Sphenopalatine Ganglion Block: Pediatric Migraine

SPG is known to be an effective treatment among adults with migraine, but little is known about its use in the pediatric population.

The use of sphenopalatine ganglion blockade (SPG) in children with migraine headaches is a safe and effective treatment for reducing headache scores, according to the results of a study presented at the Society of Interventional Radiology's 2017 Annual Scientific Meeting. The minimally invasive treatment takes only minutes to provide relief for migraine headaches, the study showed.

“This treatment, performed in an outpatient setting by an interventional radiologist, can safely relieve a child's migraine quickly,” Robin Kaye, MD, section chief of interventional radiology in the department of medical imaging at Phoenix Children's Hospital and a co-author of the study, said in a press release. “By reducing the need for medications that come with serious side effects or intravenous therapies that may require hospital stays, children don't have to miss as much school and can get back to being a kid sooner.”

Although migraines are more commonly discussed in adults, migraines affect about 12% of people aged 12 and younger. SPG is known to be an effective treatment among adults with migraine, but little is known about its use in the pediatric population.

With SPG procedures, a small flexible catheter is inserted into each nostril and local anesthetic is administered to the SPG, a nerve bundle thought to be associated with migraines, located at the back of the nose. Briefly disabling the SPG can disrupt and reset the headache circuit, breaking a cycle of severe migraines and reducing the need for medication. The minimally invasive SPG block takes almost immediate effect with relief potentially lasting for months, researchers said.

In this study, Kaye and colleagues performed 310 SPG procedures in 200 patients with migraine aged 7 to 18. Prior to undergoing SPG, the patients recorded headache scores on a scale of 1 to 10.

The procedure was performed supine with neck in hyperextension and anesthesia of the bilateral nares was accomplished with lidocaine spray and gel. Patients remained supine with neck in hyperextension for 10 minutes. After the procedure, headache scores were recorded again.

The mean headache score decreased more than two points from pre-intervention of 5.55 to 3.28 post-intervention (P<0.0001).

“While it isn't a cure for migraines, this treatment has the potential to really improve the quality of life for many children,” Kaye said. “It can be performed easily, without complications, and gives quick pain relief, which is important to parents who want to see their children happy, healthy, and pain free again. If needed, we can also repeat the treatment if or when the migraine returns.”

The researchers noted that SPG blocks are not a frontline treatment. A child only qualifies for the therapy if he/she has been diagnosed with a severe migraine that has not responded to first-line treatments.

Reference: Dance L, et al. Safety and efficacy of sphenopalatine ganglion blockade in children – initial experience. Abstract #10. Presented at SIR Annual Scientific Meeting, March 4-9, 2017. 

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