How Long Does A Sphenopalatine Ganglion (SPG) Block Last? What is the Best Method to Extend Headache and Migraine Relief?

The duration of action will vary with both the method of delivery, the anesthetic utilized and characteristics of the individual patients.

The new tran-snasal catheter delivery devices all deposit anesthetic over the mucosa covering the pterygopalatine fossa. The three devices are the Sphenocath, the Allevio and the TX360 used in the MiRx protocol.

All three of these devices are basically medical squirt guns that deliver liquid anesthetic which passes thru tissues and into the ganglion. The correct positioning and delivery is important with these devices, but it is also important how the the patient remains supine (on their back) after delivery. Ideally a minimum of ten to twent minutes is best.

I routinely utilize lidocaine2% because of safety and extremely low toxicity as well as the fact that lidocaine has anti-inflammatory effects. Other types of anesthetic include mepivicaine, Bupivacaine Hydrochloride (marcaine) and articaine. These can be done with or without vasoconstrictors which help the anesthesia last longer. If pepeated anesthetic relieve all or most of the pain on multiple occasions an alcoholblock will last for 3-6 months.

An important factor is the frequency of Sphenopalatine ganglion blocks. Typically there is two weeks between applications of anesthetic with all three devices.

Injection techniques tend to give more extended relief which can be increased by using longer lasting anesthetics. It is possible to utilize an intra-oral injection through the Greater Palatine Foramen, a procedure that dentists and ENT’s are trained and comfortable with oral injections. In general dentists are more gently in giving these injections than any other medical professional.

Extra-oral injections can be done with radiographic guidance though it is rarely needed for delivery of anesthetic. The suprazygomatic approach is very easy to preform without radiographic guidance and is actually far easier than a mandibular trigeminal block that dentists do on a daily basis. Injection techniques should be tried on patient who do not respond to topical nasal application before giving up on SPG Blocks.

How long does an SPG Block last? The more times the block is repeated success is seen to improve with repetitive use.

To really extend the duration of pain relief the best approach is to treat all patients to self-administer SPG Blocks on a regular basis. My patients typically begin doing the blocks twice a day initially.

Self-administration on a daily or twice daily basis will give the longest acting relief. More important to patients is that they can do it as often as necessary to maintain a high quality of life.

Quality of life improves with pain relief but self administration has another important aspect, it gives the patient control of their pain. Relief is usually almost instananeous or within seconds to minutes.

SPG Blocks are not only used to treat chronic headaches, migraines and TMJ disorders but also problems like depression, anxiety, and stress reactions.  Patients who self-administer with cotton-tipped nasal catheters can easily do blocks two or more times daily without having their lives disrupted by trips to physician or emergency rooms.  Self administration offers continual capillary feed of anesthetic to the area of the sphenopalatine ganglion keeping a high continuous level of anesthesia.

My personal experience is that patients need SPG Blocks less over time when doing self-administration.  Because they are so easy to do and minimally expensive there are  no barriers to using them as frequently as needed.  This is very comforting to patients who when relieved of pain and the stress of knowing they will be in pain again begin to feel safe and secure.  The fact that costs of doing a self -administered block is less than $1.00 per application it becomes affordable for patients without insurance or who do not receive coverage.  They can utilize these blocks as often as needed without financial strain.  The initial appointments are the only financiacial burder but typically the cost for a consultation, exam, initial block and supplies for 100 self-administered block is about $1250 dollar total.  Additional supplies are less than $100 for an additonal 100 bilateral blocks, or less than $1.00 per block.

The real savings are due to emergency room and physician visits that are no longer needed.  The ability to control pain and avoid needless suffering is priceless.

How long does a Sphenopalatine Ganglion Block Last?

Hours to days and sometimes weeks.  Alcohol injections can last months.  Learning to self-administer when successful is basically means it lasts a lifetime.  This is much like the story “Buy a man a fish and he eats for a day but teach him to fish and he will never be hungry again.

The Sphenopalatine Ganglion Block addresses both the Somatosensorey and the autonomic nervous systems.  Generally it turns down autonomic sympathetic activity and increases parasympathetic activity.  The sympathetic nerves feed the “Fight or Flight reflex” while the Parasympathetic system controls the “Feed and Breed reflex” or “eat and digest reflex”.  These parasympathetic feelings are similar to how we feel playing with babies, puppies and kittens or falling in love.

