Why haven't I Heard of SPG Blocks Before?

Authored by: Dr Shapira

The Sphenopalatine Ganglion Block has been used for while over a century. So, why does it seem like nobody has ever heard of it until recently and why is it changing now.

According to an article in the Pain Practitioner in 2004, "Sphenopalatine Ganglion Blockade: A Review and Proposed Modification of the Transnasal Technique Report of Technique" by Robert E. Windsor, MD, and Scott Jahnke, DO the accepted uses of "the SPG block are sphenopalatine neuralgia, trigeminal neuralgia, atypical facial pain, acute migraine, acute and chronic cluster headaches, herpes zoster involving the ophthalmic nerve and a variety of other facial neuralgias. The mechanism by which intranasal lidocaine alleviates the pain is not fully understood, however it is believed to reverse the parasympathetic contribution to intracranial vasodilatation by blocking the sphenopalatine ganglion. It is not considered a first line treatment for low back pain, sciatica, arthritis, or angina despite several studies showing statistical benefit."

This article shows that there are a wide variety of accepted uses of the SPG Block. The best selling book "Miracles on Park Avenue" basically described a doctor who utilized the SPG block on all comers for chronic pain with amazing results in problems like Fibromyalgia. One problem with the block was it used an aqueous solution of cocaine that is highly regulated by the DEA and only ENTs routinely used it in practice.

Sluder first used the term sphenopalatine neuralgia in 1909. He described unilateral facial pain associated with signs of parasympathetic hyperactivity such as mucosal congestion, rhinorrhea, and lacrimation. Many considered this the first description of TMJ disorders without the joint component.
TMJ Disorders are frequently referred to as "The Great Imposter" because they mimic so many other conditions.

Precacci et al found lessening of trigger point pain following SPG blocks on patients suffering from complex regional pain syndrome. This effect on trigger points is without risk of side effects compared to new drugs treating Fibromyalgia such as Lyrica. Fibromyalgia is not cured by SPG Blocks but symptoms are vastly improved. The connection of Fibromyalgia to Sleep by Moldofsky firmly placed it as an autonomic nervous disorder. The SPG Block is like a reset button for the sympathetic and parsympathetice components of the autonomic nervous system.

Boston University School of Medicine utilized SPG blocks with topical application of 10% cocaine solution and found improvement in acute low back and musculoskeletal pain. There was significant improvement compared to plcebo and patients also showed increases in mobility.

Cluster Headaches were shown to be aborted by Barre in 1982( after the topical application of cocaine. This was the first instance I found of patients being taught to apply the anesthetic at home.

Kittrelle et al showed in 1985 that lidocaine had equivlant effects to cocaine in aborting acute cluster headaches.

Berger et al in 1986 used of 4% topical Xylocaine and found it equal to 10% cocaine and better than placebo for the relief of pain in patients with chronic lower back pain.

The SPG Block is back after being utilized by only a small number of Dentists and Physicians for several years. A small number of dentists became the became the defacto experts in utilizing this block. I learned from Jack Haden in Kansas City initially but my friend Dr Barry Glassman and Larry Lockerman also increased my knowledge. I became obsessed with the literature because my wife had frequent pain from endometriosis / Endomyosis and the SPG Block removed the issue of severe pain. Later , after being diagnosed with stage four ovarian cancer we again found SPG Blocks to be helpful in controlling the pain. (not the disease)

In the last few years three companies have brought devices to market to simplify SPG Blocks. The TX360, the Sphenocath and Allevio all work by targeting squirts of anesthetic over the area of nasal mucosa covering the Ganglion.

I prefer the continuous feed method obtained with a hollow swab continually delivering anaesthetic over a period of time. My preference is based on it being highly effective, and as Barre found in 1982 patients could be taught to self administer treatment at home. This method is also extremely ineffective drastically lowering costs to both insurance companies and to patients.

When a patient is in the middle of a severe Pain episode the intra-oral injection or facial injection is most effective and will give the fastest relief.

