Evaluating the Sphenopalatine Ganglion Block as an Alternative Treatment Method to Alleviate Pain Associated with Primary Headache Disorders in the Emergency Department

Abstract

Background: Current recommended treatment options for primary headache disorders are suboptimal in that effective pain relief is untimely and associated with side effects. Objective: The primary aim of this thesis was to evaluate the effectiveness and attitudes towards an alternative treatment option, the sphenopalatine ganglion (SPG) block which belongs to a class of procedures known as peripheral nerve blocks (PNBs). Methods: We conducted a systematic review and meta-analysis studying the effectiveness of PNBs for the treatment of primary headache disorders. We also conducted a national postal survey among Canadian emergency physicians to identify current practice patterns and perspectives on PNBs. Results: We found PNBs are effective for rapid pain relief compared to placebo at 15 minutes (MD = -1.17; 95% CI: -1.82 to -0.51) and 30 minutes (MD = -0.99; 95% CI: -1.66 to -0.32). Only 55.6% of physicians have experience with PNBs (95% CI: 0.48 to 0.65) and we discovered the SPG block is the least commonly practiced type of PNB; the majority of physicians believe these procedures are safe (85%) and effective (55.1%). A future trial is needed to compare the SPG block against standard treatment. Conclusion: The SPG block may be used as an adjunct therapy for faster effective pain relief. Current physicians would consider PNBs as a first-line alternative given evidence from a future trial. A future trial is needed to compare the SPG block against standard treatment.