Sphenopalatine ganglion block for postdural puncture headache: A review of current evidence

Abstract

BACKGROUND

Postdural puncture headache (PDPH) is a significant complication of neuraxial procedures. Although conservative treatments and the invasive epidural blood patch (EBP) are currently standard approaches, the sphenopalatine ganglion (SPG) block is emerging as a promising, less-invasive alternative. The pathophysiology of PDPH involves cerebrospinal fluid leakage, resulting in reduced intracranial pressure and compensatory cerebral vasodilation, which is partially mediated by SPG stimulation. The SPG block aims to interrupt this vasodilation using local anesthetics, thereby alleviating headache symptoms.

AIM

To provide a comprehensive overview of current evidence regarding the use of the SPG block in treating PDPH, explores the anatomical and physiological basis of this intervention, describes various administration techniques for administering the block, and critically assesses the efficacy and safety data from clinical studies.

METHODS

A systematic literature search was conducted on PubMed and the Cochrane Database to identify systematic reviews and meta-analyses published up to April 2025, using the keywords “sphenopalatine ganglion block” and “post-dural puncture headache”.

RESULTS

The SPG block is a simple, noninvasive, and effective bedside procedure. Clinical studies have demonstrated that it provides rapid pain relief, with high success rates and an onset of action typically within 10-30 minutes. The most used technique is the transnasal approach, which is associated with minimal and transient adverse effects such as nasal discomfort and bitter taste.

CONCLUSION

Although EBP remains the preferred treatment for severe PDPH, the SPG block is a viable alternative for mild-to-moderate cases, often allowing patients to postpone or avoid EBP. Comparative studies suggest that SPG block has a quicker onset than EBP, though in some cases, it provides shorter duration relief. Overall, the SPG block is a safe, effective, and readily accessible treatment for PDPH. Its minimally invasive nature and high success rate in providing rapid pain relief make it an excellent first-line alternative to more invasive procedures. Further large-scale, standardized randomized controlled trials are required to optimize protocols and fully integrate the SPG block into mainstream clinical practice.

Keywords: Sphenopalatine ganglion block; Post-dural puncture headache; Postdural puncture headache; Epidural blood patch; Neuraxial procedures; Nerve block

Core Tip: Postdural puncture headache (PDPH) is a debilitating complication of spinal anesthesia. Although the epidural blood patch remains the established gold standard invasive treatment, the sphenopalatine ganglion block has emerged as a promising minimally invasive alternative. Sphenopalatine ganglion block operates by interrupting the parasympathetic pathways responsible for cerebral vasodilation, which underlies PDPH. It provides rapid pain relief in majority of cases, with minimal side effects. Its ease of application and high success rate make it an excellent alternative, allowing patients to avoid or delay more invasive procedures such as epidural blood patch, particularly in cases of mild to moderate PDPH.