Sphenopalatine Neuralgia

Sphenopalatine neuralgia is a facial pain/headache disorder in which there are attacks of pain on one side of the face, usually around the eye, upper cheek, nose, and/or upper mouth and teeth. Patients may also have headaches, usually behind the eye. Pain attacks are variable in length, and they may be accompanied by nasal congestion/runny nose, eye watering or redness, facial flushing, or other autonomic symptoms.

Sphenopalatine neuralgia is thought to be due to dysfunction of the sphenopalatine ganglion, a small collection of nerve cells in the back of the nose. Symptoms can be similar to those of other facial pain disorders: trigeminal neuralgia, cluster headache, and SUNCT/SUNHA.

Treatment of sphenopalatine neuralgia usually begins with medications. There are a wide variety of drugs that can be used, including those commonly prescribed for trigeminal neuralgia, migraine headache, and cluster headache. For patients with suspected sphenopalatine neuralgia who do not find relief with medications, a sphenopalatine ganglion (SPG) block can be a useful tool both for providing relief and for supporting the diagnosis.

For patients with bothersome symptoms despite medications and SPG blocks, sphenopalatine ganglion (SPG) rhizotomy can be an effective surgical tool for providing long-term relief. SPG rhizotomy is an outpatient procedure with an excellent safety profile that does not require an incision or anesthesia; I perform it using a minimally invasive platform called Gamma Knife.

If you live near Denver and suffer from sphenopalatine neuralgia or another facial pain disorder, please consider meeting me in consultation to learn whether you might be a candidate for SPG rhizotomy.

Importantly, please understand that I am a neurosurgeon; I perform SPG rhizotomy, but if you have not yet trialed medications or an SPG block, I may refer you to a neurologist or an interventional pain doctor to start treatment before a rhizotomy (surgery) is considered. I may also suggest an evaluation by an ENT doctor or an ophthalmologist if there is concern for another source of your pain that might be treated differently.