Sphenopalatine ganglion block reduced epidural patch use in 14-patient headache cohort

A prospective single-center French study of 14 patients with post-dural puncture headache found that sphenopalatine ganglion block (SPGB) allowed 64% of participants to avoid a subsequent epidural blood patch (EBP). The block was associated with a significant reduction in pain by 45 minutes and relief sustained through 24 hours. The findings support SPGB as a potentially useful option for some patients, but the small cohort and absence of a broad comparative evaluation mean that the results cannot establish it as a definitive replacement for EBP.

Post-dural puncture headache is a common complication of lumbar puncture that is associated with cerebrospinal fluid leakage and intracranial hypotension. EBP is considered the gold-standard treatment, but it is invasive. SPGB is described as a non-invasive technique that had shown promise in earlier studies, although it had not previously been evaluated as an alternative to EBP in clinical practice. The researchers therefore asked whether SPGB could prevent enough EBPs to be clinically relevant. Patients were enrolled prospectively in a monocentric cohort, and pain intensity was assessed with a visual analog scale (VAS) at predefined intervals for up to 24 hours after the procedure.

The participants had post-dural puncture headache meeting International Classification of Headache Disorders, third edition criteria and causing significant pain or functional impairment. SPGB was performed with 5% lidocaine administered through a MADgic atomization device. If the block failed, the investigators proceeded with an EBP. They defined clinical relevance in advance as SPGB preventing at least 50% of EBPs. The sample size of 14 was calculated to provide 90% power at an alpha risk of 5%. Because this was a prospective cohort study focused on clinical use of SPGB, the design reported in the abstract does not provide a randomized comparison establishing how SPGB compares directly with EBP.

The analyzed group had a mean age of 31.9 years, and 78% were women. SPGB was performed a median of three days after headache onset. Five of the 14 patients, or 36%, required a subsequent EBP, while nine patients, or 64%, were managed successfully with SPGB alone. The latter proportion exceeded the predefined efficacy threshold. VAS scores showed a significant reduction in pain from 45 minutes after the procedure, and that improvement was sustained at 24 hours. The study did not determine whether the pain reduction would have been comparable with another treatment strategy, so the results should be interpreted as an observed outcome in this cohort rather than proof of superiority or equivalence to EBP.

No serious adverse events occurred, and patients rated tolerability as good to moderate. Throat numbness was more frequent among responders than nonresponders, with a reported p-value of 0.014. The investigators also observed a trend toward an association between traumatic needle use and SPGB failure: the failure proportion was 80% in cases involving traumatic needle use compared with 22% in other cases, with p = 0.091. This finding was not statistically significant at the reported threshold and, given the sample size, is hypothesis-generating rather than evidence that traumatic puncture predicts failure. Based on the findings, the authors proposed an algorithm for managing post-dural puncture headache, while stating that larger comparative studies are needed before definitive treatment recommendations can be made.

Subject of Research: Prospective cohort evaluation of sphenopalatine ganglion block for post-dural puncture headache

Article Title: Potential sphenopalatine ganglion block efficacy as an alternative to epidural bloodpatch for post-dural puncture headache: a monocentric french study

Article References: Daudon, A., Koessler, S., Kremer, L., de Seze, J., & Bigaut, K. (2026). Potential sphenopalatine ganglion block efficacy as an alternative to epidural bloodpatch for post-dural puncture headache: a monocentric french study. Journal of Neurology, 273(11), 678. https://doi.org/10.1007/s00415-026-14225-x

Image Credits: AI Generated

DOI: 10.1007/s00415-026-14225-x

Keywords: post-dural puncture headache, sphenopalatine ganglion block, epidural blood patch, lumbar puncture, lidocaine, prospective cohort, pain relief, intracranial hypotension, Potential, sphenopalatine, ganglion, block