I was pleased to see this article in print as it is rare to see self-administration of Sphenopalatine Ganglion Blocks discussed. This article discusses it in terms of ongoing care after postdural puncture headache. I have been teaching patients and their doctors how to self administer SPG blocks with cotton-tipped nasal catheters. This article give a spray technique. Please refer to my previous post comparing means of delivering SPG Blocks: https://www.sphenopalatineganglionblocks.com/management-cluster-headaches-sphenopalatine-ganglion-blocks/
This study was not for chronic headache or migraine but for a shorter term postdural puncture headache.
The Saudi Journal of Anesthesiology reported in April 2018 “Intranasal lignocaine spray for sphenopalatine ganglion block for postdural puncture headache”
They used a modified technique for treating post puncture headache with a microcatheter and lidocaine spray. The delivered the anesthetic and kept the patient supine for 30 minutes. The spray contained 10% lidocaine and two puffs were given.
Patients “are advised to keep their eyes closed while the spray is administered in their nostrils. The patients are signaled to exhale after a few seconds. The spray may cause a little nasal irritation and discomfort transiently.” “The same process is repeated through the other nostril.
“The patients are allowed to stay supine and after 30 min they are asked to gradually sit up. VAS scoring is repeated and the patients are asked about the associated symptoms if they were present before the procedure. If there is no pain relief after 1 h of nasal spray, the process is repeated. The patients are kept under observation for 24 h and then allowed to be discharged from the hospital.”
The use of nasal spray with a directed catheter and keeping patient supine makes this process more effective.
Six of 11 patients reported complete relief and remained pain free after 24 hours. Five patients needed the procedure repeated after 1 hour. Three of those patients reported no relief even with repeated administration. Overall there was a 72% rate of successful pain relief, which is still impressive for this relatively non-invasive technique.
The dosage is 40 mg lidocaine (10 mg/ puff) and is well within safety limits, even if repeated. During the procedure “The patients are administered the puff at the height of inspiration and asked to hold their breaths for a few seconds. This provides time to the drug to settle on the nasal mucosa. As the patient exhales, any residual drug in the nasal passage that is yet to settle down is exhaled out rather than being inhaled in, avoiding unnecessary anesthesia beyond the nasal passage. ”
Using this simple technique eliminates the “need of invasive alternatives such as epidural blood patch which has more complications”
The Epidural blood patch is a surgical procedure that carries the same risk as an epidural punture and it uses the patients own blood injecter over to hole in the dura. the clotting serves as a patch or seal of the dura which may work similar to a compression bandage.
They suggest that this same procedure can be self-administered by the patient at home if the pain returns. This is the first article I have seen suggesting self administration after lumbar puncture.
Treatment of Chronic and Episodic Tension Headache, Cluster Headache, Chronic Daily Headache or Chronic Migraine is far better controlled by Self-administration with the cotton-tipped nasal catheters. I prefer the use of a cotton tipped nasal catheter because they offer continual capillary feed as a more effective route of administration that is easy to perform at home but does not require staying supine.
References from original article.
1. Cohen S, Ramos D, Grubb W, Mellender S, Mohiuddin A, Chiricolo A, et al. Sphenopalatine ganglion block: A safer alternative to epidural blood patch for postdural puncture headache. Reg Anesth Pain Med. 2014;39:563. [PubMed] 2. Kent S, Mehaffey G. Transnasal sphenopalatine ganglion block for the treatment of postdural puncture headache in obstetric patients. J Clin Anesth. 2016;34:194–6. [PubMed] 3. Schaffer JT, Hunter BR, Ball KM, Weaver CS. Noninvasive sphenopalatine ganglion block for acute headache in the emergency department: A randomized placebo-controlled trial. Ann Emerg Med. 2015;65:503–10. [PubMed] 4. Cardoso JM, Sá M, Graça R, Reis H, Almeida L, Pinheiro C, et al. Sphenopalatine ganglion block for postdural puncture headache in ambulatory setting. Braz J Anesthesiol. 2017;67:311–3. [PubMed] 5. Nair AS, Rayani BK. Sphenopalatine ganglion block for relieving postdural puncture headache: Technique and mechanism of action of block with a narrative review of efficacy. Korean J Pain. 2017;30:93–7. [PMC free article] [PubMed]