SPG Block: Our Method of Treatment

At Rosh Ragua we are able to effectively help those suffering from migraines and headaches using a special treatment called the SPG Block.

As part of the treatment, instead of treating the migraines or the headaches themselves – we treat their neural source. How does it work?

In the upper-back part of the inside of the nose there is a group of nerves called the SphenoPalatine Ganglion, or for short, the SPG.

This nerve cluster is responsible for a large part of our headache sensation. This is because it transmits the sensation of pain to the brain through neural signaling.

In the course of the treatment, we numb this nerve cluster, thereby blocking the neural signals that transmit the headache sensation. This block is the reason the method we use is called the SPG Block.

How is the nerve cluster numbed?
The nerve cluster is numbed with a local anesthetic called lidocaine. This is a very common and safe anesthetic. Most everyone is familiar with it or one of its “cousins” from dental clinics, where it is widely used.

In fact, It is one of the oldest and safest anesthetics that exist. Since I948 it has been used as a local anesthetic in millions of patients. The cotton swab is soaked with lidocaine and then it is paced in the nose so that it rests near the area of the SPG nerves. Lidocaine is released slowly from the tip and it crosses into the SPG. Although it only takes a moment to insert the cotton-tipped swab, we then leave it in place from 15 to 60 minutes, depending on the patient’s needs. The discomfort of the procedure is most noticeable during the placement of the cotton-tipped swab. Once it is in place, most people don’t find it bothersome.

What does blocking the nerve cluster do in the SPG Block treatment?

Using Lidocaine to numb the SPG nerve group blocks the pain signals that the nerve group sends and thereby treats migraines and headaches occurring at that moment. Thus, the treatment is expected to provide real-time relief for a headache or migraine attack.

But beyond that, the block has a lasting effect. Using the anesthetic on the nerve group creates a sort of reset. This reset breaks the cycle of pain and migraines, reduces the intensity of future migraines, and increases the time between attacks. Many of our patients report that after completing a series of treatments, instead of daily or weekly migraines, they appeared only once every few months, and with significantly lower intensity.

Additionally, many of our patients report that their migraines disappeared completely and did not return even after many months.

How is the treatment performed?

The treatment is performed gently, very similar to a familiar COVID test. Here too, with the SPG block, we use a thin and flexible swab. The difference is that the swab we use is specifically designed for administering anesthetic, and Lidocaine is released slowly from the tip directly near the SPG nerve group.

The entire procedure lasts only a few minutes (15–60 minutes), with almost no discomfort.

In certain cases where administering the medication with a swab is not possible, we may consider administering it via drops.

The treatment can be performed at our clinic, and in certain cases through a home visit.

Self-treatment of migraines with the SPG Block:

We will perform your first SPG Block treatment, and during that visit, we will teach you how to perform the treatment yourself. If you are comfortable performing the treatment yourself, and if we believe that you will be able to do it, we encourage you to do so. In this way, you can choose when to treat your own headache, and you won’t need to depend on us. We are prepared to give you support and guidance as you need it during this process, for example, via video chat to help you with the technique. Of course, if you prefer for us to do the blocks, we are prepared to do that as well.  

SPG Block: A long-standing treatment brought back to light

The SPG Block technique was first described in 1908 in the U.S. Although some doctors were very enthusiastic about it, most never used it. With the passage of time, few doctors appreciated its benefits, and it was not offered as a standard treatment of headaches.

In 2010, Dr. Grant began using the technique to treat headaches in the Labor and Delivery unit at NYU. Because many medications are not considered safe to use during pregnancy or nursing, these women had no good treatment options. Dr. Grant realized that the SPG Block would be the ideal safe and effective option for them.

The treatment proved effective very quickly. Patients Dr. Grant treated were quite pleased that their headaches weakened or even disappeared completely, and Dr. Grant quickly became a strong advocate for the SPG Block. The headache treatment that was so safe for pregnant women, he reasoned, should be offered to all patients with headaches, pregnant or not!

After moving to Israel in October 2023, Dr. Grant decided to make this a reality, and to introduce the treatment to Israelis suffering from headaches, to give them an option that they didn’t even know existed. Today, Dr. Grant is one of the few doctors here who uses the SPG Block. He hopes that the situation will change, and others will recognize the great value in this “old-new” technique.

Important considerations when choosing a treatment:
Before using any treatment for any condition, patients and doctors must carefully weigh the risks and benefits of the treatment, and compare them with the risks and benefits of other treatments, or of not treating at all

Let us consider the risks and benefits of the SPG Block treatment: The risks of the procedure are very low, and for the most part are directly related to the discomfort of the procedure (pressure in the nose as the cotton swab is inserted, nosebleed) and the expected effects of the local anesthetic lidocaine (mild burning sensation in the nose, bitter taste in the mouth, numbness sensation in the throat). These effects are very brief. For example, 2 or 3 seconds of pressure sensation when the cotton swab is passed, and 15 or 20 minutes of bitter taste or numb sensation in the throat after the treatment is completed. Nosebleed is very unusual, unless there is a history of previous nosebleeds or a bleeding disorder. The benefit of the treatment is potentially quite large. The headaches may get less severe, become less frequent. In short, the treatment can be life-changing. 

So at Rosh Ragua, we evaluate the risk-benefit analysis as strongly favoring taking a relatively small risk for a potentially huge benefit. Of course, ultimately the decision to try the SPB Block is made by each patient, not by the doctor, not by the nurse.