SPG Block Headache


A simple but underutilized intervention can be used for the treatment of a long list of chronic painful disorders such as a variety of head pain conditions, fibromyalgia, post herpetic neuralgia, and chronic neck and back pain.

The target organ for this treatment is called the Sphenopalatine ganglion or SPG for short. This is the largest accumulation of nerve cells outside the brain. Conveniently located at the back of the nose, the ganglion is easily accessible for a painless, non-invasive and non-addictive nerve block achieved by placement of cotton tip applicators soaked in local anesthetics. SPG block is not a new procedure. It was first described in 1909 by Dr. Greenfield Sluder who was a professor at Washington School of Medicine in St. Louis.

The web of incoming and outgoing nerves associated with SPG is amazingly complex. There are sensory inputs into the SPG from areas as remote as the lower back. But more importantly almost all the head and neck structures send sensory nerve signals into the ganglion. Therefore, one can explain the observation that pain in the neck and cervical spine can be referred to the head and face, and alternatively headache in most instances is associated with neck pain.

Anesthetizing this ganglion basically serves the same purpose as when we reboot our computers. It is conceptualized that in chronic pain conditions, the pain pathways start acting independently and the nerve cells continue to fire the pain signals even in the absence of the painful stimulus. The same phenomenon occurs with a computer that has been in use for long period of time and may start malfunctioning. The rebooting of the computer basically restores the original settings of the device for proper function. By the same token, performing an SPG block theoretically serves the same function as the rebooting of the nerve centers, and once the normal activity is resumed, nerves function in a more organized and controlled manner and therefore pain is abated.

The procedure is performed by a gentle insertion of cotton tip applicators soaked in local anesthetics, one in each of the nasal passages. Due to the action of local anesthetics, nasal passages rapidly become numb as the applicators are slowly advanced. Once in their final position, they are left in place for almost 30 minutes. During this time, you may take a nap, read or watch your favorite show on TV. Depending on the condition, sometimes SPG block has to be repeated on a daily basis or at least every other day with six to seven sessions.

It is comforting to know that SPG block is one of the many options available for the treatment of chronic painful conditions. The notion that, “you have to learn to live with pain” seems to be a thing of the past.

This the third in a series of articles geared to increase awareness and understanding of different types of headaches and other chronic painful conditions and the available diagnostic and therapeutic options for each individual disorder. For more information, you may contact Dr. Benjamin Taimoorazy at Beverly Hills Migraine and Pain Management Institute, in Beverly Hills CA

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