Abstract
Transnasal sphenopalatine ganglion block is emerging as is an attractive and effective treatment modality for acute migraine headaches, cluster headache, trigeminal neuralgia, and several other conditions. We assessed the efficacy and safety of this treatment using 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 procedure (70.9%, 78.2%, and 70.4%, resp.). The rate of headache relief (50% or more reduction in headache intensity) was 27.3% at 15 minutes, 20% at 2 hours, and 22.2% at 24 hours. The mean pain numeric rating scale decreased significantly at 15 minutes, 2 hours, and 24 hours, respectively. Most patients rated the results as very good or good. The procedure was well-tolerated with few adverse events. This treatment is emerging as an effective and safe option for management of acute migraine attacks.
Highlights
Migraine is a common primary headache disorder, causing significant disability and personal, societal, and financial burden [1]
Several studies [6,7,8] have shown that migraine patients with poor response to acute treatment are at increased risk for transformation to chronic migraine (CM), with roughly 2.5-3.5-fold greater odds of developing CM [6]; patients with a moderate or better acute treatment efficacy did not have a significant increased risk
The parasympathetic preganglionic cell bodies originate in the superior salivatory nucleus in the pons, and the parasympathetic fibers run in the nervus intermedius through the geniculate ganglion, forming the greater petrosal nerve (GPN)
Summary
Migraine is a common primary headache disorder, causing significant disability and personal, societal, and financial burden [1]. It is a highly prevalent condition, affecting 11% of adult population worldwide, including people of all ages, races, geographical areas, and income levels [2]. SPG, known as the pterygopalatine ganglion (PPG), is a large extracranial parasympathetic ganglion with multiple neural connections (Figure 1), including autonomic, motor, and sensory [11, 12]. This complex neural structure is located deeply in the pterygopalatine fossa (PPF) posterior to the middle turbinate and maxillary sinus [11], on each side of the face.
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