Sphenopalatine ganglion: block, radiofrequency ablation and neurostimulation - a systematic review

Kwo Wei David Ho, Rene Przkora, Sanjeev Kumar, Kwo Wei David Ho, Rene Przkora, Sanjeev Kumar

Abstract

Background: Sphenopalatine ganglion is the largest collection of neurons in the calvarium outside of the brain. Over the past century, it has been a target for interventional treatment of head and facial pain due to its ease of access. Block, radiofrequency ablation, and neurostimulation have all been applied to treat a myriad of painful syndromes. Despite the routine use of these interventions, the literature supporting their use has not been systematically summarized. This systematic review aims to collect and summarize the level of evidence supporting the use of sphenopalatine ganglion block, radiofrequency ablation and neurostimulation.

Methods: Medline, Google Scholar, and the Cochrane Central Register of Controlled Trials (CENTRAL) databases were reviewed for studies on sphenopalatine ganglion block, radiofrequency ablation and neurostimulation. Studies included in this review were compiled and analyzed for their treated medical conditions, study design, outcomes and procedural details. Studies were graded using Oxford Center for Evidence-Based Medicine for level of evidence. Based on the level of evidence, grades of recommendations are provided for each intervention and its associated medical conditions.

Results: Eighty-three publications were included in this review, of which 60 were studies on sphenopalatine ganglion block, 15 were on radiofrequency ablation, and 8 were on neurostimulation. Of all the studies, 23 have evidence level above case series. Of the 23 studies, 19 were on sphenopalatine ganglion block, 1 study on radiofrequency ablation, and 3 studies on neurostimulation. The rest of the available literature was case reports and case series. The strongest evidence lies in using sphenopalatine ganglion block, radiofrequency ablation and neurostimulation for cluster headache. Sphenopalatine ganglion block also has evidence in treating trigeminal neuralgia, migraines, reducing the needs of analgesics after endoscopic sinus surgery and reducing pain associated with nasal packing removal after nasal operations.

Conclusions: Overall, sphenopalatine ganglion is a promising target for treating cluster headache using blocks, radiofrequency ablation and neurostimulation. Sphenopalatine ganglion block also has some evidence supporting its use in a few other conditions. However, most of the controlled studies were small and without replications. Further controlled studies are warranted to replicate and expand on these previous findings.

Keywords: Block; Nerve stimulation; Neuromodulation; Neurostimulation; Radiofrequency ablation; Sphenopalatine ganglion.

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The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Overview of the systematic review process
Fig. 2
Fig. 2
Risk of bias summary of randomized-controlled studies

