A new study is beginning at UCSF to study the effects of various nasal anesthetics for the prevention of migraines.  This is an enormous opportunity for patients in the San Francisco area who are interested in preventing migraines.

This study will focus on different anesthetics.  This author feels that the anesthetic is far less important than the frequency of the blocks.  In my practice I routinely teach self-administration of SPG Blocks with cotton-tipped nasal catheters giving patients full contol of when to utilize these blocks as preventive agent as well as for acute pain.

Sphenopalatine Ganglion Blocks or Pterygopalatine Ganglion Blocks were originally described by Greenfeld Sluder MD in 1908 to treat “Sluder’s Neuralgia” which is now thought to be either Cluster Headaches or TMJ Disorder headaches.

The Sphenopalatine Ganglion is the largest Parasympathetic Ganglion of the head and it contains Sympathetic fibers from the Superior Sympathetic Chain.  These sympathetic and parasympathetyic nerves travel along the fibers of all branches of the Trigeminal Nerve.  The Trigeminal Nerve is often referred to as “The Dentist’s Nerve” due to the expertise of dentists in dealing with the nerve that goes to the teeth, the dental pulp, the periodontal ligaments, the gums, the anterior 2/3 of the tongue, the mucosal  lining of the nose and sinuses and many other structures.  More importantly it also goes to the TMJoints, the joint capsules, the retrodiscal lamina which is richly innervated, the masitcatory muscles, the muscle spindles and golgi tendon organs, the muscles that open and close the eustacian tube and the tensor of the air drums.  It is the largest proprioceptive input to the brain and accounts for over 50% of all brain input after amplification in the Reticular Activating System.

The Trigeminal nerve is of  key importance to every type of headache.   Much of this is believed to be directly related to the autonomic nerves, both sympathetic and parasympathetic fibers  that travel on the trigeminal nerve branches.

TMJ disorders are often called “The Great Imposter” because they duplicate so many pain disorders.  In recent time there has been a classification of headache disorders that suffers greatly from misunderstanding the input to the brain from the trigeminal nervous system to the limbic system and the effects on the Hypothalamus, Pituitary and Adrenal glands.

When Sluder first studied this subject it was 30 years prior to Dr Costen’s articles on Costen’s Syndrome, now know as TMJ disorders or TMD.  The ULF-TENS utilized in Neuromuscular Dentistry acts as a neuromodulation device for the Sphenopalatine Ganglion as well as working directing on the trigeminally innervated muscles by a single synapse reflex.