Amazing Stories of Pain Relief surround Sphenopalatine Ganglion Blocks. These amazing autonomic blocks have been used for over 100 years with success. I personally began using them after the book “Miracles on Park Avenue” was published and given to me by a patient who asked me to find someone who did this in Chicago. I learned the procedure from Dr Jack Haden in Kansas City when I realized there was no one in Chicago or Illinois familiar with the procedure.
Please view this video about a patient who suffered severe pain for over ten years. This video is from the end of her first consultation visit during which I performed bilateral SPG Block.
The Sphenopalatine Ganglion is part of the Autonomic Nervous System and is the largest Parasympathetic Gangli of the head. It has both Sympathetic andParasympathetic nerves passing through it. The Sphenopalatine Ganglia is also known as the Pterygopalatine GanglioN, Meckel’s Ganglion and the Nasal Ganglion. It was first described in 1908 by Sluder as a symptom complex consisting of neuralgic, motor, sensory and gustatory manifestations that he attributed to the sphenopalatine ganglion.(see pubmed abstract below)”It is proposed that the condition described by Sluder is a neurovascular headache that most closely resembles cluster headache in its aetiology and clinical manifestations” This is amazing as SPG Blocks may still be the best method of treating cluster headaches as well as most other migraines and chronic headaches.
There are multiple approaches to delivering SphenoPalatine Ganglion Blocks. There are three recently FDA approved devices: The Sphenocath, the Allevio and the TX360 (MiRx protocol). All three are basically squirt guns allowing anesthetic to be squirted over the area of nasal mucosa overlying the area of the Ganglia. These are all utilized by a physician in his office and typically are relatively expensive and require the patient lying on their back for an extended period of time.
There are also multiple injection approaches for doing Spenopalatine Ganglion Blocks. The first is via the Greater Palatine Foramen in the posterior portion of the hard palate of the maxilla. I utilized this method for years in my office. Unfortunately, most physicians are not comfortable with this approach with the exception of ENT’s. I continue to utilize it but now primarily utilize the Supra-Zygomatic approach to Spenopalatine Ganglion Blocks which is relatively easy to teach and preform and it can give amazing results almost instantaneously in stopping a severe headache or migraine. It is my favorite injection techniqu. It is also possible to do an SPG Block that passes thru the maseter muscle which has some discomfort. I used to utilize this approach more in the past but now only use it if I am also doing trigger point injections in the maseter muscle. It is also possible to do the injection from an approach between the condylar neck and the coronoid process. These procedures can be done with or without fluoroscopy. I do not see a need to do flouroscopy or ultrasound guidance. The inferior alveolar block done daily by most dentists is a much more complicated injection when you understand the anatomy. ENT’s, Plastic Surgeons and especially Dentists who treat TMJ disorders know this anatomy extremely well.
This video is of a physician who just received his first Supra-Zygomatic approach Sphenopalatine Ganglion Block. He had no medical issues but is working with PTSD veterans and plans on using SPG Blocks to help turn off their anxiety and depression (known uses of SPG Blocks). He describes how he felt after the procedure. He wanted to experience it personally before utilizing it on PTSD Veterans.
Sphenopalatine Ganglion Blocks are basically a reset button of the brain, like hitting Control/Alt/ Delete when you computer freezes up. The next video is a patient who suffered from severe Fibromyalgia for over 9 years. This is just a couple of minutes int treatment.
The Sphenopalatine Ganglion consists of both sympathetic and parasympathetic nerves it also has a sensory root derived from the maxillary division of the trigeminal nerve. It is important to understand the the Sphenopalatine Ganglion is part of the brain located outside of the skull making it readily accessible to anesthetic. The Trigeminal nerve, as well as all other cranial nerves are actually brain cells with part of the nerve in the brain and part in the periphery. Dentists routine anesthetise the Trigeminal Nerve on every patient they numb for dental work. This is why the Sphenopalatine Gangliaon Block is well within the scope of dental practice. No one is more qualified than well trained dentists to administer this block. I taught about 100 dentist these techniques at the ICCMO meeting in 2015 in California and will be teaching it again in Buenos Aires, Argentina in March 2017. I also have small courses at my office in the technique.
The best method, in my opinion is the cotton-tipped catheter delivery method. The catheter allows continual delivery of anesthetic to the area of the Sphenopalatine Ganglion. What makes this method the most successful application is multifold. First, the patient can stand , lay down, sit, work at a computer or other activities while doing the block. What makes it most superior is that the patients can self administer the blocks as needed once or twice a day for twenty to 30 minutes or for extended periods. Even more important after initial appointment patients can self administer for about $1.00 per application. They can avoid massive amounts of extremely medication, they avoid doctors visits and trips to the Emergency room. The downside is occasional slight discomfort during application. This video has a patient, Karen who just received her first blocks and she discusses the way it felt going in.
