A new article on treatment of post dural puncture headaches may also hold key to treatment of headaches with a large upper cervical component. The article is in Journal of Clinical Anesthiology. J Clin Anesth. 2019 Feb;52:69-70. doi: 10.1016/j.jclinane.2018.09.015. Epub 2018 Sep 12.
The Sphenopalatine Ganglion is located in the pterygopalatine fossa along with the maxillary division of the trigeminal nerve and the maxillary artery. The Sphenopalatine Ganglion is the largest Parasympathetic Ganglion of the head and it also carries somatosensory nerves and sympathetic fibers from the superior sympathetic chain. There is over a 100 year history of use of the SPG Block or Sphenopalatine Ganglion Block for treating pain since it was first discovered by Dr Greenfeld Sluder. It was used to treat a severe chronic pain issue called Sluder’s Neuralgia now thought to be either Cluster Headache or TMJ Disorder.
The diagnosis of TMJ disorder or Costen’s Syndrome did not come into being until 1934. Both Dr Costen and Dr Sluder wer Otolaryngologists or ENTs.
Occipital nerve blocks, and Greater and Lesser occipital nrerve blocks have long been used in the treatment of headaches and migraines but the combination of addressing headaches with both SPG Blocks addressing autonomics has not been discussed as much in the literature.
Neuromuscular Dentistry utilizes the Myomonitor, an Ultra-low Frequency TENS designed to relz the masticatory muscles. This was an innovation from Dr Bernard Jankelson, a Seattle Prosthodontist. Neuromuscular Dentistry is extremely effective in the treatment of many types of headaches and migraines and is accepted by the American Dental Association for treating TMJ disorders.
The Myomonitor utilize a three wire TENS with one lead at the back of the neck (input) and two leads over the coronoid notch. Due to the nature of nerve transmission this unit relaxes all masticatory muscles but will also stimulate the Sphenopalatine Ganglion and the nerves that are covered by the greater and lesser occipital blocks.
This study adds to the understanding of the effectiveness of neuromuscular dentistry in treating some of the most difficult headaches disorders.
There are many approaches to delivering SPG Blocks, both intra-oral and extra-oral injections as well as nasal approaches using catheters. There are three commercially available nasal catheter systems, the Sphenocath, the Allevio and the TX360.
Dr Sluder originally utilized pledgets of cotton soaked in anesthetic or cocaine. Today it is possible to utilize a nasal catheter that is cotton-tipped that delivers a continual flow of anesthetic via capillary action. This simple but effective system is extremely cost effective but more importantly is easily self administered by patients giving them control of their pain and autonomic nervous system These blocks can also treat depression, anxiety, PTSD and a variety of eye and ear related symptoms as well as help with TMJ disorders.
Dr Shapira regularly teaches patients how to self-administer SPG Blocks in his Highland Park, Il office. Website www.ThinkBetterLife.com
These blocks which almost were lost as “Forgotten Medicine” were revived in large part due to the Popular Book “Miracles on Park Avenue” by Albert B Gerber that detailed the practice of Dr Milton Reder an New York City ENT in the tradition of Drs Sluder and Costen.
Dr Sluder later became chair of the Otolaryngology Department at Washington University School of Medicine and wrote a textbook “Nasal Neurology”.