The Sphenopalatine Ganglion Block (SPG Block) is an under-used but very effective treatment for cluster headaches, migraines, and other headaches that involve the trigeminal nerve. A few weeks ago, a man who suffered from cluster headaches asked us for help. We hadn’t treated cluster headaches before and explained that while we couldn’t guarantee success, there was a good chance that we could help his headaches.
Cluster headaches are much less common than migraines. For every 100 people with migraines, there is only one person who suffers from cluster headaches. But their pain is very severe, which is why the cluster headache is called “the suicide headache.”
Fortunately, SPG blocks with lidocaine work for migraines and cluster headaches. The SPG block has many advantages compared to other forms of treatment: it can be very effective, it does not cause side effects, and it is very safe. There are no injections or pills, and the treatment can be used in combination with other medications you may wish to take. Unfortunately, very few cluster headache patients are aware that SPG block is an option.
Case report: A 72-year-old man with cluster headaches asked us for help. For the past 30 years, he experienced bouts of cluster headaches every year that lasted for two to three months. The headaches were on the left side of his head including around his eye and were very severe. Each headache lasted approximately 70 minutes. They usually occurred twice a day, every day, in the late afternoon and soon after midnight. Over the years, he tried many different treatments including triptans, oxygen, and greater occipital nerve blocks. Some of the treatments gave him more relief than others, but because the headaches were severe, that he usually needed to inject himself with imitrex, a triptan, every time he had a headache. Sometimes a second headache would occur after the first one was controlled, so he would need to take a second dose of imitrex. Triptans have many problems. People who use triptans more than 10 days per month may develop “medication overuse headache,” which causes reduced effectiveness of the triptan and may also cause chronic daily headaches.
We met him during the first week of his 2026 bout. We used a catheter to administer lidocaine, a local anesthetic, into the left side of his nose, the side where he had the pain. We left the catheter in place for an hour. We taught him how to perform the block on himself and had him practice the method during our visit. We instructed him to do the treatment every day for 1-2 hours.
That night, he experienced 3 headaches, one immediately after the other. He did not feel that the SPG block would work quickly enough, so he used triptan injections for each headache. During the first week of treatment, he was skeptical about the SPG block because he still had two cluster headaches. But he continued to do the SPG block himself every day, sometimes twice a day, getting more comfortable with it over time.
He soon noticed that the intensity and frequency of his headaches began to decrease. He also noticed that the droopy left eyelid he has during the bouts began to improve. During the first week of treatment, he reported two cluster headaches. During the second week of treatment, he reported six headache days but described them as “minor” and he did not need to give himself imitrex. During this time he also had two occipital nerve blocks, but he explained that that block does not reliably relieve his pain. During the third week he had three headache days and during the fourth week he had two headache days. He said that all of the headaches were minor and most stopped without needing imitrex. By the fifth week he had no headache days and he was very pleased to tell us that his bout was definitely over. This was a very unusual event, because in the past the bout would always last two or three months. During that one month, he had only twelve headache days (rather than thirty headache days) and most of those twelve were mild and did not require any triptan.
He was happy to be feeling well, and stopped performing the SPG block, and has not suffered from headaches since then.
