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Sphenopalatine ganglion block for the treatment of acute headache: An old treatment revisited

Published:February 06, 2021DOI:https://doi.org/10.1016/j.ajem.2021.02.007
      The sphenopalatine ganglion (SPG) is a collection of parasympathetic nerve cells located just behind the bony structures of the nose. It is closely associated with the trigeminal nerve, which is the main nerve involved in headache disorders [
      • Piagkou M.
      • Demesticha T.
      • Troupis T.
      • Vlasis T.K.
      • Skandalakis P.
      • Makri A.
      • et al.
      The pterygopalatine ganglion and its role in various pain syndromes: from anatomy to clinical practice.
      ]. SPG nerve blocks for the treatment of headache were first described in the 1900's using a technique involving the application of numbing medication onto cotton swabs then placed into the back of the nose [
      • Piagkou M.
      • Demesticha T.
      • Troupis T.
      • Vlasis T.K.
      • Skandalakis P.
      • Makri A.
      • et al.
      The pterygopalatine ganglion and its role in various pain syndromes: from anatomy to clinical practice.
      ]. If effective, an SPG nerve block would potentially be the ideal headache treatment – fast acting, while avoiding the need for intravenous access, and minimal adverse effects. However, several studies have been published over the years regarding SPG blockade with mixed results. The purpose of our study was to test the efficacy of noninvasive sphenopalatine ganglion block for the treatment of acute headache in the emergency department (ED) using 2% lidocaine spray delivered by atomizer to each nostril.

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