My First SPG Block (or The Time I Sneezed On My Doctor)

I am currently going to Jefferson Headache Center and I'm on a combination of medications and Botox. However I still felt like there was more I could do to get my migraines and headaches under control. Luckily for me, my mom was on the case.

Unbeknownst to me, my mom had been researching treatments for chronic migraines and headaches. And she stumbled across one that might work for me - Sphenopaletine Ganglion blocks (or SPG blocks). An SPG block is basically introducing lidocaine to the Sphenopaletine Ganglion nerve, which resides in your nasal cavity. SPG blocks have been around for a while but they used to be very painful (using a needle through the roof of your mouth) or inaccurate (using a long cotton swab to place the medicine up your nose). More recently, however, a new procedure has been introduced. It uses a catheter placed up the nose (with or without fluoroscope) to deliver the lidocaine directly to the nerve. Obviously, this tends to be more successful when done under fluoroscope.

So when my mom told me about it, I was interested in trying it out. She found a company that specializes in the catheter used for the new procedure and asked them if there were any doctors in the area that I could see. The first one I went to see didn't go well. When I arrived, the nurse informed me I was supposed to bring any recent scans I've had done. When I informed her that I had none with me and no one told me about them, she insisted that I had to have known, because she makes all the calls and she always tells people to bring scans. Since the doctor wouldn't see me without scans, I left. I was very put off by the receptionist's attitude and didn't want to return to that practice.

After that disappointment, my mom located a different doctor, quite a bit further away from us. This would be Dr. B, with Fox Chase Pain Management all the way out in Trevose, PA. Visiting him was much more pleasant. His receptionists and nurses were kind, and he was wonderful. He took the time to answer all of my questions and agreed to try an SPG block. He did warn me that SPG blocks are only known to help with pain in the forehead and behind the eyes. While I do have pain in other areas of my head, the worst is in my forehead and behind my eyes, so I thought it was a good idea to try anyway.

Getting an SPG block done under fluoroscope and with a catheter isn't terribly painful, but nor is it terribly pleasant. I was able to eat a small breakfast and take my medicine the morning of because this procedure isn't done under anesthesia. When I arrived for the block at the surgical center, I signed a bunch of forms and then waited to be called. When I was called, I was asked to give a urine sample, and then change out of all my clothing except underwear and put on a gown. I then had the option of sitting or laying on a gurney in a curtained off cubicle. Eventually, a nurse came and wheeled my gurney into the OR. I then had to move onto the OR bed, which is either tilted so your head is lower than your feet, or has pillows or towels to place under your shoulders to tilt your head back.

Dr. B, who does the procedure under fluoroscope, inserted a catheter up my nose and sprayed dye inside my nasal cavity to detect where the medicine would land. If the dye doesn't show itself as landing on the sphenopaletine ganglion, then he would attempt to maneuver the catheter and spray dye again. This is the uncomfortable part, because the catheter usually ends up touching the sensitive insides of the nose. This is also the part where I had a massive sneezing fit and proceeded to sneeze all over poor Dr. B. Luckily, he has a sense of humor and took the whole thing in stride.

A word of warning - the dye used for this procedure will drip down your throat and, while it doesn't necessarily taste that bad, it is thick and may cause mild choking. There should be a nurse standing by with apple juice, or something similar, to help you wash it down.

Once the dye shows it is reaching the sphenopaletine ganglion, Dr. B replaced the dye with lidocaine. It will be sprayed in the same manner as the dye, but the lidocaine has a bitter taste. Once again, apple juice will be your best friend!

The whole thing is then repeated in the other nostril. After it was done, I needed to stay lying with my head back for about 5 minutes. Then, I was wheeled to a recovery room and given more apple juice. Once the nurses were sure I was able to stand on my own with no dizziness, I was allowed to dress and leave.

I had some minor sinus pain for a few days following the procedure, and after that - relief! It really does eliminate (or at least lessen) the pain in my forehead and behind my eyes. I can tell when it's starting to wear off and, after a few more SPG blocks, discovered a pattern. It would begin to wear off after approximately 3 months (the length of time it lasts varies from person to person). So now, every 3 months, I make a trip to Trevose, PA and get another SPG block. I am very pleased with how this treatment is working for me and would definitely suggest trying it at least once to anyone who suffers from pain in the forehead and behind the eyes.

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