I currently teach courses to Physicians and Dentists on administration of SPG Blocks. I also teach patients how to utilize this excellent treatment to improve their quality of life. When patients are in a doctors office their quality of life is lessened, when they can use SPG Blocks to turn of their pain without disrupting their lives the truly have an excellent treatment.

To learn more about treatment with SPG Blocks contact me thru www.ThinkBetterLife.com.

I utilize SPG Blocks along with TENS, Diagnostic neuromuscular orthotics, neuromuscular dentistry, trigger point injections, transcranial neurotransmitter modulation, spray and stretch, NuCalm and other techniques to restore quality of life as rapidly as possible.

Patient Testimonials are available on the ICCMO website:
http://occlusiontmjauthority.com/dr-ira-shapira-testimonials/ and at

There is an extensive Bibliography from PubMed at the end of this article.

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Elahi F, Reddy CG.

Pain Physician. 2015 May-Jun;18(3):E403-9.

Long-term efficacy of a double-blind, placebo-controlled, randomized study for repetitivesphenopalatine blockade with bupivacaine vs. saline with the Tx360 device for treatment of chronic migraine.

Cady RK, Saper J, Dexter K, Cady RJ, Manley HR.

Headache. 2015 Apr;55(4):529-42. doi: 10.1111/head.12546. Epub 2015 Mar 31.

Transnasal sphenopalatine ganglion block for the treatment of postdural puncture headache in the ED.

Kent S, Mehaffey G.

Am J Emerg Med. 2015 Mar 14. pii: S0735-6757(15)00168-0. doi: 10.1016/j.ajem.2015.03.024. [Epub ahead of print] No abstract available.

Noninvasive sphenopalatine ganglion block for acute headache in the emergency department: a randomized placebo-controlled trial.

Schaffer JT, Hunter BR, Ball KM, Weaver CS.

Ann Emerg Med. 2015 May;65(5):503-10. doi: 10.1016/j.annemergmed.2014.12.012. Epub 2015 Jan 7.

Successful Management of Refractory Headache and Facial Pain due to Cavernous Sinus Meningioma with Sphenopalatine Ganglion Radiofrequency.

Elahi F, Ho KW.

Case Rep Neurol Med. 2014;2014:923516. doi: 10.1155/2014/923516. Epub 2014 Sep 29.

Sphenopalatine ganglion block: a safer alternative to epidural blood patch for postdural puncture headache.

Cohen S, Ramos D, Grubb W, Mellender S, Mohiuddin A, Chiricolo A.

Reg Anesth Pain Med. 2014 Nov-Dec;39(6):563. doi: 10.1097/AAP.0000000000000172. No abstract available.

A double-blind, placebo-controlled study of repetitive transnasal sphenopalatine ganglionblockade with tx360(®) as acute treatment for chronic migraine.

Cady R, Saper J, Dexter K, Manley HR.

Headache. 2015 Jan;55(1):101-16. doi: 10.1111/head.12458. Epub 2014 Oct 23.

Transnasal topical sphenopalatine ganglion block to treat tension headache in a pregnant patient.

Grant GJ, Schechter D, Redai I, Lax J.

Int J Obstet Anesth. 2014 Aug;23(3):292-3. doi: 10.1016/j.ijoa.2014.04.010. Epub 2014 May 10. No abstract available.

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Curr Pain Headache Rep. 2014;18(8):438. doi: 10.1007/s11916-014-0438-z. Review.

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An unusual challenge in performing sphenopalatine ganglion block with enlarged coronoid process: Jacob's disease.

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Shimizu T.

Rinsho Shinkeigaku. 2013;53(11):1131-3. Review. Japanese.

A novel revision to the classical transnasal topical sphenopalatine ganglion block for the treatment of headache and facial pain.

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Pain Physician. 2013 Nov-Dec;16(6):E769-78.

Cluster headache: potential options for medically refractory patients (when all else fails).

Tepper SJ, Stillman MJ.

Headache. 2013 Jul-Aug;53(7):1183-90. doi: 10.1111/head.12148. Epub 2013 Jun 28. Review.

