b1. What is Sphenopalatine Ganglion Block

What is its Purpose, How does it Work?

The mechanism of cluster headaches is believed to involve the uncontrolled dilation and contraction of blood vessels. Therefore, in cases of persistent cluster headaches and migraines that do not respond to medication treatments, sphenopalatine ganglion block can be administered. The sphenopalatine ganglion is a nerve network located deep next to the nostrils. It is possible to reach this ganglion with imaging methods, accompanying needles or needle-like electrodes. Ensuring the reduced function of this ganglion for certain periods can prevent the arrival of cluster headaches and migraine crises.

 

Region where the sphenopalatine ganglion is located

 

What preparations are required before a Sphenopalatine Ganglion Block?

• Ask your physician to explain the method to you in detail before the sphenopalatine ganglion block procedure. Your physician will require written consent from you, as per the law.

• Inform your physician about all your other ailments, medications you are taking, and any allergens and medications that cause allergies if any. Herbal medications like Vitamin E, glucosamine, garlic, and ginseng can also cause bleeding.

• It's advisable to consult your relevant physician as all blood-thinning medications except aspirin need to be stopped.

• Bring all your previously conducted examinations, MRIs, CT scans, and laboratory findings with you when going for the procedure.

• Wear comfortable clothing and leave your watches, rings, and other jewelry at home.

• Water and food intake should be stopped at least 4 hours before the procedure. However, medications required for other systemic diseases can be taken with a small amount of water.

• Sedation, which is a superficial anesthesia procedure, will be applied during the procedure, so returning home alone is not allowed. You should come with a companion.

How is the Sphenopalatine Ganglion Block Administered, How Long Does it Take?

One of the methods chosen when drug therapy cannot provide adequate pain control or loses its effect is the sphenopalatine ganglion block. The intervention to the sphenopalatine ganglion is applied in two stages.

In the first stage, a combination of local anesthetic and steroid is given to the ganglion. It's then waited for a few days. If effective, pulsed radiofrequency waves are sent to the sphenopalatine ganglion to reduce its functioning.

• The intervention is conducted in an operating room environment. After being laid on your back, the cheek area where the intervention will take place is numbed with local anesthesia.

• During this time, blood pressure, heart rate, and respiration are continuously monitored by an anesthesiologist.

• Under radiological imaging guidance, a special needle-electrode is advanced to the area where the nerve is located. Once the needle’s position is confirmed radiologically, stimuli are sent through a radiofrequency device and the patient is asked whether they feel stimulation in the painful area.

• Once it's confirmed that the needle is in the correct place, radiofrequency current is sent. The process lasts between 2 to 6 minutes. Superficial anesthesia is applied during this stage to prevent the patient from feeling pain.

• The entire procedure lasts about 30 minutes.

• The intervention can be repeated twice within a month. In patients who benefit, it can be reapplied a few years later.

• The patient can return to work a day after the procedure.

• There is a risk of infection during each intervention, however, this risk is very minimal. There won’t be any numbness in the nerves following this intervention.

Treatment of the sphenopalatine ganglion under imaging