A sphenopalatine ganglion block (SPG) block is a minimally invasive way to treat migraine and migraine-like headaches. It involves using lidocaine to numb the SPG, which disrupts the migraine pathway. It is a treatment reserved for resistant migraine headaches and only treats a particular headache but not the root cause of the headaches. It is increasingly used for post-concussive headaches as well.

Preparing for the Procedure

This procedure is performed with no sedation. There are no preoperative tests that need to be performed.

During the Procedure

For an SPG block, the patient will come into the interventional radiology suite and lay on their back on our table. A shoulder roll will be placed under their shoulders which puts their neck into hyperextension. 

The x-ray camera will be placed on either side of the head (in a lateral projection). Jelly lidocaine will then be injected into each nostril. A jelly lidocaine-soaked Q-tip will then be placed in each nostril as well. This will be left in place for 5 minutes. 

A device known as a Sphenocath (soft, angled, rubber straw) will then be inserted into the nose under x-ray guidance and placed above the middle turbinate. A small amount of x-ray contrast will then be injected to confirm positioning. The patient will then be asked to swallow and not swallow for as long as possible. 4% lidocaine is then injected slowly. 

This procedure is duplicated on the other nostril. The patient then lays in that position for 15-20 minutes.

After the Procedure

There are no post-operative instructions for this procedure. This procedure usually results in a 50% or more reduction in the headache pain scale when the patient leaves the room. Anecdotally we have seen patients have effects from this procedure up to 2 days later.