References

    1. Piagkou M, Demesticha T, Troupis T, Vlasis K, Skandalakis P, Makri A, Mazarakis A, Lappas D, Piagkos G, Johnson EO. The pterygopalatine ganglion and its role in various pain syndromes: from anatomy to clinical practice. Pain Pract. 2012;12(5):399–412. doi: 10.1111/j.1533-2500.2011.00507.x.
    1. Oluigbo CO, Makonnen G, Narouze S, Rezai AR. Sphenopalatine ganglion interventions: technical aspects and application. Prog Neurol Surg. 2011;24:171–179.
    1. Scudds RA, Janzen V, Delaney G, Heck C, McCain GA, Russell AL, Teasell RW, Varkey G, Woodbury MG. The use of topical 4% lidocaine in spheno-palatine ganglion blocks for the treatment of chronic muscle pain syndromes: a randomized, controlled trial. Pain. 1995;62(1):69–77. doi: 10.1016/0304-3959(94)00232-4.
    1. Kent S, Mehaffey G. Transnasal sphenopalatine ganglion block for the treatment of postdural puncture headache in the ED. Am J Emerg Med. 2015;33(11):1714.e1711–1714.e1712. doi: 10.1016/j.ajem.2015.03.024.
    1. Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA, Group CBM. Group CSM The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928. doi: 10.1136/bmj.d5928.
    1. Costa A, Pucci E, Antonaci F, Sances G, Granella F, Broich G, Nappi G. The effect of intranasal cocaine and lidocaine on nitroglycerin-induced attacks in cluster headache. Cephalalgia. 2000;20(2):85–91. doi: 10.1046/j.1468-2982.2000.00026.x.
    1. Barre F. Cocaine as an abortive agent in cluster headache. Headache: J Head Face Pain. 1982;22(2):69–73. doi: 10.1111/j.1526-4610.1982.hed2202069.x.
    1. Kittrelle JP, Grouse DS, Seybold ME. Cluster headache: local anesthetic abortive agents. Arch Neurol. 1985;42(5):496. doi: 10.1001/archneur.1985.04060050098017.
    1. Felisati G, Arnone F, Lozza P, Leone M, Curone M, Bussone G. Sphenopalatine endoscopic ganglion block: a revision of a traditional technique for cluster headache. Laryngoscope. 2006;116(8):1447–1450. doi: 10.1097/01.mlg.0000227997.48020.44.
    1. Pipolo C, Bussone G, Leone M, Lozza P, Felisati G. Sphenopalatine endoscopic ganglion block in cluster headache: a reevaluation of the procedure after 5 years. Neurol Sci. 2010;31(Suppl 1):S197–S199. doi: 10.1007/s10072-010-0325-2.
    1. Kanai A, Suzuki A, Kobayashi M, Hoka S. Intranasal lidocaine 8% spray for second-division trigeminal neuralgia. Br J Anaesth. 2006;97(4):559–563. doi: 10.1093/bja/ael180.
    1. Peterson JN, Schames J, Schames M, King E. Sphenopalatine ganglion block: a safe and easy method for the management of orofacial pain. Cranio. 1995;13(3):177–181. doi: 10.1080/08869634.1995.11678065.
    1. Manahan AP, Malesker MA, Malone PM. Sphenopalatine ganglion block relieves symptoms of trigeminal neuralgia: a case report. Nebr Med J. 1996;81(9):306–309.
    1. Candido KD, Massey ST, Sauer R, Darabad RR, Knezevic NN. A novel revision to the classical transnasal topical sphenopalatine ganglion block for the treatment of headache and facial pain. Pain Physician. 2013;16(6):E769–E778.
    1. Cady R, Saper J, Dexter K, Manley HR. A double-blind, placebo-controlled study of repetitive transnasal sphenopalatine ganglion blockade with tx360(®) as acute treatment for chronic migraine. Headache. 2015;55(1):101–116. doi: 10.1111/head.12458.
    1. Cady RK, Saper J, Dexter K, Cady RJ, Manley HR. Long-term efficacy of a double-blind, placebo-controlled, randomized study for repetitive sphenopalatine blockade with bupivacaine vs. saline with the Tx360 device for treatment of chronic migraine. Headache. 2015;55(4):529–542. doi: 10.1111/head.12546.
    1. Cho DY, Drover DR, Nekhendzy V, Butwick AJ, Collins J, Hwang PH. The effectiveness of preemptive sphenopalatine ganglion block on postoperative pain and functional outcomes after functional endoscopic sinus surgery. Int Forum Allergy Rhinol. 2011;1(3):212–218. doi: 10.1002/alr.20040.
