Is Sphenopalatine Ganglion Block Treatment Effective on Postspinal Headaches
Condition: Headache Disorders; Central Nervous System Diseases
MeSH terms: Ganglion Cysts; Nervous System Diseases; Central Nervous System Diseases; Headache Disorders; Headache
Study type: Interventional

Summary: 
      This study evaluates effect of sphenopalatine ganglion block in post dural puncture headache.
      Half of participants will receive standard supportive treatment and other half of patients
      will be performed sphenopalatine ganglion block.
    

Detailed description: 
      Spinal anesthesia is known subarachnoid block also commonly used regional anesthesia technic.
      Spinal anesthesia is frequently performed in obstetric patients undergoing cesarian section,
      which has several advantages including less deep vein thrombosis incidence, low opioid
      requirement, early mobilization and early lactation also has some complications too.
      Postdural headache is one of the most known complications of spinal anesthesia.

      The etiology of the postspinal headache remains unclear. Severeness of the symptoms and
      amount of the cerebrospinal fluid leakage have been found positive correlating. The
      cerebrospinal fluid supports brain with it's mass effect. When a leakage of the fluid occurs,
      support of the brain decreases and pain sensitive structures of the brain gets more
      sensitive. In this condition 5 th 9th and 10 th cranial nerves, falks cerebelli, tentorium
      and blood vessels are affected most. Decreased cerebrospinal fluid volume causes decreased
      brain volume and compensatory mechanisms lead to cerebral venous dilatation. Conservative
      treatments are iv hydration, analgesic agents, caffeine or theophylline. Epidural blood patch
      is the gold standard for the treatment . However epidural blood patch is an invasive technic
      and has some complications such as dural puncture, infection and neurologic trauma.

      Sphenopalatine ganglion is one of the four parasympathetic thin ganglion in skull.
      Parasympathetic fibers innervates cerebral and meningeal blood vessels which cause
      vasodilatation and stimulate nociceptor activation on meninges. Consequently headache is
      related with sensory cortex.

      Transnasal SPG block is performed successfully in chronic pain syndromes including migraine,
      cluster headaches and atypic face pain. Likewise the SPG block is performed in acute
      treatment of postspinal headache. However gold standard of the treatment is epidural blood
      patching which is interventional and has many risks. Several studies enrolled limited
      participants offer SPG block primarily in the literature.
    

Intervention name(s): sphenopalatine ganglion block; conservative treatment
Intervention type(s): Procedure; Drug
Intervention description(s): the intervention will be performed on sitting position. Lidocaine 2% viscous (0.5ml) will be apply on cotton swab sticks and one will be gently inserted into nostril, along the floor of the nose. Stick will be used to insert it as far as it goes with the intention to reach the nasopharyngeal wall (posterior wall of the nose). At that position the swab stick will be left undisturbed for 20 minutes.; Conservative treatments are iv hydration, analgesic agents, caffeine or theophylline
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: spinal anesthesia; sphenopalatine ganglion block; postspinal headache