Roberta Jurash, DDS, MPT, MSc.
Sphenopalatine Ganglion (SPG) Block
The Sphenopalatine Ganglion (SPG) is a group of nerve cells that is linked to the
trigeminal nerve, the main nerve involved in headaches and facial pains. Located in the back of the nose, the SPG carries information about sensation, including pain signals,
and also plays a vital role in autonomic functions, such as tearing and nasal congestion.
The link between the SPG and the trigeminal nerve is pivotal in understanding head and facial pain. By applying local anesthetics (numbing medication) to block or partially block the SPG, we can offer substantial relief from headaches and facial pain. It prevents the pain signal from reaching the brain, induces very site specific vasoconstriction around the brain, hence calming down the hyper-excitability of the autonomic nervous system and all the while, calming down the
vasospasm in patients, therefore effectively eliminating headaches and some facial pain syndromes.
SPG Block Procedure
On the day of the procedure, you should be able to travel to and from our office independently, as no sedating medications are required. We will monitor your blood pressure and heart rate both before and after the procedure to ensure your safety. Using the TX360 Device, you will remain seated throughout the process. The device is gently inserted into one nostril, delivering numbing medication through a syringe. The catheter is then removed, and this process is repeated in the other nostril. The entire procedure typically lasts 10-20 seconds, after which we will ask you to stay for a 15-minute observation period.
During the procedure you may feel a mild sensation of pressure, an urge to sneeze, or a fleeting sensation of something in your nose. There may also be a brief burning sensation or a bad taste in your mouth due to the possibility of minor drips of the numbing medication into the throat. These sensations are typically brief and part of the expected experience.
Potential SPG Block Side Effects
Most side effects are temporary, including throat numbness, low blood pressure, and nausea. Throat numbness usually subsides within a few hours. During this time, we advise refraining from eating or drinking to prevent any choking risk. While rare, nasal bleeding, infection, or a temporary increase in pain have been reported in some cases.
Frequency of SPG blocks
SPG blocks can be repeated as needed to reduce pain. One study has shown reduced frequency and severity of chronic migraine pain over a six month period with bi-weekly treatments for 6 weeks (a total of 12 procedures). However, the SPG block is most effective when integrated into a comprehensive treatment plan.
Reference Article
Pain Physician. 2013 Nov-Dec;16(6):E769-78.
A Novel Revision to the Classical Transnasal Topical Sphenopalatine Ganglion Block for the Treatment of Headache and Facial Pain.
Background: The sphenopalatine ganglion (SPG) is located with some degree of variability near the tail or posterior aspect of the middle nasal turbinate. The SPG has been implicated as a strategic target in the treatment of various headache and facial pain conditions, some of which are featured in this manuscript. Interventions for blocking the SPG range from minimally to highly invasive procedures often associated with great cost and unfavorable risk profiles.
Conclusion: SPG block with the Tx360® is a rapid, safe, easy, and reliable technique to accurately deliver topical transnasal analgesics to the area of mucosa associated with the SPG. This intervention can be delivered in as little as 10 seconds with the novice provider developing proficiency very quickly. Further investigation is certainly warranted related to technique efficacy, especially studies comparing efficacy of Tx360 and standard cotton swab techniques.