Suprazygomatic Sphenopalatine Ganglion Block May Quickly Relieve Status Migrainosus Pain

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The sphenopalatine ganglion plays a critical role in the transmission of pain and other autonomic responses associated with migraine.
The sphenopalatine ganglion plays a critical role in the transmission of pain and other autonomic responses associated with migraine.

Regional anesthetic suprazygomatic sphenopalatine ganglion (SPG) block may quickly and effectively relieve status migrainosus, according to a study published in Headache.

Although it is known that the SPG plays a critical role in the transmission of pain and other autonomic responses associated with migraine, the current treatment of migraine with SPG block via transnasal lidocaine was found to provide only moderate relief and to be poorly tolerated.

The study included participants with a diagnosis of migraine, based on the International Headache Society criteria, who had been diagnosed with status migrainosus, had failed to respond to ≥2 abortive medications, and had received a suprazygomatic SPG block (n=88). Participants rated their pain using a 1 to 10 Likert scale before and 30 minutes after the injection. The 88 participants received a total of 252 suprazygomatic SPG block procedures after traditional medications failed to relieve their symptoms.

At 30 minutes after injection, participants reported a 67.2% reduction in pain severity, with a median reduction of 5 points on the Likert scale (P <.0001).

There were no significant adverse events or complications after injections; 1 participant developed a transient cranial nerve VI palsy, which resolved completely after 6 hours.

"[Suprazygomatic SPG block] may provide a relatively inexpensive, therapeutic abortive therapy in patients with [status migrainosus], which in turn would reduce the number of patients' visits to the [emergency department] and need for hospitalization," the researchers wrote.

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Reference

Mehta D, Leary MC, Yacoub HA, et al. The effect of regional anesthetic sphenopalatine ganglion block on self-reported pain in patients with status migrainosus [published online July 25, 2018]. Headache. doi: 10.1111/head.13390

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