Introduction: Postdural puncture headache1 (PDPH) is an occipitofrontal type of headache, a known complication of subarachnoid block or spinal anesthesia. There are several forms of treatments available for PDPH that includes conservative treatments such as bed rest with 15 degree head down, abdominal binders, pharmacological therapy with caffeine, paracetamol, sumatriptan, pregabalin, or nonsteroidal antiinflammatory drugs. Epidural blood patch is the gold standard when supportive treatment fails. Still PDPH remains a difficult situation for clinicians.
Materials and methods: Sphenopalatine ganglion is a parasympathetic ganglion through which sympathetic nerves passes. Sphenopalatine ganglion block has been used for treatment of different types of headache including cluster headache, migraine and atypical facial pain. Transnasal sphenopalatine ganglion block (SPGB) is being used recently for the management of PDPH also. Transnasal Sphenopalatine ganglion block is a noninvasive procedure in which local anesthetic is applied locally to the mucosal surface on the posterior pharyngeal wall superior to middle turbinate under which lies the sphenopalatine ganglion.
Discussion: Review of literature supports the use of SPGB in PDPH. It is becoming popular for its simplicity in use and high success rate compared to epidural blood patch.
Nafiu OO, Salam RA, et al. Post dural puncture headache in obstetric patients: experience from a West African teaching hospital. Int J Obstet Anesth 2007;16:4–7. DOI: 10.1016/j.ijoa.2006.05.001.
Atim A, Ergin A, et al. Epidural blood patch for the management of post-dural puncture headache. J Nervous Sys Surgery 2009;2:67–71.
Oedit R, van Kooten F, et al. Efficacy of the epidural blood patch for the treatment of post lumbar puncture headache BLOPP: a randomized, observer-blind, controlled clinical trial. BMC Neurol 2005;5:12. DOI: 10.1186/1471-2377-5-12.
Davies JM, Murphy A, et al. Subdural hematoma after dural puncture headache treated by epidural blood patch. Br J Anaesth 2001;86:720–723. DOI: 10.1093/bja/86.5.720.
Desai MJ, Dave AP, et al. Delayed radicular pain following two large volume epidural blood patches for post-lumbar puncture headache: a case report. Pain Physician 2010;13:257–262.
Matute E, Bonilla S, et al. A Bilateral greater occipital nerve block for post-dural puncture headache. Anaesthesia 2008;63:551–560. DOI: 10.1111/j.1365-2044.2008.05531.x.
Takmaz S, Ünal KÇ, et al. Treatment of post-dural puncture headache with bilateral greater occipital nerve block. Headache 2010;50:869–881. DOI: 10.1111/j.1526-4610.2010.01656.x.
Nair AS, Rayani BK. Sphenopalatine ganglion block for relieving postdural puncture headache: technique and mechanism of action of block with a narrative review of efficacy. Korean J Pain 2017;30(2):93–97. DOI: 10.3344/kjp.2017.30.2.93.
Cohen S, Levin D, et al. Topical Sphenopalatine Ganglion Block Compared With Epidural Blood Patch for Postdural Puncture Headache Management in Postpartum Patients: A Retrospective Review. Reg Anesth Pain Med 2018;43:880–884. DOI: 10.1097/AAP.0000000000000840.
Channabasappa SM, Manjunath S, et al. Transnasal sphenopalatine ganglion block for the treatment of postdural puncture headache following spinal anesthesia. Saudi J Anaesth 2017;11:362–363. DOI: 10.4103/sja.SJA_59_17.
Furtado I, Lima IF, et al. Ropivacaine use in transnasalsphenopalatine ganglion block for post dural puncture headache in obstetric patients-case series. Rev Bras Anestesiol 2018;68:42–44. DOI: 10.1016/j.bjan.2017.04.019.
Kochhar A, Khanooja S, et al. Evaluation of spheno-palatine block for the treatment of post-dural puncture headache following spinal anaesthesia: a randomized study. Eur J Pharm Med Res 2017;4(12):231–234.
Puthenveettil N, Rajan S, et al. Sphenopalatine ganglion block for treatment of post-dural puncture headache in obstetric patients: an observational study. Indian J Anaesth 2018;62:972–977.
Kent S, Mehaffey G. Trasnasalsphenopalatine ganglion block for the treatment of postdural puncture headache in obstetric patients. J Clin Anaesth 2016;34:194–196. DOI: 10.1016/j.jclinane.2016.04.009.
Windsor RE, Jahnke S. Sphenopalatine ganglion blockade: a review and proposed modification of the transnasal technique. Pain Physician 2004;7:283–286.
Cady R, Saper J, et al. A doubleblind, placebocontrolled study of repetitive transnasalsphenopalatine ganglion blockade with tx360® as acute treatment for chronic migraine. Headache 2015;55:101–116. DOI: 10.1111/head.12458.
Candido KD, Massey ST, et al. A novel revision to the classical transnasal topical sphenopalatine ganglion block for the treatment of headache and facial pain. Pain Physician 2013;16:E769–E778.
Kent S, Mehaffey G. Trasnasal sphenopalatine ganglion block for the treatment of postdural puncture headache in obstetric patients. J Clin Anaesth 2016;34:194–196. DOI: 10.1016/j.jclinane.2016.04.009.
Cardoso JM, Sá M, et al. Sphenopalatine ganglion block for postdural puncture headache in ambulatory setting. Rev Bras Anestesiol 2017;67(3):311–313. DOI: 10.1016/j.bjane.2016.09.003.
Dubey P, Dubey PK. Intranasal lignocaine spray for sphenopalatine ganglion block for postdural puncture headache. Saudi J Anaesth 2018;12:364–365. DOI: 10.4103/sja.SJA_680_17.
Abdullayev R, Kucukebe OB, et al. Incidence of postdural puncture headache: two different fine gauge spinal needles of the same diameter. J Obstet Anaesth Crit Care 2014;4(2):64. DOI: 10.4103/2249-4472.143874.
Schaffer JT, Hunter BR, et al. Non-invasive sphenopalatine ganglion block for acute headache in the emergency department: a randomized placebo-controlled trial. Ann Emerg Med 2015;65:503–510. DOI: 10.1016/j.annemergmed.2014.12.012.
