An older article from 1979 in Arch Phys Med Rehabil discusses use of Sphenopalatine Ganglion Blocks or SPG Blocks for treating multiple “remote effects” including “psychosomatic” symptoms.
SPG Blocks are routinely utilized to treat headaches, migraines and especially Cluster Headaches as well as other Trigeminal Autonomic Cephalgias (TAC). Sphenopalatine Ganglion Blocks may be the safest treatment for intractable headache as well.
The Sphenopalatine Ganglion is the Largest Parasympathetic Ganglion of the head and also carries Sympathetic fibers from the Superior Sympathetic Chain. One of the Autonomic Symptoms it has been shown to treat is Intractable Hiccups. Self-administered SPG Blocks are a godsend to patients allowing them to treat symptoms without visits to physicians offices or hospital emergency departments.
A newer article on intractable hiccups from February 2018 in Medicine (Baltimore) also discusses intractable headaches and states “Intractable hiccups, although rare, may result in severe morbidity, including sleep deprivation, poor food intake, respiratory muscle fatigue, aspiration pneumonia, and death. Despite these potentially fatal complications, the etiology of intractable hiccups and definitive treatment are unknown.” This study looked at 28 patients who received continuous cervical epidural blocks on patients who failed other treatments.
This treatment was done until the hiccups disappeared for 48 hours and was then stopped. Results were very successful with “.Cumulative complete remission rates were 60.71% after the first cervical epidural block, 92.86% after the second, and 100% after the third.”
Janet Travell, President Kennedy’s physician and author of the landmark book “Myofascial Pain and Dysfunction: A Trigger Point Manual” reported elimination of hiccups with injections into the Omohyoid muscles.
Another study in 2013 showed a case report of a 5 year case of hiccups relieved with HRV (Heart Rate Variability)and paced respiration Biofeedback.
If biofeedback can cure intractable headaches it is non-invasive and the treatment of choice. If it cannot the second line of treatment to be considered, in my opinion, is self-administered SPG Blocks that can be delivered minimally invasively through the nose with Lidocaine and cotton-tipped catheters giving continual capillary feed to the Sphenopalatine Ganglion (also known as SPG, Nasal Ganglion, Sluder’s Ganglion, Meckel’s Ganglion and the Pterygopalatine Ganglion).
Because it is minimally non-invasive and offers contiual feed without risks from cervical injection or Omohyoid injections (near laryngeal nerves)and it also help relieve anxiety and turn off the sympathetic fight or flight reflex it could be used in combination with biofeedback.
The side effects of SPG Blocks ar reduced anxiety and a sense of well being and it has ben shown to eliminate almost 1/3 of essential hypertension. It could also be used to treat Post Dural Headache that could arise from cervical epidural blocks. It has been shown to be as or more effective than standard treatment of epidural blood patch .
Sphenopalatine (nasal) ganglion: remote effects including “psychosomatic” symptoms, rage reaction, pain, and spasm.
Many articles implicate the nasal ganglion in the production of remote symptoms and discuss treatment. Symptoms are primarily spastic, involving both visceral and voluntary muscles including muscle spasm in the neck, shoulder, and low back; asthma, hypertension, intestinal spasm; diarrhea, angina pectoris, uterine spasm; intractable hiccup, and many others. All these symptoms appear to have 2 common denominators. They are mediated by the autonomic nervous system and at least in some instances can be “psychosomatic.” The sphenopalatine ganglion (SPG) is a major autonomic ganglion located superficially in the pterygopalatine fossa, with major afferent distribution to the entire nasopharynx and important connections with the trigeminal nerve, facial nerve, internal carotid artery plexus of the sympathetic nervous system and, as shown in the rat, direct connection with the anterior pituitary gland. This paper presents arguments supporting the following hypotheses: 1. The SPG probably has a crucial role in lower animals in declenching the reflex responses known collectively as the rage reaction. 2. The SPG is a major point of entry to the autonomic system exposed to pathologic influences and readily accessible for therapeutic influences and readily accessible for therapeutic intervention. 3. A wide variety of symptoms are produced or maintained by alteration in autonomic system tonus and some of these may be affected by intervention on the SPG. 4. The possible relationship of some symptoms and “psychosomatic” conditions to the autonomic nervous system and the rage reaction must be considered.20.
Continuous cervical epidural block: Treatment for intractable hiccups.
Intractable hiccups, although rare, may result in severe morbidity, including sleep deprivation, poor food intake, respiratory muscle fatigue, aspiration pneumonia, and death. Despite these potentially fatal complications, the etiology of intractable hiccups and definitive treatment are unknown. This study aimed to evaluate the effectiveness of continuous cervical epidural block in the treatment of intractable hiccups.Records from 28 patients with a history of unsuccessful medical and invasive treatments for hiccups were evaluated. Continuous cervical epidural block was performed with a midline approach at the C7-T1 or T1-T2 intervertebral space with the patient in the prone position. The epidural catheter was advanced through the needle in a cephalad direction to the C3-C5 level. Catheter placement was confirmed using contrast radiography. A 6-mL bolus of 0.25% ropivacaine was injected, and a continuous infusion of 4 mL/h of ropivacaine was administered through the epidural catheter using an infuser containing 0.75% ropivacaine (45 mL ropivacaine and 230 mL normal saline). When the hiccupsstopped and did not recur for 48 hours, the catheter was removed.Cumulative complete remission rates were 60.71% after the first cervical epidural block, 92.86% after the second, and 100% after the third. One patient complained of dizziness that subsided. No other adverse effects were reported.Continuous C3-C5 level cervical epidural block has a successful remission rate. We suggest that continuous cervical epidural block is an effective treatment for intractable hiccups.
Use of paced respiration to alleviate intractable hiccups (Singultus): a case report.
Heart rate variability (HRV) biofeedback is an emerging treatment for many health conditions involving dysregulation of the autonomic nervous system including hypertension, gastric pain, anxiety, and depression. Hiccups are frequently considered an annoyance. However, when intractable (lasting over 1 month), they can become debilitating, with some patients resorting to invasive treatments that often involve the phrenic nerve. Theoretically, HRV biofeedback should also provide a means to stimulate the phrenic nerve and could be an alternative option. We report the successful treatment of a 5 year-long case of intractable hiccups with one session of HRV biofeedback training. These results suggest that biofeedback may be a useful, non-invasive means of relieving intractable hiccups. No clear causality can be inferred from a single case, and further study is needed to determine if this finding has wider applicability.