Minimally Invasive Procedure Breaks the Migraine Cycle

A new study demonstrates that image-guided, intranasal sphenopalatine ganglion (SPG) nerve blocks provided ongoing relief to migraine patients.

Researchers at Albany Medical Center (AMC; NY, USA) and SUNY Empire State College (ESC; Saratoga Springs, NY, USA) conducted a retrospective analysis of 112 participants with migraine or cluster headaches, who scored the severity of their symptoms on a visual analog scale (VAS). The researchers then inserted a catheter through the nasal passages and toward the rear of the nasal cavity. A 4% lidocaine solution was then dripped in situ, absorbed through the bone and into the SPG, anesthetizing the nerve bundle in the ganglion and blocking neurotransmission. Depending on the type of headache disorder being treated, the procedure was repeated in the other nostril.

The results showed that before treatment, the patients reported an average VAS score of 8.25, with scores greater than 4 at least 15 days per month. The day after the SPG block, the patient’s scores were cut in half, to an average of 4.1. Thirty days after the procedure, patients reported an average score of 5.25, a 36% decrease from pretreatment. Additionally, 88% of patients indicated that they required less or no migraine medication for ongoing relief. The study was presented at the Society of Interventional Radiology annual scientific meeting, held during March 2015 in Atlanta (GA, USA).

“Administration of lidocaine to the sphenopalatine ganglion acts as a ‘reset button’ for the brain’s migraine circuitry,” said lead author and study presenter interventional radiologist Kenneth Mandato, MD. “When the initial numbing of the lidocaine wears off, the migraine trigger seems to no longer have the maximum effect that it once did. Some patients have reported immediate relief and are making fewer trips to the hospital for emergency headache medicine.”

The SPG is a collection of nerve cells that is closely associated with the trigeminal nerve, the main nerve involved in headache disorders due to its linkage to the brainstem and the meninges. The SPG contains both sensory and autonomic nerves, which supply the lacrimal glands and the membranes lining the nasal cavity and sinuses, which explains why autonomic features, including tearing of the eyes and nasal congestion or discharge, can occur during cluster headache and migraine. The phenomenon is known as trigeminal autonomic reflex.

Related Links:
Albany Medical Center
SUNY Empire State College