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. SPG Block Referral: https://thinkbetterlife.com/referrals/
Why are Sphenopalatine Ganglion Block So Effective for headaches and what type of headaches do they treat?
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 and the fact that these autonomic structures travel with 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. They are well know among Neuromuscular Dentists as being a vital tool for helping patients and associated facial pain patients with TMD (TMJ disorders) and MPD (Myofascial Pain and Dysfunction). They are especially effective in Sympathetically maintained pain 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 ENT whose entire practice was treatment of widely diverse problems with Sphenopalatine Ganglion Blocks.
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
and also a sense of relaxation or well being often describing the feeling of stress and/or anxiety literally melting away in minutes.
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.
The other injection technique is 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 Transnasal Approaches to doing Sphenopalatine Ganglion Blocks which are the most minimally invasive. The first is Q-tips soaked in Anaesthetic (most commonly lidocaine) 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 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 reported that there is lower success with the transnasal approach but that is only true of the q-tips. 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. They are preformed by physicians and the patient must remain supine (on their back) for 20-30 miutes after delivery of anesthetic. All three devices are high tech “squirt guns” that leave a puddle of anesthetic on the mucosal wall over the ganglion.
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 will have a shorter duration and a less intense effect. the cotton tipped nasal catheter actually approaches the effectiveness of injection techniques. More impotant the patient can repetively repeat the procedure in the comfort of their home or office drastically increasing effectiveness. I find the most intense fastet results with the Suprazygomatic injection which is very atraumatic to the patient. The Greater Palatine Approach is also very effective but Suprazygomatic appears to have the bestr results. This author does not do the injections from a lateral approach because of posssible 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 fibes. The Reset is essentially turning of Sympathetic Overloar 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-inflamatory 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.
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.
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 worh 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.