Impact of sphenopalatine ganglion blocks on high‐frequency episodic and chronic migraine: A retrospective study

OBJECTIVES/BACKGROUND: The aim of this study was to assess the effectiveness and safety of sphenopalatine ganglion block using a dedicated catheter device in a migraine population. Sphenopalatine ganglion block has been used by clinicians in the treatment of headache disorder. The sensory and autonomic fibers that travel through the sphenopalatine ganglion provided the rationale for symptoms associated with these syndromes. Among different devices, dedicated transnasal catheter devices enable targeted delivery of local anesthetics (e.g., lidocaine) to the sphenopalatine ganglion region. To date, there are no randomized controlled trials evaluating transnasal sphenopalatine ganglion block performed with a dedicated catheter device in treatment and prevention of migraine. METHODS: We conducted an open label, uncontrolled, retrospective, single-center study to evaluate the characteristics and outcomes of patients affected by high-frequency episodic or chronic migraine with or without medication overuse, according to the criteria of the International Classification of Headache Disorders, 3rd edition. We assessed changes in the Migraine Disability Assessment Questionnaire, Numeric Pain Rating Scale, Monthly Migraine Days (MMDs), and Monthly Acute Migraine Medications (MAMMs). The questionnaires were administered at baseline and 1, 3, 6, and 13 months after treatment. Patients were treated from May 2022 to December 2023. RESULTS: A total of 76 participants were screened, and 30 were included. After 1 and 3 months of treatment, statistically significant reductions in MMDs (median baseline [T0] vs. 1 month [T1]: 19.5 vs. 11.5, p<0.001; median T0 vs. 3 months [T2]: 19.5 vs. 16.5, p=0.009), and MAMMs (median T0 vs. T1: 20 vs. 10, p<0.001; median T0 vs. T2: 20 vs. 16; p=0.007) were detected. Numeric Pain Rating Scale (median T0 vs. T1: 8 vs. 5.5, p=0.001) and Migraine Disability Assessment Questionnaire (mean T0 vs. T2: 161.9 vs. 121.9, p<0.001) significantly decreased at T1 and T2, respectively. A marked reduction in monthly triptan and nonsteroidal anti-inflammatory drug use was observed at T1 (median T0 vs T1: 7 vs. 3.5, p<0.001 and median T0 vs T1: 16 vs. 5, p<0.001, respectively) and T2 (median T0 vs. T2: 7 vs. 4, p<0.001 and median T0 vs. T2: 16 vs. 10.5, p=0.014, respectively). Half of the patients (15/30) reached a 50% reduction in MAMMs, and 40% (12/30) of participants reported 50% reduction in MMDs at 1-month follow-up. Seventeen nonsevere adverse events were observed, mostly local discomfort. CONCLUSION: Transnasal sphenopalatine ganglion block performed with a dedicated catheter device may represent a safe therapeutic option for patients with disabling migraine. Although the procedure was associated with improvements in migraine symptoms, these findings are preliminary. Prospective studies are needed to further confirm these findings.