Although used in the treatment of headache disorders for decades, studies assessing the use of sphenopalatine ganglion (SPG) blocks are limited in number and breadth. Specifically, data are lacking that compare the efficacy available catheters (SphenoCath [Dolor Technoogies LLC], Allevio [Jet Medical], Tx360 [Tian Medical LLC]) targeting the SPG in patients with headache, assess which headache disorders these catheters should target, or propose frequency of use. To assess SPG block device use for the treatment of primary headache disorders among headache specialists, Jessica Ailani, MD, and colleagues conducted a survey of American Headache Society members and published their results in Neurology Clinical Practice.

“Survey questions covered what devices (if any) were used, what types of headaches were treated, what anesthetic and volume was used, and how helpful the survey participants found the procedure in treating patients’ headache disorders,” explains Dr. Ailani. Among participants, 56.3% had performed SPG blocks on 50 or fewer patients.

The most commonly used methods of SPG block application were the SphenoCath (42.4%) and Tx360 (41.8%), with respondents citing ease of use as the top reason for preferring these applicator types. The most commonly treated headache disorder with SPG blocks was chronic migraine, which was also rated as the mostly likely type to respond to this treatment. “SPG blocks were often used as needed for treatment of headache,” adds Dr. Ailani. “Those who were experienced in performing SPG blocks appeared to find them more successful when used as stand-alone, as-needed treatments and tended to report that acute relief was not predictive of enduring response.”

Although the study suggests that SPG blocks may be effective when use as needed for chronic migraine, according to Dr. Ailani, evidence-based protocols are lacking, leading clinicians to not utilize this treatment approach more frequently. “More research is needed to understand, for example, if SPG blocks are more effective when performed more frequently for a specific period of time or when done monthly or if SPG blocks are better for treating acute headache versus as a preventative with frequent dosing.”

References

Sphenopalatine ganglion block in primary headaches
https://cp.neurology.org/content/early/2019/12/04/CPJ.0000000000000773