Sphenopalatine Ganglion Blocks (SPG Blocks, Nasal Blocks or Ptreygopalatine Ganglion Blocks) are used for a wide variety of problems, most commonly headache disorders which affect almost half of the population on a yearly basis. There are multiple methods of delivering SPG Blocks but most are minimally invasive. Sphenopalatine Ganglion Blocks are one of the safest treatment for headaches available. Self-Administered Sphenopalatine Ganglion Blocks (SASPGB) with Cotton-Tipped Catheters and Continual Capillary Feed of Lidocaine have become the Gold Standard of care in the opinion of this author. They are also extremely patient friendly allowing patients to avoid emergency room visits and visits to physicians offices.
Learn to Self-Administer SPG Block and Referral: https://thinkbetterlife.com/referrals/
Why are Sphenopalatine Ganglion Block So Effective for headaches and what type of headaches do they treat?
Migraine relief and Migrane prophgylactic prevention is a key action of Sphenopalatine Ganglion Blocks. Prevention is especially responsive to Self-Administered SPG Blocks with Cotton-Tipped Catheters with Continual Capillary Feed. This bathes the mucosa over the medial wall of the Pterygopalatine fossa with 2% lidocaine for an extended period of time. Frequency of administration is important in Migraine prophylaxis.
Cluster Headaches are especially sensitive to treatment with the SPG Block. SPG Blocks are so effective for Cluster Headache that many consider them the first treatment of choice. In addition to Cluster Headaches they are also very effective for treating Migraine and all of the other Autonomic Cephalgias. It is believed that Dr Sluder who originally described SPG blocks to treat “Sluder’s Neuralgia” was describing either severe TMJ disorder or Cluster headaches.
The excellent results in treating headaches and Migraines is related to the anatomical positioning of the Ganglion on the Maxillary Division of the Trigeminal Nerve in the Pterygopalatine Fossa near the Foramen Rotunda where it exits the cranium. The important fact is that these autonomic structures travel with all of the branches of the Trigeminal Nerve which is part of every headache experienced by patients. These trigeminal nerves also travel to multiple dental structures including teeth, periodontal ligaments Temporomandibular Joints (TMJ, TM Joints) and Jaw Muscles. The autonomic fibers also travel with the trigeminal nerve and innervate the anterior 2/3 of the meninges of the brain to control blood flow, a vitally important asprect of vascular headaches. The use of Sphenopalatine Ganglion Blocks are well know among Neuromuscular Dentists as being a vital tool for helping facial pain patients with TMD (TMJ disorders) and MPD (Myofascial Pain and Dysfunction). They are especially effective in Sympathetically maintained pain (CRPS or Complex Regional Pain Syndrome) and pain associated with high stress, anxiety and worry.
Dentists who treat Orofacial pain, Craniofacial pain and Tension Headaches should have thorough understanding of these blocks and the autonomic nervous system.
The book “MIRACLES ON PARK AVENUE” was written about Dr Milton Reder an Otogenerian ENT whose entire practice was treatment of widely diverse problems with Sphenopalatine Ganglion Blocks. Patients came to Dr Reder from around the world for his treatments. His treatment protocol wFAQ, FAQ SPG Blocks, Frequently asked questions SPG Blocksapplications of Sphenopalatine Ganglion Blocks delivered Trans-nasally. For many years he utilized a cocaine solution similar the that utilized by Dr Greenfeld Sluder who first identified the Ganglion and its use in treating severe pain of migraine, tension, and cluster headaches.
What can a patient expect when they receive the Sphenopalatine ganglion block?
Each patient has an individual response to these blocks but the majority experience rapid relief of pain shortly after the Sphenopalatine ganglion block is given. The blocks do not only turn off the pain and suffering but also act to prevent future episodes of tension headaches, New Daily Persistent Headache migraines, and cluster headaches. During the procedure many patients experience immediate or nearly immediate relief from the procedure. They often refer to the rapid speed of relief as miraculous. Many patients feel a profound sense of relaxation or well being often describing the feeling of stress and/or anxiety literally melting away in minutes. The following video is of a patient who came to learn to Self-Administer SPG Blocks for severe migraine treatment and prophylaxis. What she experienced was a complete elimination of her anxiety for the first time in her entire life:
A brand new finding in 2016 & 2018 (abstracts below) is that Sphenopalatine Ganglion Blocks are capable of eliminating about one third of all Essential Hypertension. This is probably due to decreasing sympathetic overload. It is extremely important for any patients who have headaches or migraines associated with hypertension or high blood pressure.
What are the different methods of performing Sphenopalatine ganglion blocks?
This is an excellent question because it can vary widely depending on who is doing the procedure and the approach taken. There are multiple techniques of injecting the ganglion where in lies in the Pterygopalatine Fossa with anesthetic entering thru the pterygopalatine fissure. This can be done by a Suprazygomatic Approach which is extremely effective and one of the most comfortable of injection techniques. It can also be done thru the coronoid notch in front of the TM Joint which requires passing thru the masseter muscle. It is also possible to do an inferior approach.
