the disease or less frequently on a daily basis in the chronic form. The pathogenesis of CH involves the activation of parasympathetic nerve structures located within the sphenopalatine ganglion (SPG), which explains many of the associated symptoms, whereas the activation of the ipsilateral hypothalamic gray matter may explain its typical circadian and circannual periodicity. A number of surgical approaches have been tried in cases of chronic CH resistant to pharmacologic therapy, of which SPG blockade has been shown to have certain efficacy. We have adopted a new technique based on endoscopic ganglion blockade that approaches the pterigo-palatine fossa by way of the lateral nasal wall and consists of the injection of a mixture of local anesthetics and corticosteroids, which was performed in 20 selected patients with chronic CH, according to the International Headache Society criteria (18 male, 2 female; mean age 40 yr), who were selected for SPG blockade because they were totally drug resistant. The symptoms improved significantly, but always only temporarily, in 11 cases. These results should be considered rather good because, unlike other frequently used techniques, SPG blockade is not invasive and should therefore always be attempted before submitting patients to more invasive surgical approaches.

PMID: 16885751

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J Neurosurg. 1997 Dec;87(6):876-80.

Efficacy of sphenopalatine ganglion blockade in 66 patients suffering from cluster headache: a 12- to 70-month follow-up evaluation.

Sanders M, Zuurmond WW.

Department of Anesthesiology, Spaarne Hospital, Haarlem, The Netherlands.

This study was conducted to evaluate the efficacy, based on 12- to 70-month follow-up data, of radiofrequency (RF) lesions of the sphenopalatine ganglion made in patients suffering from cluster headache. Sixty-six patients suffering from either episodic (Group A, 56 patients) or chronic (Group B, 10 patients) cluster headache who were not responsive to pharmacological management were treated by RF lesioning in the sphenopalatine ganglion. Complete relief of pain was achieved in 34 (60.7%) of 56 patients in Group A and in three (30%) of 10 patients in Group B. No relief was found in eight patients (14.3%) in Group A and in four (40%) in Group B. The mean time of follow up was 29.1 +/- 10.6 months in Group A and 24 +/- 9.7 months in Group B, ranging from 12 to 70 months. With regard to side effects and complications, temporary postoperative epistaxis was observed in eight patients and a cheek hematoma in 11 patients; a partial RF lesion of the maxillary nerve was inadvertently made in four patients. Nine patients complained of hypesthesia of the palate, which disappeared in all cases within 3 months. The authors conclude that RF lesioning in the sphenopalatine ganglion via the infrazygomatic approach may be performed in patients suffering from cluster headache that does not respond to pharmacological therapy.

PMID: 9384398

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Acta Anaesthesiol Belg. 1981;32(1):101-7.

Cluster headache and sphenopalatine block.

1. Cluster headache is a severe unilateral head or facial pain, which lasts for minutes or hours, commonly associated with ipsilateral lacrimation and blockade of the nostril. It usually recurres once or more daily for a period of weeks or months, separated by intervals of freedom. The sphenopalatine ganglion seems to play a very important role in its pathology, 2. We created a technic of alcohol infiltration of this ganglion through a supra-zygomatic way, based on the research of the maxillary nerve by neurostimulation and the bone contact with the pterygoid process. 3. We observed a relief of pain and parsympathetic disturbances in more than 85% of our 120 cases, with a follow up between 6 months and 4 years. 4. Results obtained are discussed and analysed in connection with the definition of cluster headache. (Acta anaesth. belg., 1981, 32, 101-107).

PMID: 7293708

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