Migraine can be difficult to treat, particularly when headaches are frequent, severe, or do not respond well to standard medications. One treatment that may be considered for certain patients is a sphenopalatine ganglion (SPG) block. This minimally invasive procedure targets a cluster of nerve cells located deep behind the nose that plays an important role in headache and facial pain.
The sphenopalatine ganglion is a collection of nerve cells located behind the nasal passages. It is connected to the trigeminal nerve, one of the major nerves involved in migraine. It also contains autonomic nerve fibers that can contribute to symptoms such as tearing, nasal congestion, and facial pressure that sometimes accompany severe headaches.
Because of these connections, temporarily reducing activity in the SPG may interrupt some of the pain signals involved in a migraine attack.
Despite the name โnerve block,โ an SPG block usually does not require an injection through the face or skull. For migraine treatment, a physician administers a local anesthetic, such as lidocaine, through the nostril. The medication may be delivered using a small catheter or applicator designed to reach the back of the nasal cavity, close to the SPG.
The procedure generally takes only a few minutes and is usually performed in the office. Patients remain awake, and sedation is typically unnecessary.
An SPG block may provide relatively rapid relief for some patients with an acute migraine.
Some physicians also use a series of SPG blocks in patients with frequent or chronic migraine. The evidence for long-term migraine prevention is less established than it is for standard preventive treatments such as CGRP-targeting medications, certain oral medications, or Botox for chronic migraine.SPG blocks are generally considered one additional tool.
Patients may notice temporary numbness in the nose, throat, or roof of the mouth. A bitter taste, watery eyes, or mild nasal irritation can also occur. Serious complications are uncommon.
An SPG block will not work for everyone, but for selected patients it may offer a relatively quick, minimally invasive option for reducing migraine painโwithout adding another daily medication.
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