Dentists generally have a great deal of expertise doing head and neck blocks painlessly or with minimal discomfort because they do the on a routine basis. Spenopalatine Ganglion Blocks are often done under fluoroscopy and with IV or General anethesia which is totally unnecessary and greatly increases risks to patients. This is especially true of members who utilize neuromuscular techniques and devices in treatment of TMD disorders. Members of ICCMO are highly recommended for their knowledge and commitment. www.ICCMO.org
The other injection technique is an oral administration via the Greater Palatine Foramen. ENT’s are usually the only non-dental specialists comfortable with the Greater Palatine Foramen approach. Dentists frequently utilize palatal infiltration for extractions and root canals. There have been many reports of alleviation of migraines and other headaches after extraction of maxillary wisdom teeth. This relief is probably due to inadvertant SPG Blocks and not from the actual wisdom tooth removal.
There are several Trans-nasal Approaches to doing Sphenopalatine Ganglion Blocks which are the most minimally invasive. The first is Q-tips soaked in Anesthetic, most commonly 2% lidocaine) or covered in 4% Lidocaine Gel and placed to an area adjacent to the ganglion by passing thru the nose. This is an old technique with a 100 year + history.
The major advancement is the use of cotton-tipped nasal Catheters that give continual capillary feed of anesthetic is an amazing technique that is placed in a similar matter but which has far superior results. A major advantage is that patient can place the blocks and continue to cook, clean, read, work on computers or watch television. They do not have to stay supine (on their back). It has been wrongly reported that there is lower success of SPG Blocks with the trans-nasal approach but that is only true of delivery with the q-tips not the Cotton-Tipped Catheters with Continual Capillary Feed which is my treatment of choice. When the cotton tipped nasal catheters are used there is an extremely high success rate due to the continual capillary feed that spreads across the mucous membranes that cover the medial wall of the PterygoPalatine Fossa that houses the Ganglion and the maxillary branch of the Trigeminal nerve.
There are also several devices used to preform Sphenopalatine Ganglion Blocks. This author prefers the Sphenocath over the Allevio or TX360. These devices are designed for single use in physicians offices and emergency rooms. They are preformed by physicians and the patient must remain supine (on their back) for 20-30 minutes after delivery of anesthetic. All three devices are high tech “squirt guns” that leave a puddle of anesthetic on the mucosal wall over the medial wall of the pterygopalatine fossa where the Pterygopalatine (Sphenopalatine) Ganglion is found.
How long does the relief from the Sphenopalatine ganglion block procedure last?
The duration of relief from the procedure will vary on the delivery method and the actual anesthetic medications used. A transnasal Sphenopalatine ganglion block done with a Q-tip will have a shorter duration and a less intense effect. The use of Cotton- Tipped nasal catheters actually approaches or surpasses the results and the effectiveness of injection techniques. More important the patient can repetitively preform the SPG Block procedure in the comfort of their home or office drastically increasing effectiveness.
I find the most intense and rapid results with the Suprazygomatic injection which is relatively atraumatic to the patient. The Greater Palatine Approach is also very effective but Suprazygomatic appears to have the best results. This author does not do the injections from a lateral approach because of possible trauma and secondary myositis to the jaw muscles in the area.
Some patients may receive days, weeks or months of relief from a single block. This author believes this is because the block essentially resets the brain and autonomic nervous system similar to hitting Control- Alt- Delete to reset you computer.
The Sphenopalatine Ganglion is the largest Parasympathetic Ganglion of the head but also has many Sympathetic fibers. The Reset is essentially turning of Sympathetic Overload which results in “Fight or Flight” reflex. It then allows the Parasympathetic System to predominate. This is where feelings of well being are stored. The parasympathetic response is the “Feed and Breed” or “Eat and Digest” reflex. It makes us feel similar to playing with puppies, kittens or babies. It sis a natural stress reliever.
What medications are used for SPG Blocks?
Lidocaine, a dental anesthetic is the most common anesthetic used usually 2-4% without vasoconstrictors (epinephrine) or preservatives. Many other anesthetics can be used but lidocaine is extremely effective and has natural anti-inflammatory effects which are helpful. Long-term anesthetics can be used but this author prefers to use lidocaine as safe and effective ans teach his patients to self administer blocks at home as the most effective approach. Allergies are usually to preservatives for vasodilators in the lidocaine not to plain lidocaine. Plain lidocainr is used stabilize heart activity in the ER.
What other uses are there for Sphenopalatine Ganglion Blocks Besides Headaches.
SPG Blocks are effective for treating essential hypertension probably as a result of reduced Sympathetic activity. This also reduced anxiety and panic attacks and associated depression.
The reduction of Sympathetic overload also make the SPG Block helpful for treating Anxiety, Depression, PTSD and Panic Attacks.
CRPS or Chronic Regional Pain Syndrome is caused my Sympathetically Maintained Pain. As the Sympathetic System is put to rest it is easier to treat CRPS.
Many Fibromyalgia patients respond well to SPG Blocks.
Other sympathetic /stress disorders like IBS and Pelvic pain may respond. It is important to remember this is not a treatment for these disorders but a treatment for sympathetic overload.
