Sphenopalantine Ganglion Block for Headache


    Sphenopalantine Ganglion Block for Headache

    “I have a headache”….the number of times we as ED providers have taken care of a patient with this complaint is uncountable. Once we have established that the source of the headache is not life threatening we then move on to how to treat and make the patient more comfortable. Standard care of practice has been OTC medications (Tylenol, Ibuprofen, etc) which are great first line options and more importantly don’t require an IV line. However when we fail to relieve our patients symptoms we grab IV medications which often do the trick. But what if there was another option prior to administering IV medications?

    The sphenopalantine ganglion block could be a potential fast acting and effective option for treating these benign headaches.  In a 2015 study conducted by Schaffer et al comparing bupivacaine anesthesia vs saline solution of the sphenopalatine ganglion for acute headache the primary outcome was 50% reduction of pain at 15 minutes. The sphenopalantine ganglion causes a parasympathetic-mediated vasodilation of the cerebral vasculature which in turns causes the patient to experience a headache. The idea behind the sphenopalantine ganglion block is that by anesthetizing that ganglion you will offset most of the vasodilation, in turn improving the headache.


    1.) Soak the end of a cotton swab in a couple mmls of lidocaine or bupivacaine

    2.) Insert the cotton swab intranasally on the affected side until you meet resistance

    3.) Leave swab in for 5-10 mins


    Bottom line:  The sphenopalatine ganglion block is cost effective, easy to perform, and to date, no harms from the procedure itself have been reported. It could be a great alternative for headache treatment without having to place an IV



    1.) Schaffer JT et al. Noninvasive Sphenopalatine Ganglion Block for Acute Headache in the Emergency Department: A Randomized Placebo-Controlled Trial

    • Welcome! This is the website for the Mount Sinai Emergency Ultrasound Division. It serves as an information resource for residents, fellows, medical students and others seeking information about point-of-care ultrasound. There is a lot ofRead more

    • renal handling of water

      If you were on a tea & toast diet, how much water would you need to drink before you develop hyponatremia? I haven’t seen anyone work out the numbers before so here are my calculations. AndRead more

    • acute acidemia physiology

      As alluded to in the first post, don’t be fooled by a “normal” potassium in the setting of DKA because osmotic diuresis and H+/K+ exchange means that total body potassium is actually LOW. You all knowRead more

    • renal handling of potassium

      the first symptom of hyperkalemia is death Earlier post covered temporizing measures to counter hyperkalemia — namely, intracellular shift, increasing cardiac myocyte threshold potential. Give furosemide if the patient still urinates and consider dialysis, but then askRead more

    • bicarbonate revisited

      Previous post reviewed the safety of balanced crystalloids in hyper K. But what was up with serum bicarbonate decreasing with saline administration? This post introduces a new way of looking at the anion gap to possiblyRead more

    • hyperkalemia and balanced crystalloids

      Is it safe to give LR or plasmalyte to a hyperkalemic patient (these balanced crystalloids have 4-5 mEq/L K as opposed to 0 mEq/L K in normal saline)? Postponing the discussion of renal handling of potassium toRead more

    • hyperkalemia physiology

      You’ll likely encounter hyperkalemia on your next Resus / Cardiac shift, and you’ll instinctively treat it. But take a moment to review the fascinating physiology behind the “cocktail”! First, consider how K+ is buffered byRead more

    • Slow down your tachycardia (but not really)

      You’re sitting in resus bemoaning the departure of your most beloved attending when suddenly a patient wheels in without warning. The patient looks relatively stable but the triage RN tells you her heart rate wasRead more

    • Otitis externa: use the ear wick!

      Acute otitis externa (AOE) is a common complaint seen in pediatric as well as adult emergency departments. AOE is typically not accompanied by acute otitis media, although concurrent cases are possible. Also called “swimmer’s ear”Read more