The truly exciting news about SPG Blocks is how they are used in combination with Neuromuscular Dentistry to actually correct the underlying issues of nociception entering the Trigeminal Nervous System. THIS NOCICEPTION COMED FROM TEETH, PERIODONTAL LIGAMENTS, JAW JOINTS, JAW MUSCLES, SINUS LININGS ,MUCOSA AND GINGIVA AND FROM THE TONGUE. THIS INPUT AFTER AMPLIFICATION IN THE RETICULAR ACTIVATING SYSTEM IS OVER HALF OF ALL INPUT TO THE BRAIN.
This is the best way to reduce dangerous long and short term side effects from medications like Triptans and other medications for pain and migraines. (see pubmed abstract below) I typically use 4% lidocaine with no epinephrine or preservatives for the blocks.
The following video is a patient treated with a combination of techniques including SPG Blocks and Neuromuscular Dentistry. Her second video is about her SPG Block in American Sign Language.
These patients also had combination of Neuromusclar Dentistry and SPG Blocks
All migraines and headaches are products of the Trigeminal Nervous System.
It could be stated that the Trigeminal Nerve is the “MASTER OF THE UNIVERSE OF HEADACHE”
The entire universe of headaches is directly related to the Trigeminal Nervous System. One major system of the Trigeminal Nervous System is the Trigemino-vascular System. This is the system where the trigeminal nerve controls the blood flow to the anterior two thirds of the meninges of the brain. The control is asserted by release of vasoactive neuropeptides like CGRP or Calcitonin Gene Related Peptide.
CGRP is produced and released by both peripheral and central trigeminal neurons. CGRP is a potent vasodilator and when released by trigeminal nerves in the meninges it creates vasodilation. It is this vasodilation that cause migraines to be labeled vascular headaches.
MIGRAINES ARE ACTUALLY NEUROGENIC HEADACHES THAT LEAD INTO VASCULAR DILATION WORSENING AND PEAKING OF EFFECTS. THE VASODILATION IS SECONDARY NOT PRIMARY.
CGRP is produced primarily in cell bodies of motor neurons, and CGRP related to migraines is released by the trigeminal nerve.
THE TRIGEMINO-VASCULAR SYSTEM IS THE MASTER OF THE UNIVERSE OF TRIGEMINAL VASCULAR HEADACHES OR BASICALLY ALL HEADACHES.
The Trigeminal Nerve is often called the Dentist’s Nerve because for practical purposes dentists are the Masters of the maxillary, mandibular and ophthalmic branches of the Trigeminal Nerve.
If the Trigeminal Nerve is responsible for headaches thru the Trigemino- vascular system and trigeminal cervical complex then controlling the input that intiates headaches is certainly part of dentistry. Controlling the noxious input through the trigeminal nerve responsible for setting of vascular headaches is the dentist.
The Neuromuscular Dentist is recognized experts of working with the Trigeminal nervous system to create an occlusion based on physiologic rest. Occlusion is determined ideal when function is followed by a return to physiologic rest.
It should the be fair to assert that Neuromuscular Dentists are the Trigeminal Nervous System Specialists including the three main branches, especially the mandibular branch that include motor neurons responsible for release of CGRP which is responsible for the vascular effects seen in migraine.
Neuromuscular Dentists trained to deliver Sphenopalatine Ganglion Blocks (SPG Blocks) are also Masters of The Autonomic Trigeminal Universe.
Add to this that dentists control the structures that manage airway, balance and posture as well as the Mesencephalic Nucleus the fastest synapse and only electrical synapse in the CNS. Te mesencephalic nucleus is the proprioceptive nucleus of the trigeminal nerve.
The NHLBI of the NIH has reported on “Cardiovascular and Sleep Related Consequences of TMJ Disorders”
Putting all this information together.
Dentists are the masters of the Trigeminal Nerve
Neuromuscular Dentists are the Masters of the masters understanding input and output to the CNS through the Trigeminal Nervous System
The Trigeminal Nerve and its components the trigeminovascular system and Trigeminal-cervical complex are the masters of the universe of all headaches in addition to providing key control of basic physiologic functions such as sleep and breathing.
One can only conclude the “NEUROMUSCULAR DENTISTS ARE THE MASTERS OF THE UNIVERSE FOR PREVENTING, ABORTING AND ELIMINATING MIGRAINES.”