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Int Forum Allergy Rhinol. 2012 Jul-Aug;2(4):325-30. doi: 10.1002/alr.21035. Epub 2012 Apr 5.

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Am J Rhinol Allergy. 2012 Jan-Feb;26(1):e40-5. doi: 10.2500/ajra.2012.26.3697.

Bilateral sphenopalatine ganglion blockade improves postoperative analgesia after endoscopic sinus surgery.

DeMaria S Jr, Govindaraj S, Chinosorvatana N, Kang S, Levine AI.

Am J Rhinol Allergy. 2012 Jan-Feb;26(1):e23-7. doi: 10.2500/ajra.2012.26.3709.

The effectiveness of preemptive sphenopalatine ganglion block on postoperative pain and functional outcomes after functional endoscopic sinus surgery.

Cho DY, Drover DR, Nekhendzy V, Butwick AJ, Collins J, Hwang PH.

Int Forum Allergy Rhinol. 2011 May-Jun;1(3):212-8. doi: 10.1002/alr.20040. Epub 2011 Apr 13.

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Acta Neurol Taiwan. 2011 Sep;20(3):213-27. Review. Chinese.

Sphenopalatine endoscopic ganglion block in cluster headache: a reevaluation of the procedure after 5 years.

Pipolo C, Bussone G, Leone M, Lozza P, Felisati G.

Neurol Sci. 2010 Jun;31 Suppl 1:S197-9. doi: 10.1007/s10072-010-0325-2.

Endoscopic neural blockade for rhinogenic headache and facial pain: 2011 update.

Rodman R, Dutton J.

Int Forum Allergy Rhinol. 2012 Jul-Aug;2(4):325-30. doi: 10.1002/alr.21035. Epub 2012 Apr 5.

Anatomically and physiologically based guidelines for use of the sphenopalatine ganglion blockversus the stellate ganglion block to reduce atypical facial pain.

Klein RN, Burk DT, Chase PF.

Cranio. 2001 Jan;19(1):48-55. Review.

Endoscopic transnasal neurolytic sphenopalatine ganglion block for head and neck cancer pain.

Varghese BT, Koshy RC.

J Laryngol Otol. 2001 May;115(5):385-7.

Patient-administered sphenopalatine ganglion block.

Saade E, Paige GB.

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Endoscopic sphenopalatine ganglion block for pain relief.

Murty PS, Prasanna A.

Indian J Otolaryngol Head Neck Surg. 1998 Jan;50(1):99-105. doi: 10.1007/BF02996789.

Sphenopalatine ganglion block for treatment of sinus arrest in postherpetic neuralgia.

Saberski L, Ahmad M, Wiske P.

Headache. 1999 Jan;39(1):42-4.

Sphenopalatine ganglion block for the treatment of myofascial pain of the head, neck, and shoulders.

Ferrante FM, Kaufman AG, Dunbar SA, Cain CF, Cherukuri S.

Reg Anesth Pain Med. 1998 Jan-Feb;23(1):30-6.

Sphenopalatine ganglion block relieves symptoms of trigeminal neuralgia: a case report.

Manahan AP, Malesker MA, Malone PM.

Nebr Med J. 1996 Sep;81(9):306-9.

Lack of effect of sphenopalatine ganglion block with intranasal lidocaine on submaximal effort tourniquet test pain.

Silverman DG, Spencer RF, Kitahata LM, O'Connor TZ.

Reg Anesth. 1993 Nov-Dec;18(6):356-60.

Sphenopalatine ganglion block: a safe and easy method for the management of orofacial pain.

Peterson JN, Schames J, Schames M, King E.

Cranio. 1995 Jul;13(3):177-81.

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AMSTER JL.

N Y State J Med. 1948 Nov 15;48(22):2475-80. No abstract available.

Vasomotor rhinitis and sphenopalatine ganglion block.

Prasanna A, Murthy PS.

J Pain Symptom Manage. 1997 Jun;13(6):332-8.

