Midterm clinical outcomes of repetitive transnasal sphenopalatine ganglion blockade in chronic migraine

Aim: Chronic migraine affects the quality of life negatively and causes a high rate of disability. There is a requirement for specific prophylactic treatment options in chronic migraine patients. We aimed to evaluate the effects of repetitive transnasal sphenopalatine ganglion blockade (SPG) on headache days, severity and duration of attacks, drug abuse, conversion to episodic migraine, and responses to chronic migraine treatment. Materials and Methods: Patients who were referred to the pain clinic by neurology clinics, diagnosed with chronic migraine for at least six months, and were unresponsive to prophylactic treatments or could not tolerate prophylactic treatments were evaluated retrospectively. Patients undergoing four-session bilateral transnasal sphenopalatine ganglion blockade per week were included. Sphenopalatine ganglion blockade was performed with 0.5 cc, 0.5% bupivacaine-impregnated swab sticks for 30 minutes. Results: In the first, third, sixth, and ninth-month follow-ups of 40 patients, a statistically significant improvement was found in the number of headache days and parameters of attack severity and frequency, compared to baseline values (p<0.001). Baseline drug abuse decreased from 55% (n=22) to 25% (n=10) at month nine, and regression was statistically significant (p<0.001). Of 40 patients, migraine severity was detected to turn into very low frequency in 14 (35%), low frequency in eight (20%), and high-frequency episodic migraines in seven (17.5%) patients at month nine. Patients’ responses were 26, 31, 30, and 28% in the first, third, sixth, and ninth months, respectively. No life-threatening or comorbid side effects were detected. Conclusion: Requiring a simple administration tool and easy-to-administer, sphenopalatine ganglion blockade may be a safe alternative for chronic migraine prophylaxis.