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Sphenopalatine Ganglion Block for Chronic Rhinitis

Minimally invasive autonomic ganglion blockade for refractory rhinitis and headache

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our KBB (Kulak Burun Boğaz) department. Book Appointment →

What is Sphenopalatine Ganglion Block for Chronic Rhinitis?

The sphenopalatine ganglion (SPG, pterygopalatine ganglion) is a parasympathetic ganglion located in the pterygopalatine fossa, providing autonomic innervation to the nasal mucosa, lacrimal gland, and palatine glands. Activation of the SPG mediates rhinorrhea, congestion, lacrimation, and many features of chronic rhinitis and cluster headache. Targeting the SPG with local anesthetics, neurolytic agents, radiofrequency ablation, or peripheral neurostimulation provides therapeutic benefit.

SPG block is approached via transnasal topical application (cotton-tipped applicator soaked with lidocaine or bupivacaine, applied to the posterior superior nasopharynx through devices such as Sphenocath, Tx360, Allevio), transoral via greater palatine canal, or infrazygomatic with image guidance. Topical transnasal application is the simplest and safest, while infrazygomatic radiofrequency or pulsed radiofrequency provides more durable effect.

Indications include chronic refractory rhinitis (especially vasomotor or non-allergic), cluster headache (acute and prophylactic), migraine, trigeminal autonomic cephalalgias, post-dural puncture headache, post-traumatic headache, atypical facial pain, and trigeminal neuralgia (selected cases). Effects on rhinitis include reduction of rhinorrhea and congestion. Repeated treatments may be needed; SPG neurostimulation devices (Pulsante by Autonomic Technologies, no longer marketed in some regions) provided long-term option for cluster headache.

Symptoms

Chronic rhinorrhea (clear, watery)
Nasal congestion
Postnasal drip
Sneezing
Vasomotor rhinitis (triggered by temperature, food, irritants)
Non-allergic rhinitis with negative allergen testing
Refractory to topical steroids and antihistamines
Cluster headache (severe unilateral pain with autonomic features)
Migraine (especially with autonomic features)
Trigeminal autonomic cephalalgia
Hemicrania continua
SUNCT/SUNA
Paroxysmal hemicrania
Post-dural puncture headache
Post-traumatic headache
Atypical facial pain
Trigeminal neuralgia (selected cases)
Sluder neuralgia (historical term)
Quality-of-life impairment from refractory symptoms
Failure or intolerance of standard therapies

Risk Factors

Chronic refractory rhinitis
Vasomotor rhinitis
Hormonal rhinitis (pregnancy, hypothyroidism)
Drug-induced rhinitis (rebound from decongestants, ACE inhibitors)
Senile rhinitis
Cluster headache
Episodic and chronic cluster headache
Migraine
Tension-type headache (less commonly)
Post-dural puncture headache from spinal anesthesia
Trauma to face or head
Postoperative pain after sinus surgery
Trigeminal autonomic disorders
Atypical facial pain
Refractory to standard pharmacotherapy
Coagulopathy or anticoagulation (relative contraindication)
Local infection in nasal cavity
Tumor or anatomical abnormality of pterygopalatine fossa
Allergy to local anesthetics
Pregnancy (relative consideration depending on technique)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Refractory chronic rhinitis unresponsive to standard therapy
  • Vasomotor rhinitis with disabling symptoms
  • Cluster headache
  • Migraine refractory to abortive and preventive therapy
  • Trigeminal autonomic cephalalgia
  • Post-dural puncture headache
  • Post-traumatic headache
  • Considering minimally invasive procedural therapy
  • Failed or intolerant of medications
  • Specialty pain management referral
  • Otolaryngology evaluation for refractory rhinitis
  • Multidisciplinary headache center evaluation

Treatment Methods

01
Comprehensive evaluation by otolaryngology, pain medicine, or headache specialist
02
Detailed history and physical examination
03
Sinus and nasal endoscopy
04
CT or MRI as indicated for anatomical evaluation
05
Allergy testing for rhinitis evaluation
06
Medication review and optimization
07
Trial of evidence-based standard therapies first
08
Topical transnasal SPG block with cotton-tipped applicator (4% lidocaine or 0.5% bupivacaine) applied to posterior superior nasopharynx
09
Specialized devices (Sphenocath, Tx360, Allevio) for catheter-based topical application
10
Transoral SPG block via greater palatine canal under endoscopic visualization
11
Infrazygomatic SPG block with fluoroscopy or CT guidance
12
Single or repeat blocks (often weekly for several weeks initially)
13
Radiofrequency ablation or pulsed radiofrequency for durable effect
14
Cryoablation in selected cases
15
SPG neurostimulation (historical Pulsante device) for chronic cluster headache
16
Coordination with primary disease management (nasal steroids, antihistamines for rhinitis; preventive medications for headache)
17
Lifestyle modifications and trigger avoidance
18
Post-procedure monitoring for complications (epistaxis, infection, neuropraxia)
19
Repeat blocks as needed
20
Multidisciplinary follow-up including rhinology, headache medicine, pain management
21
Patient education and shared decision making
22
Cost and insurance considerations
23
Avoid in pregnancy unless benefit clearly outweighs risk
24
Caution with anticoagulation and bleeding disorders

Which Department to Visit?

You can visit our KBB (Kulak Burun Boğaz) department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About KBB (Kulak Burun Boğaz) Department

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.