AS ICCMO COMPOSES THE HUB OF KNOWLEDGE FOR NEUROMUSCULAR DENTISTRY WE COULD ALSO CONCLUDE THE ICCMO IS THE HUB FOR PREVENTION, TREATMENT AND ELIMINATION OF MIGRAINES BY MEANS OF RESTORING PHYSIOLOGIC HEALTH AND HOMEOSTASIS.
THE FRINGES OF MIGRAINE TREATMENT IS THROWING DANGEROUS DRUGS AT THEM LIKE NSAIDS….KILL OVER 40,000 A YEAR, PRESCRIPTION OPIODS WHICK KILL ANOTHER 18,000 A YEAR . THE HEADACHE SPECIALISTS WHO DECLARE THAT THE BEST TREATMENT IS THROWING MORE AND MORE DRUGS AT PATIENTS IS THE ANSWER POSSIBLY SHOULD RECONSIDER THEIR POSITIONS. TRIPTANS, ARE AMAZING FOR MIGRAINE BUT ALSO CARRY RISKS. THE DRUGS THAT CARRY THE BIGGEST RISKS ARE THE OPIODS THAT OFTEN FIND THEIR WAY INTO THE HANDS OTHER THAN THE PATIENT THEY ARE PRESCRIBED FOR.
According to the CDC: ” The United States is in the midst of an opioid overdose epidemic.
Opioids (including prescription opioid pain relievers andheroin) killed more than 28,000 people in 2014, more than any year on record. At least half of all opioid overdose deaths involve a prescription opioid.
Overdose deaths involving prescription opioids have quadrupled since 1999,1 and so have sales of these prescription drugs.2 From 1999 to 2014, more than 165,000 people have died in the U.S. from overdoses related to prescription opioids.1
Opioid prescribing continues to fuel the epidemic. Today, at least half of all U.S. opioid overdose deaths involve a prescription opioid.1 In 2014, more than 14,000 people died from overdoses involving prescription opioids.”
The following information is from the ASAM: The American Society of Addiction Medicine
“Opioid Addiction Opioids are a class of drugs that include the illicit drug heroin as well as the licit prescription pain relievers oxycodone, hydrocodone, codeine, morphine, fentanyl and others.1 Opioids are chemically related and interact with opioid receptors on nerve cells in the brain and nervous system to produce pleasurable effects and relieve pain. 1 Addiction is a primary, chronic and relapsing brain disease characterized by an individual pathologically pursuing reward and/or relief by substance use and other behaviors.2 Of the 21.5 million Americans 12 or older that had a substance use disorder in 2014, 1.9 million had a substance use disorder involving prescription pain relievers and 586,000 had a substance use disorder involving heroin.3 It is estimated that 23% of individuals who use heroin develop opioid addiction.4 National Opioid Overdose Epidemic Drug overdose is the leading cause of accidental death in the US, with 47,055 lethal drug overdoses in 2014. Opioid addiction is driving this epidemic, with 18,893 overdose deaths related to prescription pain relievers, and 10,574 overdose deaths related to heroin in 2014.5 From 1999 to 2008, overdose death rates, sales and substance use disorder treatment admissions related to prescription pain relievers increased in parallel. The overdose death rate in 2008 was nearly four times the 1999 rate; sales of prescription pain relievers in 2010 were”
What is Sluder’s neuralgia?
In 1908 Sluder described a symptom complex consisting of neuralgic, motor, sensory and gustatory manifestations that he attributed to the sphenopalatine ganglion. He stated that treatment directed at the ganglion successfully alleviated these symptoms. Over the last 90 years several reports have described patients as having sphenopalatine neuralgia and have directed treatment at the ganglion. The symptoms described and the criteria for patient selection in these studies has often been varied and deviated from Sluder’s description. In reports claiming cures with treatment directed at the ganglion the duration of post-treatment follow-up has been short. This article discusses Sluder’s description and attempts to analyse its features in the light of current understanding of the different mechanisms and categories of facial pain. It is proposed that the condition described by Sluder is a neurovascular headache that most closely resembles cluster headache in its aetiology and clinical manifestations. We propose that the term Sluder’s neuralgia should be discarded as there are serious flaws in its original description and many authors have misused the term leading to persistent confusion about it.
[Myocardial infarction in a patient free of coronary artery disease].
Triptans are widely used for treating migraine attacks. Their mechanism of action is attributable to cerebrovascular vasoconstriction. Vasoconstriction can occur also in the coronary arteries. Mild chest symptoms not related to myocardial ischemia have been reported among triptan users. Severe cardiovascular events have also been reported, but they are extremely rare. There are few observational studies focusing on the cardiovascular risks of triptans. Triptans are nevertheless considered contra-indicated in patients with coronary artery disease. We report a case of zolmitriptan-induced myocardial infarction in a patient free of coronary artery disease.