If you’re reading this, chances are you—or someone you love—knows what it’s like to live under the weight of migraines or chronic headaches. My career in medicine has been focused on relieving pain and finding new and better ways of doing so. As an anesthesiologist for 40 years in New York City, I had the privilege of relieving pain of patients during and after their surgery. For 30 of those years I was an obstetric anesthesiologist, providing pain relief for labor and childbirth, both natural and cesarean. It was in the Labor and Delivery department that I first used the sphenopalatine ganglion (SPG) block. I was impressed how effective the SPG block was to relieve different types of headache pain in my patients. In fact, there is no safer and more effective way to treat headaches during pregnancy or nursing than the SPG block.
As soon as I saw how well the SPG block worked, I realized my mission would not be limited to treating headaches in my patients only, but rather to spread the word about the remarkable SPG block to other people suffering from headaches everywhere, to enable them to reclaim their lives.
I’ve Always Lived “Outside-the-Box”
Early in my career, I understood that the conventional tools doctors use may not always get the job done. That realization put me on a decades-long enjoyable and rewarding path to research new and better ways to care for my patients. One of the treatments wasn’t new at all. The SPG block was first described more than 100 years ago, in 1908. It has been used ever since to treat many different kinds of headaches including migraines. But the SPG block never achieved widespread acceptance, despite its effectiveness. By the beginning of the 21st century, not many doctors were using it. One of them happened to be a close friend of mine, Dr. Shaul Cohen, an Israeli anesthesiologist who was practicing in the US. Dr. Cohen was the first to use the SPG block to treat headaches that can be caused by epidurals for childbirth. He encouraged me to try the SPG block, and to my delight, it worked! An epidural headache can be very severe, and the SPG block gave us a great new option to treat this condition.
I soon began using SPG blocks to treat other types of headaches in pregnant and nursing women, because the small amount of medication used for the block, the local anesthetic lidocaine, has a very long history of safety in pregnancy. A while later I then tried the SPG block to treat severe shoulder pain that occurs in some women during and after cesareans, and that had no reliable treatment option. When I saw how well the SPG block stopped this shoulder pain, I was very pleased. I reported my findings immediately to Dr. Cohen, and he was even more excited than I was! I remember our phone conversation as if it were yesterday. He said “This is great! I told you about a new way I found to treat epidural headaches and now you found a way to use it for shoulder pain!” We were like two kids, thrilled with our discoveries. As I mentioned above, my career has been enjoyable and rewarding. But there has also been some frustration. I naively thought that once we found a better way to treat pain, other doctors would start to use the SPG block also. Dr. Cohen and I published our experience in medical journals to inform other doctors about the wonders of the SPG block, but very few were interested in trying it.
Why were very few doctors interested in using the SPG block??? Because doctors, and most everyone else, tend to think in the same way. Call it “inside-the-box” thinking. They are reluctant to deviate from the conventional way of doing things. The problem with this type of thinking is that it doesn’t advance medicine, it doesn’t advance science, and it stifles innovation. Without an outside-the-box approach, progress is much less likely to occur. Had Dr. Cohen not tried to use the SPB block to treat an epidural headache, we would not have that option today. And had I not tried the SPG block to treat shoulder pain related to cesareans, we still would have no effective way of treating that pain.
Why are very few doctors interested in using the SPG block???
Because doctors, and most everyone else, tend to think in the same way. Call it “inside-the-box” thinking. They are reluctant to deviate from the conventional way of doing things. The problem with this type of thinking is that it doesn’t advance medicine, it doesn’t advance science, and it stifles innovation. Without an outside-the-box approach, progress is much less likely to occur. Had Dr. Cohen not tried to use the SPB block to treat an epidural headache, we would not have that option today. And had I not tried the SPG block to treat shoulder pain related to cesareans, we still would have no effective way of treating that pain.
New Ideas Always Look Crazy Until They Change Everything
As Dr. Peter Diamandis observed: “The day before something is a breakthrough it’s a crazy idea.” That line has stayed with me. It reminds me that innovation never starts from acceptance of the status quo, it starts from charting a new path.
The history of medicine is full of breakthroughs that were initially dismissed as “ridiculous” “crazy” or “unscientific.” Hand washing, sterilizing instruments, even anesthesia itself ! Every advancement is initially met with skepticism, and often derision.
To me, having seen so many lives changed after years, even decades, of suffering from headaches, I am frustrated that a safe and effective treatment, the SPG block, is not only rarely used, most patients and doctors don’t consider it as an option. because they have never even heard of it. That is crazy!
Thinking differently isn’t always comfortable. Not for patients, not for doctors, not for the medical community. When people first hear about the SPG block, they often raise an eyebrow – or two. A nerve block through the nose? Seriously? If this is such a great option, why have I never heard of it? But after the block, they feel the relief. Sometimes for the first time in years. And in that moment, “crazy” turns into a wonderful reality. A life-changing experience.
The Mission of Rosh Ragua Headache Clinic: Treating Patients and Changing the Culture
I didn’t become a doctor to manage symptoms. I became a doctor to help people heal. I was complaining that very few people in Israel are aware that the SPG block is an option. My wife finally told me: Stop complaining! Open a clinic! Of course, she was right, so I did, and Rosh Ragua Headache Clinic was born. And I found the best nurse for the clinic: our daughter Alexandra, a graduate of Reichman University and Tel Aviv University Nursing School.
Our goal is to explain to Israelis that there is another option to treat their headaches that they have never heard of. Rosh Ragua is dedicated to personalized patient-centered care. We are committed to work with people who wish to lessen their headache pain, and ideally, to eliminate the pain completely. We realize that headaches don’t always happen during daytime hours, so we are also available at other times. We do home visits if the patient is unable to leave their home during a headache. We also depend on the cooperation of our patients. Our model is to work together as a team to defeat the headaches, and our patients are the most important member of the team.
A summary of our common-sense approach:
- identify (or discover) better treatment options that are safe and effective
- present all the choices to patients to enable them to make their own decisions
- treat every patient with the same dedication as if they were a member of my family
- never give up on a patient who is suffering
So next time you experience a migraine or a headache that interferes with your ability to function, talk to us. We’ll be happy to treat you as well with an SPG block, safely, effectively, and with full attention.
