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ESRA19-0664 Transnasal topical sphenopalatine ganglion block to treat chronic drug-resistant migraine: a case report

Background and aims The rationale for using SPG blocks to treat headaches is that local anesthetics in low concentrations could block the sensory fibers and thereby reduce pain while maintaining autonomic function. We report a successful case of the Tx360® Nasal Applicator employment in a patient with several chronic migraine. Methods A 38-year-old caucasian woman with a long history of chronic migraine with trigeminal pattern, BMI 27, no smoking history, without comorbodity, was referred to our pain clinic because of intractable pain. For analgesia amitriptyline, clonazepam, ergotamine, nonsteroidal anti-inflammatory drugs had been tried but had produced minimal benefit. on physical examination, she had considerable pain on light touch of the skin overlying the nose, the maxillae, and the forehead. We initiated a trial of SPGB by instillation using Tx360® Nasal Applicator (Tian Medical). With patient in seated position, we inserted the catheter intranasally and we instilled 7,5% levobupivacaine, 3 ml into each nostril. Results After 20 minutes she reported a diminution of her pain by at least 50% as indicated on a visual scale from 0 to 10. We repeated the treatment twice a week for 3 weeks (total 6 treatments). on subsequent follow-up visits over a period of 3 months, she reported a consistently reduction of her pain by 50% to 60%. Conclusions This clinical observation suggests that repetitive SPG blocks using levobupivacine may be an effective treatment for chronic migraine. the Tx360® Applicator is the only device with which patient remain seated position, reducing discomfort during instillation.