A Novel Revision to the Classical Transnasal
Topical Sphenopalatine Ganglion Block for the
Treatment of Headache and Facial Pain
Authors: Candido Kenneth D. 
Published: March 2021

Background: The sphenopalatine ganglion (SPG) is located with some degree of variability near
the tail or posterior aspect of the middle nasal turbinate. The SPG has been implicated as a strategic
target in the treatment of various headache and facial pain conditions, some of which are featured
in this manuscript. Interventions for blocking the SPG range from minimally to highly invasive
procedures often associated with great cost and unfavorable risk profiles.
Objective: The purpose of this pilot study was to present a novel, FDA-cleared medication delivery
device, the Tx360® nasal applicator, incorporating a transnasal needleless topical approach for SPG
blocks. This study features the technical aspects of this new device and presents some limited clinical
experience observed in a small series of head and face pain cases.
Study Design: Case series.
Settings: Pain management center, part of teaching-community hospital, major metropolitan city,
United States.
Methods: After Institutional Review Board (IRB) approval, the technical aspects of this technique
were examined on 3 patients presenting with various head and face pain conditions including
trigeminal neuralgia (TN), chronic migraine headache (CM), and post-herpetic neuralgia (PHN).
The subsequent response to treatment and quality of life was quantified using the following tools:
the 11-point Numeric Rating Scale (NRS), Modified Brief Pain Inventory — short form (MBPI-sf),
Patient Global Impression of Change (PGIC), and patient satisfaction surveys. The Tx360® nasal
applicator was used to deliver 0.5 mL of ropivacaine 0.5% and 2 mg of dexamethasone for SPG
block. Post-procedural assessments were repeated at 15 and 30 minutes, and on days one, 7, 14,
and 21 with a final assessment at 28 days post-treatment. All patients were followed for one year.
Individual patients received up to 10 SPG blocks, as clinically indicated, after the initial 28 days.
Results: Three women, ages 43, 18, and 15, presented with a variety of headache and face pain
disorders including TN, CM, and PHN. All patients reported significant pain relief within the first 15
minutes post-treatment. A high degree of pain relief was sustained throughout the 28 day follow-up
period for 2 of the 3 study participants. All 3 patients reported a high degree of satisfaction with this
procedure. One patient developed minimal bleeding from the nose immediately post-treatment which
resolved spontaneously in less than 5 minutes. Longer term follow-up (up to one year) demonstrated
that additional SPG blocks over time provided a higher degree and longer lasting pain relief.
Limitations: Controlled double blind studies with a higher number of patients are needed to prove
efficacy of this minimally invasive technique for SPG block.
Conclusion: SPG block with the Tx360® is a rapid, safe, easy, and reliable technique to accurately
deliver topical transnasal analgesics to the area of mucosa associated with the SPG. This intervention
can be delivered in as little as 10 seconds with the novice provider developing proficiency very
quickly. Further investigation is certainly warranted related to technique efficacy, especially studies
comparing efficacy of Tx360 and standard cotton swab techniques.
Key words: Trigeminal neuralgia, trigeminal neuropathy, migraine, headache, post-herpetic
neuralgia, sphenopalatine ganglion block