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.

Spheno-what?

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.

Treatments

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

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.
View References
  1. Autonomic Technologies, http://www.ati-spg.com/us/en/clinical-trials/pathway-ch2-cluster-headache-study/, retrieved online 9/28/2014
  2. Jion, Yasmin; and Robbins, Matthew S., “The Sphenopalatine Ganglion (SPG) and Headache Disorders”, http://www.achenet.org/resources/the_sphenopalatine_ganglion_spg_and_headache_disorders_part_ii/, retrieved online 9/28/2014

Comments

View Comments (11)
  • winifred53
    3 years ago

    I have chronic migraines triggered by barometric pressure. Facial migraine is an almost daily problem for me as I have 25 headaches a month. My neurologist tried both the SPG block and the nerve block on the vertebrae in my neck with no relief. At the present time I am back on Topiramte (I had to take a break due to kidney stones) and my neurologist does not want to give me any pain meds to speak of at this time. I have extreme pain in the eyebrow, bridge of my nose, left eye, upper teeth, left ear, left temple area. I have to be very careful as the pain can cause suicidal thoughts. I am considering changing neurologists, which will make neurologist #5. I fell on the ice 13 years ago smacking the back of my head on the sidewalk and they believe that is what is causing my migraines for the past 13 years.

  • paizley
    4 years ago

    I went to an ENT for what I thought was chronic sinusitis. I do have sinus issues and allergies but he told me there was no evidence of infection after CT imaging. He found a polyp, mucus retention cyst, deviated septum. He suggested I see a neurologist to be eval for migraine. I have had migraines in the past but there was never facial pain. My typical ones presented with scintillating scotomas and sometimes just those and no pain. The neurologist agreed with the ENT. I was put on Topamax to be titrated upward but found I couldn’t take the higher doses. My most recent migraine was exceptionally painful. I woke up with it and it lasted about 12 hours. I couldn’t take meds because I would throw those up before they were even half way down my throat. The next day I had an abdominal migraine. I haven’t had one in 6-8 weeks and am not taking anything. I can go months and months, sometimes over a year, and not have a migraine then I’ll have a period where I’ll have several in a row. Go figure.

  • Ellen H
    4 years ago

    Neuro-modulation: I submitted myself for a temporary Neuro-modulation wherein two electrodes were implanted in the back of my head. The two leads were then connected to a monitor that administered electrical impulses to the trigeminal nerve.

    Well, anything that could go wrong, did go wrong. The right lead fell out of my head; I have no idea when or how that happened. The day after surgery I woke up with a screaming migraine in my face and a screaming migraine in the back of my head at the surgical site. So much for reduced pain.

    The monitor kept turning itself OFF. The representative of the Neuro-modulation company tried to reprogram it and still it turned itself OFF. We switched monitors and tried a different one. It kept turning itself OFF. The monitors drained three batteries in four days. All in all, this has to be one of the worst experiences of my life.

    Here’s what I want to say to those of you who might be thinking of the SPG Neuro-modulation. BEFORE you have something implanted in your MOUTH, find a way to determine whether or not the equipment is going to work right in the first place or whether the chances for success for you are good.

    My surgery was in the back of my head and it was a temporary procedure. I will never again permit anyone to implant anything in my body ever again. I will live with the pain. I am done with trying “new” things.

    I have to be fair. I know one patient who had the same surgery I did. It was completely successful. Afterwards she had the permanent electrodes implanted and is very happy with the results.

    This commentary is offered as a cautionary tale. Thank you. Ellen Henegar.

  • lisacb12
    4 years ago

    I had a done about a year and a half ago. My neuro suggested this, and I went to a pain doctor that was supposed to be wonderful. He told me it is 98% effective, and he had patients of over a year or so that were “cured”. I had a headache when I went in, and when I left. I never had any relief. The pain doctor’s office never followed up with me. I guess you can claim high rates of success, if you never follow up with your patients to see if it worked. About a year later, I started hearing that this procedure has to be repeated every so often. I also found that out the same about the botox I had a few months before that (which worked for about three days, different doctor). The sphenocath was not comfortable in any way. The doctor put a small amount of numbing cream on a q-tip and barely put it in my nostril. I immediately sneezed, and they did not re-apply. I hope it works for others, though. My insurance did pay for most of that.

