Sphenopalatine (Pterygopalatine, Nasal) Ganglion Blocks and Neuromodulation of the Sphenopalatine Ganglion are rapidly becoming the Holy Grail of treatment of headaches and migraines of the Trigeminal Nervous System. It is generally accepted that over 99% of all headaches are primarily or secondarily products of the Trigeminal Nervous System. Migraine patients are often denied this life changing treatment due to general lack of knowledge by medical practitioners.
A 2018 paper “Sphenopalatine Ganglion Block for the Treatment of Acute Migraine Headache” concluded that transnasal lidocaine “was well-tolerated with few adverse events. This treatment is emerging as an effective and safe option for management of acute migraine attacks.” The article was on administration with the “Sphenocath® device. “55 patients with acute migraine headaches underwent this procedure, receiving 2 ml of 2% lidocaine in each nostril. Pain numeric rating scale (baseline, 15 minutes, 2 hours, and 24 hours) and patient global impression of change (2 hours and 24 hours after treatment) were recorded. THE MAJORITY OF PATIENTS BECAME HEADACHE FREE AT 15 MINUTES, 2 HOURS, and 24 HOURS AFTER THE PROCEDURE”
The most effective approach to migraines is prevention and Self-Administered Sphenopalatine Ganglion Blocks are extremely effective in this role. The Sphenocath can be utilized by patients at home but the use of Cotton-Tipped Catheters with Continual Capillary Feed have a multitude of advantages in both convenience and effectivenss over the Sphenocath. The Sphenocath can be utilized for self administration for select patients with tight nasal passages.
It has long been known that Blocking the Sphenopalatine Ganglion (SPG) can also treat back pain associated with the thoracolumbar spine. SPG Blocks functions in the same manner in treating thoracolumbar pain as it does eliminating and treating headaches and migraines, by relief of painful vascular and muscular spasm. There is an excellent article “Sphenopalatine Ganglion Block for the Relief of Painful Vascular and Muscular Spasm with Special Reference to Lumbosacral Pain” from 1948 by J Lewis Amster MD. Sphenopalatine Ganglion Blocks were part of incredibly important research that became “Forgotten Medicine” amid the current pharmacologic approaches to pain.
This patient was treated with an SPG Block for his back pain. He learned SASPGB or Self-Administration of SPG Blocks for a long-term solution. https://www.youtube.com/watch?v=4lvBh4oBZfE&t=2s
The Trigeminal Nerves (Cranial Nerve V) are the largest of the 12 paired Cranial Nerves. Cranial Nerve V accounts for over 50% of all input into the brain after amplification in the Reticular Activating System. In addition, direct Trigeminal Nerve input to the brain. The Trigeminal nervous system also controls the blood flow to the anterior 2/3 of the meninges of the brain.
All types of headaches including tension headaches, sinus pressure and headaches, retro-orbital (behind the eye) pain, head and facial pain, trigeminal neuralgia and TMD are directly under control of the Trigeminal Nerve. Cluster Headaches are the best known Trigeminal Autonomic Cephalgia which also includes Paroxysmal Hemicrania (chronic or episodic), SUNCT or Short-lasting unilateral neuralgi form headache attacks with conjunctival injection and tearing, SUNA or Short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms and LASH or Long-lasting autonomic symptoms with hemicrania.
This is a video of a patient who learned to Self-Administer SPG Blocks: https://www.youtube.com/watch?v=NPwQ9zpo0ug
All of these headaches can be treated or prevented by directly addressing the Trigeninal Nerves and associated Autonomic nerves of Sphenopalatine Ganglion with blocks and neuromodulation. Neuromuscular approaches to TMJ disorders have used Ultra-Low Frequency TENS safely for over 50 years which relaxed musculature while acting as serendipitous neurostimulator of the Sphenopalatine Ganglion. The Sphenopalatine Ganglion is found on the Maxillary Division of the Trigeminal Nerve after it exits cranium through Foramen Rotunda in the Pterygopalatine Fossa. The maxillary Artery is also found in the fossa.
The trigeminal nerve has four parasympathetic ganglia that are associated and connected with the Trigeminal Nerve. The largest is Sphenopalatine Ganglion and blockage of this ganglion can treat, eliminate and prevent migraine, TACs, tension and muscle contraction headaches and anxiety. The other cranial parasympathetic ganglia connected to the Trigeminal Nerve are the Ciliary Ganglion (responsible for vision and sensitivity to light issues of migraines and TMJ disorders), the Otic Ganglion (affecting Ear, TMJ and some facial pain and ear symptoms) and the Submandibular Ganglion which can relate to issues with burning mouth syndrome and changes in taste as well as other oral mucosal pain of autonomic origin.
The four parasympathetic Ganglion all contain not just parasympathetic fibers but also Somatosensory nerves and Sympathetic Nerves via Carotid Plexus and Superior Cervical Ganglion. The sympathetic fibers that go the SPG pass through Superior Sympathetic Ganglion but include sympathetic fibers from the entire Cervical Sympathetic Chain and from the Stellate Ganglion.
The neurology of all headaches is directly associated with dentistry. It is generally acknowledged that neuromuscular dentists (ICCMO.org) are experts in the field of treating chronic headaches, migraines, and TMD (TMJ disorders) by correcting noxious input into the brain the Trigeminal Nerve and brain. The effects of this input affects the entire body as shown by Shimshak et al in their landmark article
“Health care utilization by patients with temporomandibular joint disorders” published in CRANIO Journal in 1998 which cleared showed by examination of insurance records that patients with TMJ disorders had a 300% increase in medical utilization in all fields of medicine except obstetrics.
This is a paper I had published in CRANIO Journal detailing connections of the autonomic nervous system to Neuromuscular Treatment of TMJ Disorders.
“Neuromuscular dentistry and the role of the autonomic nervous system: Sphenopalatine ganglion blocks and neuromodulation. An International College of Cranio Mandibular Orthopedics (ICCMO) position paper”
A 2019 article in the Journal of Headache and Pain looked into the connections of migraine and low back pain.”The Association Between Headache and Low Back Pain: a Systematic review” Unfortunately, the paper ignored the oral structures and airway effects that are responsible for forward head and Neck Posture that often is an underlying cause of low back pain. Mariano Rocobado is the leading expert in TMJ disorder physical therapy and has discussed the effects on Forward Head Posture on muscles down the entire spine.
An excellent resource on Sphenopalatine Ganglion Treatments by Kwo Wei David Ho is “Sphenopalatine ganglion: block, radiofrequency ablation and neurostimulation – a systematic review”
More to come on this subject.