Facial pain during migraine explained
Do you ever get sinus pain, watery eyes, nasal congestion, jaw or ear pain during a migraine? You can blame these strange symptoms on your sphenopalatine ganglion.
The sphenopalatine ganglion, or SPG as it is often called, is a bundle of nerves located behind the bony structures of the sinuses. It contains both sensory (feeling) nerves and autonomic nerves. The autonomic nerves are responsible for tear production and sinus congestion. They can also be blamed for a runny nose. The sensory nerves can be blamed for any pain you feel in your face, eyes, or jaw during an attack.
You see, the SPG connects to both the brain stem and meninges (covering of brain) through the trigeminal nerve. When the blood vessels of the meninges expand, they send pain signals back to the trigeminal nerve. Those signals pass through the SPG and sometimes trigger excessive tear production, sinus congestion, runny nose, or pain in the eyes, nose, face, and jaw even in the absence of a cold or sinus infection.
There is a treatment that can provide temporary relief from these symptoms. An SPG nerve block may offer a few weeks to months of relief. The procedure is relatively quick and can be administered in a doctor’s office in about 30 minutes. Patients are asked to lie on their back with head tilted back and toward the painful side. An anesthetic nasal spray can be giving to reduce discomfort, but the procedure is not painful. An applicator or catheter is then inserted into the back nostril and anesthetic is applied. It absorbs through the bone into the SPG. Patients must lie still for 30 minutes to give the medicine time to absorb. Recently there have been new advancements in applicators that make the procedure more comfortable.
Side effects include discomfort, numbness when swallowing, a bitter taste, nosebleed, and light-headedness which resolve quickly after the procedure. Rarely, seizures, allergic reactions, and infections occur.
The clinical advantage is to provide symptom relief while allowing time to create a more permanent treatment plan or give preventive medications time to take effect. Just remember that it’s not a cure or a preventive treatment. It is a long-lasting treatment for acute pain. Like all other treatments, it will not work for everyone.
Other treatments to block the SPG nerve signals include:
Laser therapy, called Argus Neurostimulator, emits a laser through a probe to administer a nerve block. It is faster than traditional nerve blocks and equally non-invasive. This option is still undergoing studies to determine its effectiveness and safety.
SPG Neruomodulation is surgical neurostimulation of the nerve cluster. General anesthesia is required to implant the device through the mouth with the leads positioned on the SPG. Once implanted, the device is turned on for acute pain relief by placing a remote controller against the cheek on the affected side. Temporary side effects include numbness and pain in face, gums, teeth post-op, plus the typical risks of surgery.
Studies are ongoing for treatment of both migraine and cluster headaches. Since cluster headaches are so decidedly unpleasant and happen to be one of my primary migraine triggers, I will do just about anything to stop an attack before it gets out of control. I have applied to participate in the SPG Neuromodulation study to test the effectiveness of this device at aborting cluster headachs. The closest research site is still waiting on approval to begin recruitment. However, there is a study based at the University of Ohio that is recruiting volunteers. For more information, you can visit the study’s page at ClinicalTrials.gov or a description of the study at the Autonomic Technologies website.1,2
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