Very effective for turning off stress reactions and PTSD.

Do SPG Blocks cure pain?  Yes, for some people but they are excellent at controlling and eliminating pain.

Neuromuscular diagnostic orthotics are extremely effective at controlling and eliminating pain related to TMJ disorders.  This is partially due to the use of the Myomonitor which has an amazing 50 year safety record in stimulating the trigeminal and facial nerves to relax muscles and reduce myofascial pain and nociceptin into the trigeminal nervous system  Almost 100% of all headaches are controlled by the trigeminal nervous system

The Myomonitor also acts as a Sphenopalatine Ganglion Stimulator.  The BNS 40 is a smaller Myomonitor for patient home use.  While it is FDA approved for specific uses related to TMJ disorders it can  drastically reduce and eliminate a wide variety of chronic headaches and migraines on its own but is best used inconjuction with neuromuscular orthotics.

Comments 10

  1. Julie Borschke

    Does this work for Trigeminal neuralgia? Does insurance cover these treatments?
    By spraying it in the nose does it reach the trigeminal nerve?

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      Insurance coverage may vary, it used to be well covered but is now excluded bu BCBS. Spraying in the nose is not very effective but can help. Using a nasal catheter to deliver it is more effective and can be done with Sphenocath, Allevio or TX360 device. Injections can also be utilized. My preferred method is to teach self-administration utilizing cotton-tipped catheters to my patients. This allows you to have control.
      Trigeminal Neuralgia will get partial to complete relief for most patients. Inreasing the frequency of the blocks increases the effectiveness.
      I will initially have patients utilize them twice daily and the decrease to once daily when symptoms are well controlled. Each and every patient is unique. Self-Administration is extremely cost effective over time and can avoid many trips to the ER or physicians offices.

    2. Tracy McClellan

      Yes. The day of procedure was painful. But the next 3 days were amazing, now I’ve been trying to reach my doctor to ask about frequency. He laughed at me when I asked about self administration.

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        I have been teaching patients to self administer SPG Blocks for over 30 years. Ideally, your physician should have looked into teaching self-administration instead of laughing at you. Laughing was inappropriate.

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            Dear Barbie,

            I have been utilizing Sphenopalatine Ganglion Blocks since 1986 and I been teaching patients how to Self-Administer SPG Blocks almost as long.
            I teach doctors in the US and around the world how to self-administer the blocks.

            Below is a recent abstract of a medical article on self administration.

            Please feel free to contact my office if you would like to learn the procedure.

            Rev Esp Anestesiol Reanim. 2019 Oct;66(8):447-450. doi: 10.1016/j.redar.2019.02.007. Epub 2019 Aug 5.
            Intranasal self-administration of local anesthetic (ropivacaine) for sphenopalatine ganglion block, for treatment of second trigeminal branch neuralgia secondary to maxillary sinus curettage: A case report.
            [Article in English, Spanish]
            Lima MH1, Campos MJ2, Valentim A2, Paulo L2, Rego S2, Semedo E2.
            Author information
            Trigeminal neuralgia (TN) is a severe and often underestimated facial pain that affects quality of life. Pharmacological treatment is insufficient for pain control in 30% of cases and, although intervention techniques may be effective, there is a possibility of relapse and associated complications. The second division of the trigeminal nerve (V2) runs through the sphenopalatine ganglion (SPG), which is anatomically accessible to blocking due to its superficial location in the nasal cavity. We report a clinical case of a patient with uncontrolled V2 TN that was put on ambulatory self-administered SPG block with nasal swabs soaked in 0.75% ropivacaine. In the follow-up visits, we confirmed that this adjuvant treatment provided a significant pain relief over 24hours with a decrease in the number of exacerbations.

            Copyright © 2019 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

            Adjuvant treatment; Bloqueo del ganglio esfenopalatino; Hisopo nasal; Intranasal ropivacaine; Nasal swab; Neuralgia del trigémino; Ropivacaína intranasal; Sphenopalatine ganglion block; Tratamiento adyuvante; Trigeminal neuralgia

  2. Tracy McClellan

    Will you see an out of state patient who finally found relief after 11 years of trying meds, procedures and a MVD surgery which was partially effective?

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