  • JeanyB
    4 years ago

    This is very interesting! I started to get facial pain about 7 years ago. It became so severe and constant that I was off sick and crying in bed for 3 months. I eventually gained some relief with Topiramate, Nortriptyline and Propranolol, but was quite doped up with these meds. Eventually I had botox injections with a good effect.
    I have found that working on a monitor that uses pulse wave modulation (PWM) will cause me to have facial pain, then this facial pain will trigger a migraine! The PWM causes invisible flicked that migraineurs can be sensitive to. So I’m thinking the eyes pick up the flicker and the SPG gets affected and this results in pain, maybe?
    I will just stay away from PWM monitors but will keep these treatments in mind. I was nearly suicidal when I had the constant pain.

  • Pete
    4 years ago

    FYI- point of clarification: this study is at the Ohio State University, Columbus, Ohio, and not at Ohio University, Athens, Ohio (it is confusing to someone out of state).

    I underwent something similar (foot-long wooden ‘Q-tips’ into the sinuses (head tilted back) about 20 years ago at OSU pain control; hope it works for you.

  • Piglet
    4 years ago

    I tried this block for the first time about two months ago after a several day ongoing migraine, and it worked to relieve about 50% of the symptoms, so two hours later I had a Toradol shot as well. Good relief for two days. One month later, tried the two together and got almost instant relief again for two day. I get migraines about every other day and have tried most everything, but usually only time gives me this kind of relief. Cefaly was great for about six weeks but stopped being effective. The sphenopallatine block costs about $1,000 and be prepared for your insurance to question its use, though. Mine is giving my certified migraine specialist, also a neurologist, a hard time. So, the bottom line: the block and toradol combo worked really well, was quick and not too uncomfortable, but lasted only two days, not weeks to months. There may be a longer lasting surgical procedure that targets the same nerves.

  • Angiestl
    4 years ago

    I’ve been dealing with this almost constantly for the last two or three weeks. I did have a little relief during a round of antibiotics, but the relief was gone even before the antibiotics were. If you’d asked me yesterday, I’d have said I’d do just about anything to get rod of the pain, but after reading how the nerve block is given, I think that hits that limit of what I’d do. I’ve had two sinus surgeries and have had my sinuses scoped more times than I care to think about, so I know how little tolerance I have for medical devices being put up my nose! Lol!

  • Writermom
    4 years ago

    I often have runny nose, and ear pain during a migraine. I recently learned that it is not allergy or an infection, but the migraine illness itself that is causing this. Yesterday, I had an experience that never before happened. I had a migraine, apparently, without head pain. I had all the other symptoms, but no head pain. While I was sleeping on my right side, I suddenly was awakened by severe pain in my right eye, with it running (tearing) and my nose pouring absolutely clear fluid. This hurt quite a bit. My eye continued to hurt for quite some time. Since all the fluid from my nose was clear, no infection there. I had never experienced this before. I felt poorly for the rest of the day, and did not sleep more than an hour or so last night. I wonder if anyone else ever experienced anything like this.

  • Ellen H
    4 years ago

    I wonder if anyone else ever experienced anything like this…. The answer is Yes. I have always had a small migraine right between the eyes. The killer migraines began in my teens and were located in the back of my head.

    THEN in 1993, the migraines changed. I woke up one morning and the migraine was in my left eye. It was extremely painful. It lasted three weeks. And then it shifted to my right eye.

    After several years, the pain has moved out of my eyes and shifted to the brow, the arch of the cheek, temples, top of head. The migraines now reside in my face on a permanent basis. My nose runs often. And I often have blurred vision. Sometimes the blurred vision hits only one eye; then half my world is blurred and the other eye goes crazy trying to compensate.

    I have a neurologist who is a migraine specialist. I have been seeing him for 12 years. We have tried dozens of medications. My body lacks the liver enzymes that metabolize medications, which is why medications are not very helpful.

    I am beginning to like this website. At least I know I am not alone. And neither are you. Good luck. Ellen H.

  • Writermom
    4 years ago

    I also had many earaches as a child, and now wonder if these were my migraines displaying that way even then.

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