The Sphenopalatine Ganglion (SPG) plays an important role in the pathophysiology of trigeminal autonomic cephalalgias and fascial pain. However, its role in headache generation and maintenance is still not known. The study outcomes revealed that regional anaesthetic suprazygomatic SPG block effectively relieves pain in patients with status migrainosus (SM) and is associated with minimal risk.

Status migrainosus (SM) is commonly known as a debilitating migraine attack lasting more than 72 hours in patients previously known to suffer from a migraine headache. Normally, these attacks fail to respond to over the counter and abortive medications. Sphenopalatine ganglion (SPG) have a critical role in both pain propagation and the autonomic symptoms commonly concerned with migraines. SPG block via transnasal lidocaine is moderately effective in decreasing migraine symptoms, but this method is often poorly tolerated, and the results are not consistent. We proposed that an SPG block using a suprazygomatic injection approach would be a safe and effective option to abort or alleviate pain and autonomic symptoms of SM.

Through a retrospective records review, we identified patients with a well‐established diagnosis of a migraine, as per the International Headache Society criteria. Patients selected for study inclusion were diagnosed with SM who had failed to respond to 2 or more abortive medications and received a suprazygomatic SPG block. Patients rated their pain on a 1–10 Likert scale, both before and 30 minutes after the injection.

Eighty‐eight consecutive patients comprising 20 men and 68 women received a total of 252 suprazygomatic SPG block procedures in the outpatient headache clinic after traditional medications were not successful to abort their SM. At 30 minutes after the injections, there was a 67.2% (±26.6%) reduction in pain severity with a median decrease of 5 points (IQR= −6 to −3) on the Likert scale (ranging from 1 to 10). All in all, the patients experienced a statistically significant reduction in pain severity (P < .0001).

The SPG is known to play an important part in the pathophysiology of facial pain and the trigeminal autonomic cephalalgias, although its exact role in the generation and maintenance of a migraine headache remains unclear. Regional anaesthetic suprazygomatic SPG block is potentially useful for immediate relief of SM. We believe the method is simple to perform and has minimal risk.