MiRx Protocol: Amazing Treatment Results (video) after SPG Blocks.

Sphenopalatine Ganglion Block for Sympathetically maintained pain, Migraine & Headache Relief

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The sphenopalatine ganglion (SPG) is known by many names including Pterygopalatine ganglion, the nasal ganglion, Meckel’s Ganglion and Sluder’s Ganglion. The Sphenopalatine Ganglion is a nerve bundle located deep behind the face, at the posterior nasal cavity of the nose. It is part of the autonomic nervous system as well as part of the brain located outside of the calvarium. For over 100 years, the SPG has been a clinical target to treat severe headaches (Sluder 1908). Sluder’s early description has often been thought to be the first description of TMD and /or Cluster headaches. Since Sluder first described the application of cocaine or alcohol to the SPG, the SPG has been a site for the treatment of severe headache pain. It was made popular in 1986 after publication of the best selling book, “Miracles on Park Avenue” that described the practice of Miltion Reder, a New York City ENT who was known for Miraculous results of all types of chronic pain problems by utilizing SPG Blocks. Dr Reder utilized liquid cocaine which was first used in medicine as the very first dental anesthetic. Currentl, lidocaine and other agents to the SPG to achieve a nerve block (Kudrow, Kudrow et al. 1995; Maizels, Scott et al. 1996; Maizels and Geiger 1999).

PterygoPalatine Ganglion Blocks (SPG) was tested in patients with migraine (Tepper, Rezai et al. 2009) and cluster headache (Ansarinia, Rezai 2010). which showed acute stimulation of the SPG led to rapid termination of severe headache pain.

The MiRx Protocol utilizes the TX360 device to deliver anesthetic to the area of nasal mucosa that overlies the Sphenopalatine ganglion.

There are currently three FDA approved devices for delivering SPG Blocks. Only the TX360 can be called MiRx protocol due to trademark issues. The Sphenocath and the Allevio devices also are catheter deliveries of anesthetic over the area of the SPG.

The Sphenopalatine ganglion nerve block has been made is easier to preform in some patients with these new devices. They are all, in effect, highly effect “SQUIRT GUNS” that shoot anesthetic of any type to the area of the Spheonpalatine Ganglion. All three require the patient to lie Supine (on Back) for 20-30 minutes with each application.
This procedure is relatively quick and easy quickly and usually not uncomfortable.. SPG Blocks safe cost effective methods of treating and preventing migraines, cluster headaches and chronic daily headaches.

Sphenopalatine Ganglion Blocks can often offer Immediate or almost instantaneous relief. he results are immediate. Blocks of the sphenopalatine ganglion nerve are extremely effective and with repeated applications can dramatically increased the duration of migraine and headache relief.

Older techniques for doing the Sphenopalatine Ganlion (SPG) often have many advantages over these new “SQUIRT GUN” DEVICES.

The headache relief associated with older procedures can be good, excellent and even miraculous. Some patients experience instant relief regardless of the technique used but repeated applications over time increase he effectiveness regardless of the type of application.

Transnasal Technique:is the one originally utilized by Sluder and by Dr Milton Reder. The original procedure was done in physicians offices. Currently, the nasal catheter with cotton tipped applicator is probably the best method available for treating patients. The trans-nasal technique utilized capillary action to steadily and continually deliver anesthetic to the area of the Sphenopalatine Ganglion. This technique does not require the patient to lay supine for long periods but works even while the patient is upright and moving around. You can talk on the phone, use your computer or even cook and eat breakfast while utilizing one of the most effective treatments known.
While all this seems too good to be true the real advantage to the trans-nasal technique is that it is available to the patient whenever necessary even at the very first signs of discomfort. It can be used prophylactically by the patient. It does not require a visit to the physician’s office and doesn’t cost $750.00 to $1200.00.

Once a patient is taught the trans-nasal SPG Block the cost per application is as little as $1.00 per application. In my office I charge $650-$750 for initial application, teaching of the technique and giving the patient supplies for up to 100 bilateral blocks

The nasal catheter continuous capillary feed action method is by far the best route of administration for most patients but does have one disadvantage if the patient has very narrow tortuous nasal cavities. This can usually be easily overcome by application or Afrin Nasal Spray (Oxymetazoline). This shrinks the nasal tissues significantly making cotton-tipped nasal catheter insertion very easy.

I have had a few patients that cannot utilize the nasal catheter delivery device and I have taught them to utilize the Spenocath Device at home. The Sphenocath is easy enough for patients to utilize at home. The cost of any of the new the devices is approximately $75.00 per device.

There are multiple injection approaches that can be done relatively easily. The Greater Palatine Foramen is located at the back of the hard palate and can be easily reached by a small gauge needle. Usually, dentists and ENT’s are the only health care professionals capable of doing these blocks via the intra-oral approach. These blocks are routinely utilized during extractions of maxillary teeth as a routine method of numbing the palate. Once the palate is numb it is ver easy for the dentist to deliver a highly effective and therapeutic dose through the canal.

The Supra-Zygomatic injection is probably the most comfortable and easies method of doing SPG blocks and are so effective due to direct application over the ganglion.

The lateral approach can be done by injecting through the space between the condylar neck of the mandible and the coronoid process or through the masseter muscle. There are advantages to these approaches in specific patients.

The use of fluoroscopy to guide the blocks is sometimes utilized by interventional radiologists but rarely is necessary. Fluoroscopy would be the best approach to implant neurostimulator electrodes or laser stimulaters.

Ira L Shapira DDS, D,ABDSM, D,AAPM, FICCMO
Chair, Alliance of TMD Organizations
Diplomat, American Academy of Pain Management
Diplomat, American Board of Dental Sleep Medicine
Regent & Fellow, International College of CranioMandibular Orthopedics
Board Eligible, American Academy of CranioFacial Pain
Dental Section Editor, Sleep & Health Journal
Member, American Equilibration Society
Member, Academy of Applied Myofunctional Sciences
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