New research by Dr. Mandato and others from Albany Medical Center in New York shows that image-guided pterygopalatine ganglion (SPG) blocks can treat about 1/3 of all headaches, may reduce the pain and disability associated with chronic headaches, and may be an alternative to traditional therapies. The study results were presented at the Society of Interventional Radiology’s annual scientific meeting. The open study included 112 female patients with a mean age of 44.5 years who had a diagnosis of migraine (N=98) or cluster headache (N=14) and had been treated with a stable medication regimen for more than one week. The study used a visual analog score (VAS) to assess the patient’s debilitation, with a baseline VAS score of 8.25 and all patients having a VAS score greater than 4 on at least 15 days per month. In the study, the patient was first placed in a sitting position, and the physician injected lidocaine into the nasal pterygopalatine ganglion under imaging guidance; after the nasal cavity began to feel numb, the patient lay down and a catheter was inserted into one nostril, and a small amount of A small amount of 4% lidocaine hydrochloride is injected into one nostril while the patient is inhaling. The entire procedure takes about 15-20 minutes and is painless for most patients. The study showed that VAS scores decreased to 4.1 on the first postoperative day, 4.7 on the seventh postoperative day, and 5.25 on the thirtieth postoperative day, indicating a 36% reduction in scores within one month after surgery. Thirteen patients with cluster headache had a significant treatment effect, while 91 of the migraine patients had a significant effect. Patients continued to experience headache relief after one month, indicating that the effect lasted longer than the numbness. Dr. Mandato said this phenomenon is interesting, as is the use of lidocaine on the skin, whose effect lasts only a few hours, but we found that even when the numbness disappears, it still seems to stop the cycle of severe headaches. The study also found that 88% of patients needed less medication to sustain pain relief after the injection. One patient in the study with a diagnosis of migraine did not respond to the treatment, which is unexplained. Adverse effects of the treatment were low, with only one patient experiencing stomach pain after taking the drug and another having a sinus attack, which does not preclude patient interference. There are other ways to treat headaches with lidocaine, such as nasal sprays, drops and intramuscular injections, but the treatment in this study was superior and more direct. Dr. Lawrence Newman, president of the American Headache Society, noted that nerve blocks have been used to treat headaches for decades, with some anesthesiologists and neurologists dipping lidocaine in a long swab and applying it to the SPG area of the nostril, and there are now catheter products that facilitate the injection of lidocaine. The only novel aspect of this study is that it was performed under imaging guidance, which is somewhat instructive. Recent studies by Dr. Mandato and others from Albany Medical Center in New York have shown that image-guided pterygopalatine ganglion (SPG) blocks can treat about 1/3 of headaches, may reduce the pain and disability associated with chronic headaches, and may be an alternative to traditional therapies. The study results were presented at the Society of Interventional Radiology’s annual scientific meeting. The open study included 112 female patients with a mean age of 44.5 years who had a diagnosis of migraine (N=98) or cluster headache (N=14) and had been treated with a stable medication regimen for more than one week. The study used a visual analog score (VAS) to assess the patient’s debilitation, with a baseline VAS score of 8.25 and all patients having a VAS score greater than 4 at least 15 days per month. In the study, the patient was first placed in a sitting position, and the physician injected lidocaine into the nasal pterygopalatine ganglion under imaging guidance, and after the nasal cavity began to feel numb, the patient lay down and a catheter was inserted into one nostril, and a small amount of A small amount of 4% lidocaine hydrochloride is injected into one nostril while the patient is inhaling. The entire procedure takes about 15-20 minutes and is painless for most patients. The study showed that VAS scores decreased to 4.1 on the first postoperative day, 4.7 on the seventh postoperative day, and 5.25 on the 30th postoperative day, indicating a 36% reduction in scores within one month of surgery. Thirteen patients with cluster headache had a significant treatment effect, while 91 of the migraine patients had a significant effect. Patients continued to experience headache relief after one month, indicating that the effect lasted longer than the numbness. Dr. Mandato said this phenomenon is interesting, as is the use of lidocaine on the skin, whose effect lasts only a few hours, but we found that even when the numbness disappears, it still seems to stop the cycle of severe headaches. The study also found that 88% of patients needed less medication to sustain pain relief after the injection. One patient in the study with a diagnosis of migraine did not respond to the treatment, which is unexplained. Adverse effects of the treatment were rare, with only one patient experiencing stomach pain after taking the drug and another having a sinus attack, which did not preclude patient interference. There are other ways to treat headaches with lidocaine, such as nasal sprays, drops and intramuscular injections, but the treatment in this study was superior and more direct. Dr. Lawrence Newman, president of the American Headache Society, noted that nerve blocks have been used to treat headaches for decades, with some anesthesiologists and neurologists dipping lidocaine in a long swab and applying it to the SPG area of the nostril, and there are now catheter products that facilitate the injection of lidocaine. The only novel aspect of this study is that it was performed under imaging guidance, which is instructive.