SPG Block Questions & Answers
SPG Block Q & A
What is the sphenopalatine ganglion?
The sphenopalatine ganglion (SPG) is a collection of nerve cells that is located behind the bony structures of the nose. It is closely associated with the trigeminal nerve, which is the main nerve involved in headache disorders & facial pain syndromes. The SPG contains both sensory nerves and autonomic nerves. As a result, the SPG carries information about sensation, including pain, and also plays a role in autonomic functions, such as tearing and nasal discharge or congestion.
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What is the role of the sphenopalatine ganglion in headache disorders?
The SPG has connections to the brainstem (where cluster and migraine attacks may be generated) and to the meninges (coverings of the brain) by the trigeminal nerve. Inflammation and opening of the blood vessels around the meninges occur, which activate pain receptors that send pain impulses through the trigeminal nerve, eventually to the sensory area of the brain, and are perceived as pain. In migraine and cluster headache, nerves carrying these pain signals pass through the SPG, with some making connections to the autonomic nerves. This explains why in cluster headache, and sometimes in migraine, we see autonomic features including tearing of the eyes and nasal congestion or discharge. We call this the trigeminal autonomic reflex.
What is a sphenopalatine ganglion block (SPG block)?
A nerve block is a procedure to stop pain transmission through anesthesia to the nerve. In a SPG block, a local anesthetic (numbing medication) is administered to the collection of nerves in the ganglion. The least invasive way to access the SPG is through the nose. If you block or partially block the SPG, this can be helpful in reducing head and facial pain.
SPG blocks have been reported to treat the following conditions:
Migraine Trigeminal neuralgia
Herpes zoster (Shingles)
Paroxysmal hemicrania Cancer of the head or neck
Facial pain that is atypical
Complex regional pain syndrome (CRPS)
Nasal contact point headache
Spinal headaches after lumbar puncture
We perform needle-free SPG blocks by using a special device to spray a local anesthetic (numbing medication) into the nostril &/or by placing a cotton swab saturated with local anesthetic into the back of the nose so that it sits against the tissue overlying the SPG.
How is the procedure done and what should I expect during the procedure?
The day of the procedure you should be able to travel to the office and drive home afterwards.
Prior to the procedure, your blood pressure and heart rate, and possibly your cheek temperature may be checked. This depends on your provider’s preference.
No matter the device used, during the procedure you may feel mild pressure, or feel like you have to sneeze, or a brief mild discomfort or irritation like “something is in my nose.”
You will have a bad taste in your mouth if some of the numbing medication is swallowed. This is only temporary and sucking on something sweet or sour during the procedure can help, so you are encouraged to bring a mint, candy, or gum to your procedure.
Tearing and a brief temperature change in your cheek(s) may occur. Patients typically experience an immediate reduction in headache &/or facial pain, but results can take anywhere from 15 minutes to a few hours to occur.
Potential Side Effects
The most common side effects are all temporary, including numbness in the throat, bitter taste, lightheadedness (from temporary drop in blood pressure), and nausea. If you do experience throat numbness, this should not last more than a few hours, and is related to swallowing a small amount of the numbing medication. During this time, it is safest if you avoid eating or drinking anything to avoid the risk of choking. Nasal bleeding has been reported in rare cases. Although sterile technique is used, it is still possible to get an infection in rare cases - just as it is with ALL procedures.
Most insurances cover this procedure with little or no out-of-pocket cost to the patient. If you have any questions about insurance coverage, we always recommend you contact your insurance company prior to the procedure and ask whether or not they cover SPG blocks. See CPT (Procedure) code below:
SPG Block CPT 64505