“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.
HOW DO YOU DO IT?…EASY!
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