Intranasal sphenopalatine ganglion block: minimally invasive pharmacotherapy for refractory facial and headache pain.

Obah C, Fine PG.

J Pain Palliat Care Pharmacother. 2006;20(3):57-9. Review.

Combined stellate ganglion and sphenopalatine ganglion block in acute herpes infection.

Prasanna A, Murthy PS.

Clin J Pain. 1993 Jun;9(2):135-7. No abstract available.

Technique for sphenopalatine ganglion block.

Spencer RF.

Reg Anesth. 1997 Sep-Oct;22(5):483-4. No abstract available.

Does sphenopalatine endoscopic ganglion block have an effect in paroxysmal hemicrania? A case report.

Morelli N, Mancuso M, Felisati G, Lozza P, Maccari A, Cafforio G, Gori S, Murri L, Guidetti D.

Cephalalgia. 2010 Mar;30(3):365-7. doi: 10.1111/j.1468-2982.2009.01882.x. Epub 2010 Feb 1.

Sphenopalatine ganglion block under vision using rigid nasal sinuscope.

Prasanna A, Murthy PS.

Reg Anesth. 1993 Mar-Apr;18(2):139-40. No abstract available.

Sphenopalatine ganglion block before removal of nasal packing.

Hwang JH, Liu CM, Liu TC, Hsu MC.

Laryngoscope. 2003 Aug;113(8):1423-4. No abstract available.

Response to sphenopalatine ganglion block with intranasal lidocaine on submaximal effort tourniquet test pain.

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Reg Anesth. 1994 Jul-Aug;19(4):293. No abstract available.

Sphenopalatine ganglion block and pain of cancer.

Prasanna A, Murthy PS.

J Pain Symptom Manage. 1993 Apr;8(3):125. No abstract available.

A new interest in an old remedy for headache and backache for our obstetric patients: asphenopalatine ganglion block.

Cohen S, Trnovski S, Zada Y.

Anaesthesia. 2001 Jun;56(6):606-7. No abstract available.

Sphenopalatine ganglion block--80 years later.

Waldman SD.

Reg Anesth. 1993 Sep-Oct;18(5):274-6. No abstract available.

Sphenopalatine ganglion blockade: a review and proposed modification of the transnasal technique.

Windsor RE, Jahnke S.

Pain Physician. 2004 Apr;7(2):283-6.

A novel approach to transnasal sphenopalatine ganglion injection.

Yang lY, Oraee S.

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Sphenopalatine ganglion blocks for the treatment of nicotine addiction.

Henneberger JT, Menk EJ, Middaugh RE, Finstuen K.

South Med J. 1988 Jul;81(7):832-6.

Sphenopalatine endoscopic ganglion block: a revision of a traditional technique for cluster headache.

Felisati G, Arnone F, Lozza P, Leone M, Curone M, Bussone G.

Laryngoscope. 2006 Aug;116(8):1447-50.

Sphenopalatine ganglion radiofrequency ablation for the management of chronic cluster headache.

Narouze S, Kapural L, Casanova J, Mekhail N.

Headache. 2009 Apr;49(4):571-7. doi: 10.1111/j.1526-4610.2008.01226.x. Epub 2008 Sep 9.

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Olszewska-Ziaber A, Ziaber J, Rysz J.

Otolaryngol Pol. 2007;61(3):319-21. Polish.

Combined sphenopalatine ganglion and mandibular nerve, neurolytic block for pain due to advanced head and neck cancer.

Varghese BT, Koshy RC, Sebastian P, Joseph E.

Palliat Med. 2002 Sep;16(5):447-8. No abstract available.

[Block of the sphenopalatine ganglion with bupivacaine and methylprednisolone acetate in the control of facial pain].

Ciammitti B, Tesoro S, Carloni D, Bifarini G.

Minerva Anestesiol. 1991 Sep;57(9):538-9. Italian. No abstract available.

Efficacy of sphenopalatine ganglion blockade in 66 patients suffering from cluster headache: a 12- to 70-month follow-up evaluation.

