By Thomas S. May
ATLANTA -- March 3, 2015 -- Image-guided intranasal sphenopalatine ganglion (SPG) blocks can significantly reduce the pain associated with chronic migraine or cluster headaches, researchers reported here at the 40th Annual Meeting of the Society of Interventional Radiologists (SIR).
“Intranasal sphenopalatine ganglion blocks are image guided, targeted, breakthrough treatments,” said Kenneth Mandato, MD, Albany Medical Center, Albany, New York. “They offer a patient-centred therapy that has the potential to break the migraine cycle and quickly improve patients’ quality of life.”
During the treatment, researchers insert a spaghetti-sized catheter through the nasal passages and administer 4% lidocaine to the sphenopalatine ganglion.
“Administration of lidocaine to the sphenopalatine ganglion acts as a ‘reset button’ for the brain’s migraine circuitry,” said Dr. Mandato. “When the initial numbing of the lidocaine wears off, the migraine trigger seems to no longer have the maximum effect that it once did.”
The study included 112 patients (mean age, 44.5 years; 79% female) suffering from chronic migraine or cluster headaches. Patients were assessed with a visual analogue scale (VAS), ranging from 1-10, to quantify the degree of debilitation.
Patients were treated using a 4F Allevio SPG catheter, which was positioned above the middle turbinate via an intranasal approach and directed toward the SPG. The ganglion was outlined using contrast fluoroscopy, and 2 cc of 4% xylocaine was administered to both nostrils during nasal inhalation.
Patients remained in the supine position for 5 minutes before discharge, and they were re-assessed again on day 1, 7, and 30 following the procedure.
The researchers found that the mean VAS score decreased from 8.25 at baseline to 4.10 on day 1 (P <.001), 4.40 on day 7 (P < .001), and 5.25 on day 30 (P < .001).
Of the patients, 7 (6.3%) failed to respond to treatment and 99 patients (88%) required less medication after the procedure for ongoing pain relief.
While patients reported relief from their headaches, Dr. Mandato cautioned that SPG blocks are not a cure for migraines.
To further evaluate the treatment, the researchers will track how the 112 patients have responded 6 months after treatment. The researchers are also planning to conduct a double-blind, prospective study to more rigorously evaluate the effectiveness of SPG blocks in treating chronic migraines.
[Presentation title: Image-Guided Sphenopalatine Ganglion Blocks: An IR Solution for Chronic Headaches. Abstract 77]