    1. Ahmed H, Abu-Zaid E. Role of intraoperative endoscopic sphenopalatine ganglion block in sinonasal surgery. J Med Sci. 2007;7:1297–1303. doi: 10.3923/jms.2007.1297.1303.
    1. Al-Qudah M. Endoscopic sphenopalatine ganglion blockade efficacy in pain control after endoscopic sinus surgery. Int Forum Allergy Rhinol. 2016;6(3):334–338. doi: 10.1002/alr.21644.
    1. Ali AR, Sakr SA, Rahman ASM. Bilateral sphenopalatine ganglion block as adjuvant to general anaesthesia during endoscopic trans-nasal resection of pituitary adenoma. Egypt J Anaesth. 2010;26(4):273–280. doi: 10.1016/j.egja.2010.05.002.
    1. DeMaria S, Govindaraj S, Chinosorvatana N, Kang S, Levine AI. Bilateral sphenopalatine ganglion blockade improves postoperative analgesia after endoscopic sinus surgery. Am J Rhinol Allergy. 2012;26(1):e23–e27. doi: 10.2500/ajra.2012.26.3709.
    1. Kesimci E, Öztürk L, Bercin S, Kırış M, Eldem A, Kanbak O. Role of sphenopalatine ganglion block for postoperative analgesia after functional endoscopic sinus surgery. Eur Arch Otorhinolaryngol. 2012;269(1):165–169. doi: 10.1007/s00405-011-1702-z.
    1. Hwang JH, Liu CM, Liu TC, Hsu MC. Sphenopalatine ganglion block before removal of nasal packing. Laryngoscope. 2003;113(8):1423–1424. doi: 10.1097/00005537-200308000-00030.
    1. Robiony M, Demitri V, Costa F, Politi M, Cugini U. Truncal anaesthesia of the maxillary nerve for outpatient surgically assisted rapid maxillary expansion. Br J Oral Maxillofac Surg. 1998;36(5):389–391. doi: 10.1016/S0266-4356(98)90653-2.
    1. Varghese BT, Koshy RC. Endoscopic transnasal neurolytic sphenopalatine ganglion block for head and neck cancer pain. J Laryngol Otol. 2001;115(5):385–387. doi: 10.1258/0022215011907938.
    1. Prasanna A, Murthy PS. Combined stellate ganglion and sphenopalatine ganglion block in acute herpes infection. Clin J Pain. 1993;9(2):135–137. doi: 10.1097/00002508-199306000-00009.
    1. Saberski L, Ahmad M, Wiske P. Sphenopalatine ganglion block for treatment of sinus arrest in postherpetic neuralgia. Headache. 1999;39(1):42–44. doi: 10.1046/j.1526-4610.1999.3901042.x.
    1. Amster J. Sphenopalatine ganglion block for the relief of painful vascular and muscular spasm with special reference to lumbosacral pain. N Y State J Med. 1948;48(22):2475.
    1. Ruskin SL. The control of muscle spasm and arthritic pain through sympathetic block at the nasal ganglion and the use of the adenylic nucleotide. Am J Dig Dis. 1946;13(10):311–320. doi: 10.1007/BF03003575.
    1. Janzen VD, Scudds R. Sphenopalatine blocks in the treatment of pain in fibromyalgia and myofascial pain syndrome. Laryngoscope. 1997;107(10):1420–1422. doi: 10.1097/00005537-199710000-00023.
    1. Ferrante FM, Kaufman AG, Dunbar SA, Cain CF, Cherukuri S. Sphenopalatine ganglion block for the treatment of myofascial pain of the head, neck, and shoulders. Reg Anesth Pain Med. 1998;23(1):30–36.
    1. Berger JJ, Pyles ST, Saga-Rumley SA. Does topical anesthesia of the sphenopalatine ganglion with cocaine or lidocaine relieve low back pain? Anesth Analg. 1986;65(6):700–702. doi: 10.1213/00000539-198606000-00025.
    1. Cohen S, Sakr A, Katyal S, Chopra D. Sphenopalatine ganglion block for postdural puncture headache. Anaesthesia. 2009;64(5):574–575. doi: 10.1111/j.1365-2044.2009.05925.x.
    1. Schaffer JT, Hunter BR, Ball KM, Weaver CS. Noninvasive sphenopalatine ganglion block for acute headache in the emergency department: a randomized placebo-controlled trial. Ann Emerg Med. 2015;65(5):503–510. doi: 10.1016/j.annemergmed.2014.12.012.
    1. Rodman R, Dutton J. Endoscopic neural blockade for rhinogenic headache and facial pain: 2011 update. Int Forum Allergy Rhinol. 2012;2(4):325–330. doi: 10.1002/alr.21035.