I have seen Idiopathic Hives resolve within minutes which made me suspect Sympathetic overload
SPG Blocks are reported to have success with both vasomotor Rhinitis and chronic sinus pain as well.
Many insomniacs report improvement in sleep, especially patients who self administer blocks at home.
SPG Blocks instill “sense of well being” as described by this physician after his first block.
Trigeminal Neuralgia is another area of use.
There is frequently great relief in neck and shoulder pain with SPG Blocks but another autonomic block, the Stellate Ganglion Block may be more effective. It is alo used to treat PTSD. It also seems to worth with some severe back pain. https://www.youtube.com/watch?v=4lvBh4oBZfE
Bottom line. SPG Blocks should be considered if you suffer from chronic headaches, migraines, or cluster headaches and are unable to find relief, the Sphenopalatine ganglion can provide answers. It should be considered a first line approach to management of head and neck pain, but is often saved till all other approaches have failed. It is actually far safer and usually more effective than most medication approaches.
SPG Blocks are an excellent adjunctive procedure in patients with TMJ and jaw issues and by relieving sympathetic overload it reduces clenching and grinding in many patients. Cognitive behavior therapy is often used for these habits but many spontaneously resolve with SPG Blocks
Neuromuscular Dentistry utilizes Diagnostic Neuromuscular Orthotics that are frequently utilized with SPG Blocks, Trigger Point Injection and ULF-TENS to treat even the most difficult patients.
Additional Videos at : https://www.youtube.com/channel/UCk9Bfz6pklC7_UluWFHzLrg/featured
On Reddit: https://www.reddit.com/r/SPGBlocks/
Dr Shapira teaches course in SPG Blocks to Physicians and Dentists. He has recently lectured in Scottsdale, Buenos Aires and is scheduled to lecture in August 2017 in Seattle.
Bilateral sphenopalatine ganglion block reduces blood pressure in never treated patients with essential hypertension. A randomized controlled single-blinded study.
Sympathetic fibers connect sphenopalatine ganglion (SPG) with the central nervous system. We aimed to study the effect of SPG block in blood pressure (BP) in never treated patients with stage I-II essential hypertension.
We performed bilateral SPG block with lidocaine 2% in 33 hypertensive patients (mean age 48±12years, 24 men) and a sham operation with water for injection in 11 patients who served as the control group (mean age 51±12years, 8 men). All patients have been subjected to 24h ambulatory blood pressure monitoring prior and a month after the SBG block in order to estimate any differences in blood pressure parameters. We defined as responders to SBG block those patients with a 24h SBP decrease ≥5mmHg.
We found that 24h and daytime DBP (p=0.02) as well as daytime DBP load (p=0.03) were decreased in the study group a month after SPG block. In addition, a significant response was noted in 12/33 responders (36%) regarding: a. SBP and DBP during overall 24h and daytime (p<0.001) and night-time periods, b. pre-awake and early morning SBP and c. SBP (daytime and night-time) and DBP (daytime) load. No differences regarding BP were found in the sham operation group.
SPG block is a promising, minimally invasive option of BP decrease in hypertensives, probably through SNS modulation. Additionally, due to its anesthetic effect, SPG block might act as a method of selection for those hypertensive patients with an activated SNS before any other invasive antihypertensive procedure.
Copyright © 2017 Elsevier B.V. All rights reserved.
24h blood pressure measurement (24h ABPM); Arterial hypertension; Neural block; Sphenopalatine ganglion
Infiltration of the sphenopalatine ganglion decreases blood pressure in newly diagnosed and never treated patients with essential hypertension.
Sphenopalatine ganglion (SPG), an extracranial structure, is connected with the central nervous system (CNS) through sympathetic and parasympathetic nerves. We hypothesized that SPG block through sympathetic nerves anesthesia might decrease blood pressure (BP) in recently diagnosed and never treated middle-aged patients with essential hypertension.
We performed SBG block in 22 hypertensive patients (mean age 45±12years, 15 men). All patients have been subjected to 24hour ambulatory blood pressure monitoring a week prior the procedure as well as in a period of 21-30days after the SBG block in order to estimate differences in 24h average systolic (24h SBP) and diastolic blood pressure (24h DBP), daytime, nighttime, pre-awake and early morning SBP and DBP as well as BP load.
We found that 24h SBP (p=0.001) and 24h DBP (p<0.001), daytime SBP and DBP (p<0.001) as well as daytime SBP and DBP load (p=0.002 and p<0.001, respectively) were decreased in total population at 21-30days after SPG block. In 11/22 responders (24h SBP decrease ≥5mmHg), SBP and DBP were reduced during overall 24h and daytime (p<0.001) and nighttime periods (p=0.01 and p=0.06, respectively) while pre-awake SBP (p=0.09) along with daytime SBP and DBP load (p=0.07 and p=0.06, respectively) were also almost decreased.
SBG block might be a promising, non-invasive, safe, painless and easy to perform therapeutic option of BP decrease. As with renal denervation, SBG should be effective in those hypertensive patients with an activated SNS, so a period of patient selection should precede the application of this procedure.
Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
24h blood pressure measurement (24h ABPM); Arterial hypertension; Neural block; Sphenopalatine ganglion