Use of the Sphenopalatine Ganglion Block to Treat Migraine Headaches in the Emergency Department

Headaches are a common presenting complaint to the emergency department. Amongst the common non-life-threatening headaches, migraine headaches tend to be one of the more severe. Commonly, migraines are treated with the so-called “migraine cocktail.” At our facility, this cocktail is usually IV fluids, metoclopramide, diphenhydramine, and ketorolac. The patient is then left in a quiet, dark room for two to three hours, then reassessed for symptom improvement or if more medications are required. Recently we have begun to employ the sphenopalatine ganglion (SPG) block as a rapid, and easy-to-administer alternative to the classic migraine cocktail. The SPG block can often provide sufficient improvement of symptoms within 15 minutes to allow the patient to be discharged. Patients are grateful to have such rapid pain relief, and the ED flow is improved with a door-to-discharge time that can be less than an hour. The following is a series of three recent cases where we have used the SPG block to treat migraines in our ED patients.