AA COMPLEMENTARY THERAPY NOT A REPLACEMENT THERAPY: Definitely exciting new product.
A previous article discussed the best nasal catheters for prevention and treatment of migraines. Self-Administration of Sphenopalatine Ganglion with Cotton-Tipped Catheters offering continuous capillary feed is the Gold Standard for prevention and treatment when possible but for Emergency Treatment Relaspen may be the new Gold Standard. I teach patient how to use nasal lidocaine spray for making placement of catheters more comfortable and to use in emergency situations. Relaspen is an improvement on Nasal Spray Lidocaine for acute events.
Self-Administration of Sphenopalatine Ganglion (SPG) Blocks is the most effective and patient friendly approaches to treating migraine, daily headache, facial pain and anxiety. Relaspen will be a new addition to treatment possibilities. All of the alterrnative choices for doing SPG Blocks with advantages and disadvantages are considered in this article.
There are multiple methods of administering Sphenopalatine Ganglion (SPG) Blocks. There are both intra-oral (via the Greater Palatine Foramen and extraoral routes of injection thru the Pterygopalatine Fissure to deliver anesthetic to the Sphenopalatine Ganglion also known as the Pterygopalatine Ganglion.
Trans-nasal delivery of anesthetic to the SPG is a very convenient and relatively non-invasive approach to SPG Blocks. This was the original approach by Dr Greenfield Sluder who first described the Block in 1908.
It was also the method of doing SPG Blocks used by Dr Milton Reder whose practice inspired the book “Miracles on Park Avenue” The book detailed the miraculous cures /treatments that brought Dr Reder patients from around the world. The Octogenerian otolaryngologist’s entire practice was trans-nasal delivery of Sphenopalatine Ganglion Blocks.
Cotton pledgets and later cotton swabs were used to place anesthetic on the mucosa covering the medial wall of the Pterygopalatine Fossa which houses the Sphenopalatine Ganglion and the Maxillary Division of the Trigeminal Nerve where it emerges from the Foramen Rotunda as well as the Maxillary Artery.
The use of anesthetic nasal sprays of lidocaine and other anesthetics have been utilized for years with mixed success. More recently the FDA has approved 3 devices to deposit anesthetic directly over the mucosa of the medial wall of the Pterygopalatine Fossa.
The Sphenocath is the first and is a cleverly designed “squirt gun” to place lidocaine in a liquid form on the medial aspectof the Pterygopalatine Fossa overlying mucosa. Ideally for the best effect the patient will stay supine for 20-30 minutes with the head to the side of the placement site. Bilateral administration would repeat this with the other side. The Allevio device is similar to the Sphenocath.
The TX360 is another device designed to deliver bilateral anesthetic deposition in a “squirt gun” fashion while the patient is in a sitting position.
Both of these methods allow the anesthetic to pass thru the mucosa but the anesthetic is squirted in and does not remain in that location.
The utilization of Cotton-Tipped Catheters with continual Capillary delivery of anesthetics also deposits anesthetic to the same mucosa. The amount of time of anesthetic delivery is extended over a longer period of time. This author considers Cotton-Tipped Catheters with Continuous Capillary feed the Gold Standard for
Trans-nasal SPG Blocks. Learn more: https://www.sphenopalatineganglionblocks.com/spg-blocks-and-neuromodulation/
The key advantages to Self Administration of SPG Blocks (SASPGB) is that the patient is in control of when and how often the SPG Block is delivered. This eliminates costly visits to the Emergency Room or physicians. More important it gives patients control of their pain relief. The continual delivery bathes the SPG in 2% lidocaine for extended periods of time and does not require patients remain supine. If there is initially severe pain a supine position will increase the release of lidocaine initially. 2% lidocaine is very safe and has natural anti-inflammatory properties.
It is critically important that patients can comfortably deliver the lidocaine thru the catheters and usually requires 1-2 training sessions. The use of Oxymetazoline is often used initially when learning the procedure to make access easier. A nasal spray of 2% lidocaine is often utilized sensitive patients when they first learn how to self-administer the blocks with the cotton-tipped catheters. It is also possible to use a 4% lidocaine gel on the swabs but clinical experience has shown liquid 2% lidocaine is the best approach.
Some patients with very narrow nares have problems placing the cotton-tipped catheters. The oxymetazoline shrinks the nasal mucosa tissues for easier placement. If patients still find it difficult the can be taught to Self-Administer the SPG Block with the Sphenocath device. While it is a single use item for physicians patients can reuse it at home for personal use. The device is expensive ($75.00) for single use but less expensive if reused by patients at home.
The Biggest advantage besides excellent results of Self Administered SPG Blocks with Cottin Tipped Catheters is the freedom and quality of life the they produce. Patients are fully mobile and can work on computes, watch television, eat, prepare meals and all other functional daily activities. The cost per bilateral administration is less than $1.00. It is, based ob clinical experience of this author the most effective method of Delivery.
Relapsen Potable Migraine Blocker is a new hybrid delivery system that is an improvement over nasal spray administration because it focusses the delivery with small flexible catheters directly over the mucosa over the medial wall of the Pterygopalatine Fossa.
Relapsen Portable Migraine Blocker is a small portable way to deliver lidocaine quickly and comfortably to the SPG. It has the same problems as other nasal delivery systems but is easier and more comfortable application.
This is from the Relaspen website:
“Relaspen is the first medical device designed to allow patients to easily and safely self-administer an SPG block to treat an acute migraine.”
” There are three other SPG block catheter devices currently FDA cleared and available on the market, but none of them are designed for patient self-administration.”
The website site falsely states that: “the SPG block procedure is only performed in physician offices and hospitals.” This is untrue as nasal sprays and cotton-tipped swabs and cotton-tipped nasal catherters have been utilized for decades. I have been teaching patients to self-administer with cotton-tipped catheters since 1986 and have lectured worldwide on the subject, most recently in Moscow in 2019.
The beauty to Relaspen is the “in your purse of pocket” availability of this method of quick releif of migraines. This quote is from their website: “Relaspen aims to allow patients to have access to this revolutionary migraine treatment with the push of a button.”
From Relasepen Website: “Relaspen is being developed by Migraine Solutions, LLC, and is currently patent pending. Our pathway to market entails product research and development to maximize efficacy and ease of use, followed by clinical trials and submission for FDA approval.”
As the world’s leading advocate for Self-Administration of Sphenopalatine Ganglion Blocks I find this this is a very exciting new development.
I expect that I will prescribe Relasapen as an emerging migraine quick relief option.
There is little question that the Cotton-Tipped catheter with Continunual Capillary release of lidocaine will remain the gold standr for prophylactic use.
I think Relaspen will find that treatment of acute panic attacks and anxiety will be a major use of this device.
Dr James Cook the developed has created a great product and is the Founder and CEO of Migraine Solutions LLC.
A new product Ubrelvy (ubrogepant) is being heavily marketed for acute relief of migraine as well.
It is being marketed for fast relief of migraine pain as well. The difference between Relapsen and Ubrelvy is that Relapsen will work within minutes while Ubrevly has a much slower mechanism of action. CGRP are frequently involved in migraine and various drugs block the CGRP receptor sites. Aimovig (erenumab) for injection was the first CGRP antagonist marketed and Ubrevly is the newestr entry to the field.
Relapsen can be utilized immediately upon onset in conjunction with Ubrelvy to give interim almost instant relief during the first 2 hours of an acute migraine.
The following link is to the Ubrelvy website:
https://ubrelvyhcp.com/efficacy
Please go to the link and see the Graphs of relief when compared to placebo. There are 3 different graphs looking at the relief over a two hour period.