    1. Henneberger JT, Menk EJ, Middaugh RE, Finstuen K. Sphenopalatine ganglion blocks for the treatment of nicotine addiction. South Med J. 1988;81(7):832–836. doi: 10.1097/00007611-198807000-00007.
    1. Silverman DG, Spencer RF, Kitahata LM, O'Connor TZ. Lack of effect of sphenopalatine ganglion block with intranasal lidocaine on submaximal effort tourniquet test pain. Reg Anesth. 1993;18(6):356–360.
    1. Narouze S, Kapural L, Casanova J, Mekhail N. Sphenopalatine ganglion radiofrequency ablation for the management of chronic cluster headache. Headache: J Head Face Pain. 2009;49(4):571–577. doi: 10.1111/j.1526-4610.2008.01226.x.
    1. Sanders M, Zuurmond WW. Efficacy of sphenopalatine ganglion blockade in 66 patients suffering from cluster headache: a 12- to 70-month follow-up evaluation. J Neurosurg. 1997;87(6):876–880. doi: 10.3171/jns.1997.87.6.0876.
    1. Akbas M, Gunduz E, Sanli S, Yegin A. Sphenopalatine ganglion pulsed radiofrequency treatment in patients suffering from chronic face and head pain. Braz J Anesthesiol. 2016;66(1):50–54. doi: 10.1016/j.bjan.2014.06.002.
    1. Schoenen J, Jensen RH, Lantéri-Minet M, Láinez MJ, Gaul C, Goodman AM, Caparso A, May A (2013) Stimulation of the sphenopalatine ganglion (SPG) for cluster headache treatment. Pathway CH-1: a randomized, sham-controlled study. Cephalalgia 0333102412473667
    1. Jürgens TP, Barloese M, May A, Láinez JM, Schoenen J, Gaul C, Goodman AM, Caparso A, Jensen RH (2016) Long-term effectiveness of sphenopalatine ganglion stimulation for cluster headache. Cephalalgia. 10.1177/0333102416649092
    1. Barloese MC, Jürgens TP, May A, Lainez JM, Schoenen J, Gaul C, Goodman AM, Caparso A, Jensen RH. Cluster headache attack remission with sphenopalatine ganglion stimulation: experiences in chronic cluster headache patients through 24 months. J Headache Pain. 2016;17(1):67. doi: 10.1186/s10194-016-0658-1.
    1. Ansarinia M, Rezai A, Tepper SJ, Steiner CP, Stump J, Stanton-Hicks M, Machado A, Narouze S. Electrical stimulation of sphenopalatine ganglion for acute treatment of cluster headaches. Headache: J Head Face Pain. 2010;50(7):1164–1174. doi: 10.1111/j.1526-4610.2010.01661.x.
    1. Tepper SJ, Rezai A, Narouze S, Steiner C, Mohajer P, Ansarinia M. Acute treatment of intractable migraine with sphenopalatine ganglion electrical stimulation. Headache. 2009;49(7):983–989. doi: 10.1111/j.1526-4610.2009.01451.x.
    1. William A, Azad TD, Brecher E, Cherry T, Bernstein I, Bruce DM, Rohrer S, Smith Z, William M, Sabelman E, Heit G, Pezeshkian P, Sedrak M. Trigeminal and sphenopalatine ganglion stimulation for intractable craniofacial pain--case series and literature review. Acta Neurochir. 2016;158(3):513–520. doi: 10.1007/s00701-015-2695-y.
    1. Elahi F, Reddy CG. Sphenopalatine ganglion electrical nerve stimulation implant for intractable facial pain. Pain Physician. 2015;18(3):E403–E409.
    1. Ahamed SH, Jones NS. What is Sluder's neuralgia? J Laryngol Otol. 2003;117(6):437–443. doi: 10.1258/002221503321892253.
    1. Oomen KP, van Wijck AJ, Hordijk GJ, de Ru JA. Sluder's neuralgia: a trigeminal autonomic cephalalgia? Cephalalgia. 2010;30(3):360–364. doi: 10.1111/j.1468-2982.2009.01919.x.
    1. Salar G, Ori C, Iob I, Fiore D. Percutaneous thermocoagulation for sphenopalatine ganglion neuralgia. Acta Neurochir. 1987;84(1):24–28. doi: 10.1007/BF01456346.
    1. Slade SG, Linberg JV, Immediata AR. Control of lacrimal secretion after sphenopalatine ganglion block. Ophthal Plast Reconstr Surg. 1986;2(2):65–70. doi: 10.1097/00002341-198601050-00002.
    1. Devoghel JC. Cluster headache and sphenopalatine block. Acta Anaesthesiol Belg. 1981;32(1):101–107.
    1. Yang IY, Oraee S. A novel approach to transnasal sphenopalatine ganglion injection. Pain Physician. 2006;9(2):131–134.
