Going All Out for Headaches -Post dural RX with Occipital and Sphenopalatine Blocks

Post dural headache not treated with patch because of recent lyme disease. Instead they did bilateral lesser and greater occipital Nerve blocks and bilateral sphenopalatine blocks (SPB) with good effect.

multiple head

J Clin Anesth. 2018 Sep 12;52:69-70. doi: 10.1016/j.jclinane.2018.09.015. [Epub
ahead of print]
Sphenopalatine ganglion block in combination with greater and lesser occipital
nerve blocks for the management of post dural puncture headache.
Urits I et al
https://www.ncbi.nlm.nih.gov/pubmed/30218883    no abstract

I wrote about benefits of occipital nerve blocks here:
Post Dural Puncture Headache Relieved by Occipital Nerve Blocks

The use of sphenopalatine blocks is new:
Dubey, Preksha, and Prakash K. Dubey.
Intranasal lignocaine spray for sphenopalatine ganglion block for postdural puncture headache.
Saudi journal of anaesthesia 12.2 (2018): 364.

  • Their approach (different from current article) takes advantage of 10% lidocaine spray – often used with intubation

Technique verbatum:

“The patients are asked to take a deep breath and hold it and exhale after we signal to do so. As they take a full breath, at the height of inspiration, two puffs of lignocaine 10% are administered into one nostril aimed slightly medially and inferiorly. They are advised to keep their eyes closed while the spray is administered in their nostrils. The patients are signaled to exhale after a few seconds.”

  • 11 adult cases
  • 6 complete relief within 1 hour
  • 5 cases had repeated with 2 responding – giving a 72% success rate

In top article they did SPB with 4% lidocaine on a swab – I discussed SPB before here:
Upper Facial Pain Treatment- Home Based Sphenopalatine Block

Comment – they got good results with combo. The combination got them out of a tricky situation and could be used in desperate cases

addendum – a successful sphenopalatine block:

Wikle, Justin, Tejinder Singh Swaran Singh, and Rahul Rastogi.
“Sphenopalatine Ganglion.” Pain. Springer, Cham, 2019. 589-592

“A temperature probe placed over the ipsilateral zygoma, representing the V2 distribution, will show an increase in temperature of approximately 2 degrees celsius (compared to baseline) representing a sympathectomy and a successful block.”

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