• Mohammad A Mousa, David J Aria, Abeer A Mousa, Carrie M Schaefer, M Hamed H Temkit, and Richard B Towbin.
• University of Arizona College of Medicine-Phoenix, Phoenix, AZ.
• Pain Physician. 2021 Jan 1; 24 (1): E111-E116.

BackgroundPersistent headaches and migraines are common in pediatrics with various treatment options. The sphenopalatine ganglion (SPG) has been identified as communicating with the parasympathetic autonomic nervous system and pain receptors. In adults, SPG block is an established treatment but there is no published literature in pediatrics.ObjectivesThe purpose of this study is to analyze the SPG block in pediatrics.Study DesignRetrospective, single-center study.SettingThis study was conducted at Phoenix Children's Hospital in Phoenix, Arizona.MethodsA comprehensive review of patient charts from 2015-2018 of all pediatric SPG blockades performed by interventional radiology were included in the analysis. Utilizing fluoroscopic guidance, a SphenoCath was inserted into each nostril and after confirming position, and 4% lidocaine injected. Pre- and postprocedural pain was assessed using the Visual Analog Scale (VAS). Immediate and acute complications were documented.ResultsA total of 489 SPG blocks were performed in patients between ages 6 and 26 years who were diagnosed with migraine or status migrainosus. One hundred percent technical success was achieved with mean reduction of pain scores of 2.4, which was statistically significant (P < 0.0001). There were no immediate or acute complications.LimitationsResults of this study were based on retrospective study. The use of VAS may be subjective, and the need of a prospective study may be necessary.ConclusionsWith 100% technical success, statistically significant pain reduction, and no complications, we support SPG block in the pediatric population as a simple, efficacious, and safe treatment option for refractory headaches. It is routinely performed in less than 10 minutes and commonly negates the need for inpatient headache pain management. Given its minimal invasivity, we support the use of SPG blockade as a therapeutic treatment in refractory pediatric migraines as it reduces the need for intravenous medications, prolonged pain control, or hospital admission.

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