    1. Zarembinski C, Graff-Radford S. An unusual challenge in performing sphenopalatine ganglion block with enlarged coronoid process: Jacob's disease. Pain Med. 2014;15(2):329–332. doi: 10.1111/pme.12302.
    1. Kastler A, Cadel G, Comte A, Gory G, Piccand V, Tavernier L, Kastler B. Alcohol percutaneous neurolysis of the sphenopalatine ganglion in the management of refractory cranio-facial pain. Neuroradiology. 2014;56(7):589–596. doi: 10.1007/s00234-014-1354-y.
    1. Maizels M. Intranasal lidocaine to prevent headache following migraine aura. Headache. 1999;39(6):439–442. doi: 10.1046/j.1526-4610.1999.3906439.x.
    1. Yarnitsky D, Goor-Aryeh I, Bajwa ZH, Ransil BI, Cutrer FM, Sottile A, Burstein R. 2003 Wolff award: possible parasympathetic contributions to peripheral and central sensitization during migraine. Headache: J Head Face Pain. 2003;43(7):704–714. doi: 10.1046/j.1526-4610.2003.03127.x.
    1. Prasanna A, Murthy PS. Sphenopalatine ganglion block and pain of cancer. J Pain Symptom Manag. 1993;8(3):125. doi: 10.1016/0885-3924(93)90139-M.
    1. Varghese BT, Koshy RC, Sebastian P, Joseph E. Combined sphenopalatine ganglion and mandibular nerve, neurolytic block for pain due to advanced head and neck cancer. Palliat Med. 2002;16(5):447–448. doi: 10.1191/0269216302pm549xx.
    1. Cohen S, Ramos D, Grubb W, Mellender S, Mohiuddin A, Chiricolo A. Sphenopalatine ganglion block: a safer alternative to epidural blood patch for postdural puncture headache. Reg Anesth Pain Med. 2014;39(6):563. doi: 10.1097/AAP.0000000000000172.
    1. Cardoso JM, Sá M, Graça R, Reis H, Almeida L, Pinheiro C, Machado D. Sphenopalatine ganglion block for postdural puncture headache in ambulatory setting. Rev Bras Anestesiol. 2017;67(3):311–313. doi: 10.1016/j.bjan.2017.02.003.
    1. Ruskin SL. Contributions to the study of the spheno-palatine ganglion. Laryngoscope. 1925;35(2):87–108. doi: 10.1288/00005537-192502000-00001.
    1. Stechison MT, Brogan M. Transfacial transpterygomaxillary access to foramen rotundum, sphenopalatine ganglion, and the maxillary nerve in the management of atypical facial pain. Skull Basenn. 1994;4(1):15–20. doi: 10.1055/s-2008-1058983.
    1. Saade E, Paige GB. Patient-administered sphenopalatine ganglion block. Reg Anesth. 1996;21(1):68–70.
    1. Puig CM, Driscoll CL, Kern EB. Sluder's sphenopalatine ganglion neuralgia--treatment with 88% phenol. Am J Rhinol. 1998;12(2):113–118. doi: 10.2500/105065898781390253.
    1. Windsor RE, Jahnke S. Sphenopalatine ganglion blockade: a review and proposed modification of the transnasal technique. Pain Physician. 2004;7(2):283–286.
    1. Obah C, Fine PG. Intranasal sphenopalatine ganglion block: minimally invasive pharmacotherapy for refractory facial and headache pain. J Pain Palliat Care Pharmacother. 2006;20(3):57–59.
    1. Morelli N, Mancuso M, Felisati G, Lozza P, Maccari A, Cafforio G, Gori S, Murri L, Guidetti D. Does sphenopalatine endoscopic ganglion block have an effect in paroxysmal hemicrania? A case report. Cephalalgia. 2010;30(3):365–367. doi: 10.1111/j.1468-2982.2009.01882.x.
    1. Grant GJ, Schechter D, Redai I, Lax J. Transnasal topical sphenopalatine ganglion block to treat tension headache in a pregnant patient. Int J Obstet Anesth. 2014;23(3):292–293. doi: 10.1016/j.ijoa.2014.04.010.
    1. Androulakis XM, Krebs KA, Ashkenazi A. Hemicrania continua may respond to repetitive sphenopalatine ganglion block: a case report. Headache. 2016;56(3):573–579. doi: 10.1111/head.12783.
    1. Malec-Milewska M, Horosz B, Kosson D, Sekowska A, Kucia H. The effectiveness of neurolytic block of sphenopalatine ganglion using zygomatic approach for the management of trigeminal neuropathy. Neurol Neurochir Pol. 2015;49(6):389–394.
    1. Sussman WI, Mautner K, Mason RA, Bonecutter K, Shealy AK (2016) Sphenopalatine ganglion block for Management of Refractory Chronic Posttraumatic Headaches after a sport-related concussion. Clin J Sport Med. 10.1097/JSM.0000000000000325
