Migraine is a medical condition that affects more than 1 in 10 people worldwide, according to the National Institute of Neurological Disorders and Stroke. It’s most known for causing debilitating, throbbing headaches on one side of the head.

Migraine is usually treated with a combination of preventive medications and pain relievers.

The sphenopalatine ganglion (SPG) is a cluster of neurons that sits behind your nose and above your mouth. A nerve block can be applied to the SPG as a treatment for migraine headaches.

Read on to learn more about SPG blocks as migraine treatments and whether they might be helpful to you.

The SPG is also called the pterygopalatine ganglion, nasal ganglion, or Meckel’s ganglion. All of these names refer to the same structure of nerve cells.

For over a century, the SPG has been thought to play a role in some types of headaches and facial pain conditions. This is because of its location, which is close to many other neurological structures that are involved in pain perception, like the trigeminal nerve.

One common type of headache thought to be caused by the SPG is sphenopalatine ganglioneuralgia. You may know it better as a brain freeze or ice cream headache.

The SPG plays a role in mediating the usual variation of widening and narrowing of the cranial blood vessels. In migraine, some research shows that blood vessels in the brain are widened. This has long been thought to be a contributing factor in migraine attacks. A small 2017 study found evidence to support the theory that blood vessel dilation is related to migraine, but more research is still needed.

Getting an SPG nerve block means having medication injected near your SPG. Several types of medications can be used.

There are three common procedures for getting the medication to the SPG. Let’s look at these in detail.


Local anesthetics are the most commonly used medications for SPG block. According to a 2017 review, nearly a dozen anesthetics have been used for SPG block, but the most common are lidocaine and bupivacaine.

Other medications are sometimes used instead of local anesthetics. These include steroids, phenol, and ethanol.

These medications help to lower inflammation or excess activation of the SPG. This prevents the SPG from sending pain sensations and causing changes in the blood vessels and brain that cause pain.


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Illustration by Bailey Mariner

There are three common methods a doctor might use to perform an SPG block. These are the transnasal approach, the transoral approach, and the infrazygomatic approach.

Transnasal approach

The transnasal approach has been around the longest. It involves inserting a cotton-tipped swab or specialized catheter into your nose. The instrument travels down your nasal floor, which is above the roof of your mouth, until it reaches your SPG.

According to a 2019 review, the transnasal approach is the simplest and fastest procedure. In fact, a 2017 study of cancer pain found that transnasal SPG blocks could be applied at home after training. Self-injection is not used for migraine treatment.

Transoral approach

The transoral approach uses a dental needle to reach your SPG through your greater palatine foramen. This is a small opening in the roof of your mouth toward the back.

A 2019 review found the transoral approach to be less comfortable and more technically challenging than the transnasal approach, while also being more invasive.

Infrazygomatic approach

The infrazygomatic approach is the most specialized. Using this method, a doctor will reach the SPG by inserting a needle below your cheekbone. A specialized type of X-ray called a fluoroscope is used during the procedure.

This approach is the most invasive, and the use of the fluoroscope means you will be exposed to some radiation. The advantage is that it provides the most direct access to the SPG.

The research on SPG blocks generally agrees that they’re an effective treatment for migraine headache pain. But experts also tend to point out that most studies to date have small sample sizes and would benefit from additional trials.

For example, a 2021 review found a lack of studies that directly compare the effectiveness of various SPG block medications against each other. The studies that do exist haven’t determined if any one medication produces the best results.

Most research agrees that SPG blocks can relieve pain during a migraine attack. Pain relief is achieved between 10 minutes and 24 hours.

A small 2020 study found that regular SPG block treatments can lead to structural changes in the brain. Participants reported less severe headaches and fewer headaches per month. This suggests that SPG blocks may work as a preventive treatment for migraine headaches, but more research is still needed.

SPG blocks may be an effective treatment for children with migraine as well. A 2021 study found SPG blocks to reduce pain in children without immediate complications.

Getting an SPG block has some risks, but they’re generally mild. The procedure itself can cause local effects in some cases. These include:

  • nosebleeds
  • numbness
  • tearing in one or both eyes
  • bitter taste

Getting an SPG block could result in infection or hematoma (bleeding), but these risks are not common.

A 2017 study found that SPG blocks performed at home for cancer pain sometimes caused:

  • temporary difficulty breathing and swallowing
  • lightheadedness

The cost of an SPG block can vary from one practice to another. You can expect them to be over $100, and sometimes upward of $500. The cost may vary depending on which SPG block procedure you’re receiving.

Some insurance companies will cover SPG blocks for migraine, but not all companies, and not all policies.

If you have insurance and want to find out if your policy covers SPG blocks for migraine, contact your insurance company before scheduling your procedure. The doctor’s office will likely be experienced in billing SPG blocks and should be able to help you determine what your policy covers and what your cost will be.

SPG blocks may be an option for treating migraine headaches that don’t improve with standard treatment, but the lasting impact of this treatment has not been well established at this point.

Most studies agree that SPG blocks are effective for treating migraine pain. More research is needed to find out if they can also prevent migraine attacks.

In addition to migraine, SPG block has been used to treat other conditions related to headache and facial pain, such as:

Just like with SPG block for migraine, more research is needed to better understand when and how this treatment should be used for these conditions.

It has also been used as a pain management technique for various cancers of the head and neck, including cancer in the:

SPG blocks are a promising treatment for migraine pain, and may have preventive potential, too.

If you get an SPG block, a doctor will apply medication to your SPG, most commonly entering the nose with a catheter or cotton-tipped applicator. Pain relief generally happens within 1 hour.

If you think an SPG block might be an effective migraine treatment for you, make an appointment with a doctor.