Sphenopalatine ganglion block for postdural puncture headache

In a previous letter [1] we reported our experience with the application of sphenopalatine ganglion block for headache and backache for our obstetric patients. We would like to report our experience with the application of this technique for 13 patients with moderate to severe postdural puncture headache. It has been our practice over the last 8 years to offer patients with postdural puncture headache a sphenopalatine ganglion block with a cotton tip applicator filled with lignocaine 4% topical ointment as the first treatment of choice. These patients always have the option of a blood patch as backup treatment. Patients can receive this treatment once a day for up to a week, either by attending our pain clinic, or by performing the block themselves at home, following our instructions. The success of this treatment is somewhat unpredictable. Some patients have dramatic and complete relief of the headache following a single treatment. Others have improvement or transient relief of their symptoms, and continue the treatment themselves at home for up to a week, many not requiring a blood patch. Of the 13 patients mentioned above, 11 had immediate and/or complete relief of the headache and only two required a blood patch. We suggest that patients with postdural puncture headache could receive this minimally invasive technique which has minimal side effects. In most cases its use can avoid the need for a blood patch with its attendant side effects and potential complications.