    1. Byrd H, Byrd W. Sphenopalatine phenomena: present status of knowledge. Arch Intern Med. 1930;46(6):1026–1038. doi: 10.1001/archinte.1930.00140180127013.
    1. Sparer W. Cessation of convulsive seizures following injection of alcohol into spheno-palatine ganglia. Three Cases The Laryngoscope. 1935;45(11):886–890.
    1. Ruskin SL. A newer concept of arthritis and the treatment of arthritic pain and deformity by sympathetic block at the sphenopalatien (nasal) ganglion and the use of the iron salt of the adenylic nucleotide. Am J Dig Dis. 1949;16(11):386–401. doi: 10.1007/BF03002723.
    1. Quevedo JP, Purgavie K, Platt H, Strax TE. Complex regional pain syndrome involving the lower extremity: a report of 2 cases of sphenopalatine block as a treatment option. Arch Phys Med Rehabil. 2005;86(2):335–337. doi: 10.1016/j.apmr.2004.04.033.
    1. Triantafyllidi H, Arvaniti C, Palaiodimos L, Vlachos S, Schoinas A, Batistaki C, Kostopanagiotou G, Lekakis J. Infiltration of the sphenopalatine ganglion decreases blood pressure in newly diagnosed and never treated patients with essential hypertension. Int J Cardiol. 2016;223:345–351. doi: 10.1016/j.ijcard.2016.08.230.
    1. Chua NH, Vissers KC, Wilder-Smith OH. Quantitative sensory testing may predict response to sphenopalatine ganglion pulsed radiofrequency treatment in cluster headaches: a case series. Pain Pract. 2011;11(5):439–445. doi: 10.1111/j.1533-2500.2010.00445.x.
    1. Oomen KP, van Wijck AJ, Hordijk GJ, de Ru JA. Effects of radiofrequency thermocoagulation of the sphenopalatine ganglion on headache and facial pain: correlation with diagnosis. J Orofac Pain. 2012;26(1):59–64.
    1. Fang L, Jingjing L, Ying S, Lan M, Tao W, Nan J. Computerized tomography-guided sphenopalatine ganglion pulsed radiofrequency treatment in 16 patients with refractory cluster headaches: twelve- to 30-month follow-up evaluations. Cephalalgia. 2016;36(2):106–112. doi: 10.1177/0333102415580113.
    1. Bendersky DC, Hem SM, Yampolsky CG. Unsuccessful pulsed radiofrequency of the sphenopalatine ganglion in patients with chronic cluster headache and subsequent successful thermocoagulation. Pain Pract. 2015;15(5):E40–E45. doi: 10.1111/papr.12288.
    1. Dharmavaram SKA, Palanisamy V, Raju SK (2016) Conventional radiofrequency ablation of sphenopalatine ganglion for the treatment of cluster headache. Indian J Pain 30
    1. Loomba V, Upadhyay A, Kaveeshvar H. Radiofrequency ablation of the Sphenopalatine ganglion using cone beam computed tomography for intractable cluster headache. Pain Physician. 2016;19(7):E1093–E1096.
    1. Shah RV, Racz GB. Long-term relief of posttraumatic headache by sphenopalatine ganglion pulsed radiofrequency lesioning: a case report. Arch Phys Med Rehabil. 2004;85(6):1013–1016. doi: 10.1016/j.apmr.2003.07.017.
    1. Bayer E, Racz GB, Miles D, Heavner J. Sphenopalatine ganglion pulsed radiofrequency treatment in 30 patients suffering from chronic face and head pain. Pain Pract. 2005;5(3):223–227. doi: 10.1111/j.1533-2500.2005.05314.x.
    1. Nguyen M, Wilkes D. Pulsed radiofrequency V2 treatment and intranasal sphenopalatine ganglion block: a combination therapy for atypical trigeminal neuralgia. Pain Pract. 2010;10(4):370–374. doi: 10.1111/j.1533-2500.2010.00382.x.
    1. Elahi F, Ho KWD. Case report in neurological medicine. 2014. Successful Management of Refractory headache and facial pain due to cavernous sinus Meningioma with Sphenopalatine ganglion radiofrequency.
    1. Meng DW, Zhang JG, Zheng Z, Wang X, Luo F, Zhang K. Chronic bilateral Sphenopalatine ganglion stimulation for intractable bilateral chronic cluster headache: a case report. Pain Physician. 2016;19(4):E637–E642.

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