SPHENOPALATINE GANGLION BLOCKS ARE EXTREMELY EFFECTIVE FOR TREATING ACUTE CLUSTER HEADACHES. This article (abstract below) describes a patient with Jacob’s Disease.
A Second Article from June 2017 “Sphenopalatine Ganglion Block in the Management of Chronic Headaches” (abstract below) also discusses effectiveness of the SPG Block.
In the first paper The doctor wanted to do a SPG Block thru the Coronoid Notch but could not due to oversized coronoid process.
The doctor could have switched to introral delivery, suprazygomatic delivery or transnasal delivery but this patient was not offered those choices and therefore suffered thru the pain.
Ideally this patient would be taught self administration via cotton-tipped nasal catheters. This would have prevented the emergency room visit entirely.
The second article states”SPG blockade is a safe and effective treatment for chronic headaches such as cluster headaches, migraines, and other trigeminal autonomic cephalalgias.
It also points out that “The efficacy of SPG blockade could be related to the different techniques targeting the SPG and choice of therapeutic agents.”
I strongly believe it is not just the method of delivery that is important but also the frequency of givinh the SPG Block that is important. The reason self administration is so effective is that the patient can repeatedly give themselves block, especially toward the start of treatment.
This video is a patient disabled for 9 years with fibromyalgia, she initially gave the block twice a day for two weeks, the once a day, then twice a week and now for maintenance twice a month. https://www.youtube.com/watch?v=A5xUFtuZe_Y
: 10.1111/pme.12302. Epub 2013 Dec 17.
An unusual challenge in performing sphenopalatine ganglion block with enlarged coronoid process: Jacob’s disease.
Zarembinski C1, Graff-Radford S.
Sphenopalatine ganglion block for the treatment of cluster headache has been well-described for medically refractory cases. Technical challenges in performing this procedure via the mandibular notch can be found in patients with elongation of the coronoid process. Objectives include correlation of physical exam findings and computed tomography (CT) imaging, followed by recommendations for future treatment.
Patient had a history of cluster headache and a 35 mm interincisal opening. Initially, sphenopalatine ganglion block could not be performed via standard mandibular notch approach due to the inability to advance past superficial tissues. Subsequent CT scan revealed a congenitally enlarged coronoid process with a shortened ramus. Usage of a bite block facilitated completion of the sphenopalatine block on subsequent visit.
Patients with diminished oral interincisal opening and deviation of the jaw to one side are consistent with Jacob’s disease. Using a bite block in these patients may be critical to completion of the procedure.
Wiley Periodicals, Inc.
Cluster Headache; Elongated Coronoid Process; Jacob’s Disease; Sphenopalatine Ganglion Block
Curr Pain Headache Rep. 2017 Jun;21(6):27. doi: 10.1007/s11916-017-0626-8.
Sphenopalatine Ganglion Block in the Management of Chronic Headaches.
Mojica J1, Mo B1, Ng A2.
PURPOSE OF REVIEW:
Sphenopalatine ganglion (SPG) block has been used by clinicians in the treatment of a variety of headache disorders, facial pain syndromes, and other facial neuralgias. The sensory and autonomic fibers that travel through the SPG provided the scientific rationale for symptoms associated with these head and neck syndromes. Yet, despite the elucidation of this pathogenic target, the optimal method to block its pain-producing properties has not been determined. Clinicians have developed various invasive and non-invasive techniques, each of which has shown variable rates of success. We examined the available studies of sphenopalatine ganglion blockade and its efficacy in the treatment of cluster headaches, migraines, and other trigeminal autonomic cephalalgias.
Studies have demonstrated that SPG blockade and neurostimulation can provide pain relief in patients with cluster headaches, migraines, and other trigeminal autonomic cephalalgias. Patients with these conditions showed varying levels and duration of pain relief from SPG blockade. The efficacy of SPG blockade could be related to the different techniques targeting the SPG and choice of therapeutic agents. Based on current studies, SPG blockade is a safe and effective treatment for chronic headaches such as cluster headaches, migraines, and other trigeminal autonomic cephalalgias. Future studies are warranted to define the optimal image-guided technique and choice of pharmacologic agents for SPG blockade as an effective treatment for chronic headaches related to activation of the sphenopalatine ganglion.
Cluster headache; Hemicrania continua; Migraine headache; Paroxysmal hemicrania; Sphenopalatine ganglion block; Trigeminal autonomic cephalalgias