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December 2020; 10 (6) Research

Sphenopalatine ganglion block in primary headaches

An American Headache Society member survey

View ORCID ProfileJohn G. Burkett, Matthew S. Robbins, Carrie E. Robertson, Mihriye Mete, Nicolas P. Saikali, Rashmi B. Halker Singh, Jessica Ailani
First published December 4, 2019, DOI: https://doi.org/10.1212/CPJ.0000000000000773
John G. Burkett
Department of Neurology (JGB), Allegheny Health Network, Pittsburgh, PA; Department of Neurology (MSR), Weill Cornell Medical College, Bronx, New York; Department of Neurology (CER), Mayo Clinic, Rochester, MN; Medstar Health Research Institute (MM), Georgetown University Washington DC; Dent Neurologic Institute (NPS), Amherst, NY; Department of Neurology (RBHS), Mayo Clinic, Phoenix, AZ; and Medstar Health Research Institute (JA), Georgetown University Washington, DC.
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  • ORCID record for John G. Burkett
Matthew S. Robbins
Department of Neurology (JGB), Allegheny Health Network, Pittsburgh, PA; Department of Neurology (MSR), Weill Cornell Medical College, Bronx, New York; Department of Neurology (CER), Mayo Clinic, Rochester, MN; Medstar Health Research Institute (MM), Georgetown University Washington DC; Dent Neurologic Institute (NPS), Amherst, NY; Department of Neurology (RBHS), Mayo Clinic, Phoenix, AZ; and Medstar Health Research Institute (JA), Georgetown University Washington, DC.
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Carrie E. Robertson
Department of Neurology (JGB), Allegheny Health Network, Pittsburgh, PA; Department of Neurology (MSR), Weill Cornell Medical College, Bronx, New York; Department of Neurology (CER), Mayo Clinic, Rochester, MN; Medstar Health Research Institute (MM), Georgetown University Washington DC; Dent Neurologic Institute (NPS), Amherst, NY; Department of Neurology (RBHS), Mayo Clinic, Phoenix, AZ; and Medstar Health Research Institute (JA), Georgetown University Washington, DC.
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Mihriye Mete
Department of Neurology (JGB), Allegheny Health Network, Pittsburgh, PA; Department of Neurology (MSR), Weill Cornell Medical College, Bronx, New York; Department of Neurology (CER), Mayo Clinic, Rochester, MN; Medstar Health Research Institute (MM), Georgetown University Washington DC; Dent Neurologic Institute (NPS), Amherst, NY; Department of Neurology (RBHS), Mayo Clinic, Phoenix, AZ; and Medstar Health Research Institute (JA), Georgetown University Washington, DC.
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Nicolas P. Saikali
Department of Neurology (JGB), Allegheny Health Network, Pittsburgh, PA; Department of Neurology (MSR), Weill Cornell Medical College, Bronx, New York; Department of Neurology (CER), Mayo Clinic, Rochester, MN; Medstar Health Research Institute (MM), Georgetown University Washington DC; Dent Neurologic Institute (NPS), Amherst, NY; Department of Neurology (RBHS), Mayo Clinic, Phoenix, AZ; and Medstar Health Research Institute (JA), Georgetown University Washington, DC.
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Rashmi B. Halker Singh
Department of Neurology (JGB), Allegheny Health Network, Pittsburgh, PA; Department of Neurology (MSR), Weill Cornell Medical College, Bronx, New York; Department of Neurology (CER), Mayo Clinic, Rochester, MN; Medstar Health Research Institute (MM), Georgetown University Washington DC; Dent Neurologic Institute (NPS), Amherst, NY; Department of Neurology (RBHS), Mayo Clinic, Phoenix, AZ; and Medstar Health Research Institute (JA), Georgetown University Washington, DC.
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Jessica Ailani
Department of Neurology (JGB), Allegheny Health Network, Pittsburgh, PA; Department of Neurology (MSR), Weill Cornell Medical College, Bronx, New York; Department of Neurology (CER), Mayo Clinic, Rochester, MN; Medstar Health Research Institute (MM), Georgetown University Washington DC; Dent Neurologic Institute (NPS), Amherst, NY; Department of Neurology (RBHS), Mayo Clinic, Phoenix, AZ; and Medstar Health Research Institute (JA), Georgetown University Washington, DC.
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Full PDF
Citation
Sphenopalatine ganglion block in primary headaches
An American Headache Society member survey
John G. Burkett, Matthew S. Robbins, Carrie E. Robertson, Mihriye Mete, Nicolas P. Saikali, Rashmi B. Halker Singh, Jessica Ailani
Neurol Clin Pract Dec 2020, 10 (6) 503-509; DOI: 10.1212/CPJ.0000000000000773

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Abstract

Background The sphenopalatine ganglion (SPG), in the pterygopalatine fossa, is a known current and historical target for therapeutic intervention in headache disorders because of its role in cranial autonomics and vasodilation. There remains an overall lack of well-established SPG treatment protocols, particularly with the advent of newer commercial devices.

Methods A 22 multiple-choice question survey was created to evaluate clinical practice patterns with SPG block and sent to members of the American Headache Society (AHS). Questions focused on determining indications, preferred applicators, medications applied, perceived efficacy, tolerability, and reimbursement.

Results One hundred seventy-two of 1,346 (12.8%) AHS members participated. Ninety-three respondents (56.3%) had performed SPG blocks on 50 or fewer patients. The SphenoCath (42.4%) and the Tx360 (41.8%) were the most common methods of application. Ease of use was the top reason for provider preference in applicator type. SPG blocks were mostly used as an as-needed one-time procedure. When a scheduled protocol was used, twice weekly for 6 weeks was most common. Chronic migraine was the most commonly treated headache disorder and rated the most likely to respond to SPG block. Experienced clinicians found SPG more helpful as a stand-alone treatment and tended to report that acute relief was not predictive of enduring response.

Conclusions The variety of responses strongly suggests that clinicians would benefit from formalized protocols for SPG blocks. More experienced clinicians may have developed individualized protocols that they feel are more effective. The lack of evidence-based protocols contribute to clinicians not performing SPG blocks more frequently.

Footnotes

  • Funding information and disclosures are provided at the end of the article. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.

  • Received August 1, 2019.
  • Accepted October 22, 2019.
  • © 2019 American Academy of Neurology
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