Podcast #243: Sphenopalatine Nerve Block

Cluster headaches are usually intense, unilateral, and involve the periorbital area.

CN V (Trigeminal) provides sensory and autonomic innervation the face and eyes, which play roles in headache pathology.

Cluster headaches can be treated with high flow oxygen, but a new treatment involves blocking the sphenopalatine ganglion (SPG) with lidocaine. Because sensory and autonomic branches of the trigeminal traverse the SPG, lidocaine will effectively treat a cluster headache.

To block the ganglion, intranasal lidocaine may be used, or a Q-tip soaked in 4% lidocaine can be applied to the most posterior aspect of the pharynx for 10-15 minutes.