Sanders M, Zuurmond WW.

J Neurosurg. 1997 Dec;87(6):876-80.

Cluster headache: potential options for medically refractory patients (when all else fails).

Tepper SJ, Stillman MJ.

Headache. 2013 Jul-Aug;53(7):1183-90. doi: 10.1111/head.12148. Epub 2013 Jun 28. Review.

Complex regional pain syndrome involving the lower extremity: a report of 2 cases ofsphenopalatine block as a treatment option.

Quevedo JP, Purgavie K, Platt H, Strax TE.

Arch Phys Med Rehabil. 2005 Feb;86(2):335-7.

A newer concept of arthritis and the treatment of arthritic pain and deformity by sympathetic blockat the sphenopalatine (nasal) ganglion and the use of the iron salt of the adenylic nucleotide, the dynamics of muscle tonus.

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Am J Dig Dis. 1949 Nov;16(11):386-401, illust. No abstract available.

[CT guided neurolysis of the sphenopalatine ganglion for management of refractory trigeminal neuralgia].

Grégoire A, Clair C, Delabrousse E, Aubry R, Boulahdour Z, Kastler B.

J Radiol. 2002 Sep;83(9 Pt 1):1082-4. French.

Transfacial transpterygomaxillary access to foramen rotundum, sphenopalatine ganglion, and the maxillary nerve in the management of atypical facial pain.

Stechison MT, Brogan M.

Skull Base Surg. 1994;4(1):15-20.

Cluster headache and sphenopalatine block.

Devoghel JC.

Acta Anaesthesiol Belg. 1981;32(1):101-7.

Computed tomography-enhanced sphenopalatine ganglion blockade.

Vallejo R, Benyamin R, Yousuf N, Kramer J.

Pain Pract. 2007 Mar;7(1):44-6. No abstract available.

Sphenopalatine ganglion neuralgia.

Brown CR.

Pract Periodontics Aesthet Dent. 1997 Jan-Feb;9(1):99-100. No abstract available.

[Freezing of the sphenopalatine ganglion in cryotherapy of vasomotor rhinitis].

Shuster MA, Natsvlishvili VI, Aleksandrov EN.

Vestn Otorinolaringol. 1979 Nov-Dec;(6):45-9. Russian. No abstract available.

Sphenopalatine blocks in the treatment of pain in fibromyalgia and myofascial pain syndrome.

Janzen VD, Scudds R.

Laryngoscope. 1997 Oct;107(10):1420-2.

Trigeminal autonomic cephalalgias: beyond the conventional treatments.

Miller S, Matharu M.

Curr Pain Headache Rep. 2014;18(8):438. doi: 10.1007/s11916-014-0438-z. Review.

[New treatments for cluster headache].

Shimizu T.

Rinsho Shinkeigaku. 2013;53(11):1131-3. Review. Japanese.

2003 Wolff Award: Possible parasympathetic contributions to peripheral and central sensitization during migraine.

Yarnitsky D, Goor-Aryeh I, Bajwa ZH, Ransil BI, Cutrer FM, Sottile A, Burstein R.

Headache. 2003 Jul-Aug;43(7):704-14.

[Percutaneous maxillary nerve block anesthesia in maxillofacial surgery].

Robiony M, Demitri V, Costa F, Politi M.

Minerva Stomatol. 1999 Jan-Feb;48(1-2):9-14. Italian.[Treatment guidelines for acute and preventive treatment of cluster headache].

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Acta Neurol Taiwan. 2011 Sep;20(3):213-27. Review. Chinese.

Nerve blocks in the treatment of headache.

Levin M.

Neurotherapeutics. 2010 Apr;7(2):197-203. doi: 10.1016/j.nurt.2010.03.001. Review.

[Acupuncture and ganglionic local opioid analgesia in trigeminal neuralgia].

Spacek A, Hanl G, Groiss O, Koinig H, Kress HG.

Wien Med Wochenschr. 1998;148(19):447-9. German.

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Grégoire PC.