Sphenopalatine Ganglion Neuralgia - Causes, Symptoms, Diagnosis, and Treatment Options

What Is Sphenopalatine Ganglion Neuralgia?

It is a type of nerve pain known as the ‘lower half headache’ because the pain often affects the lower half of the head, eyes, temple region, and upper teeth. Sphenopalatine ganglion neuralgia is a pain syndrome somewhat similar to trigeminal neuralgia (pain related to the branches of the fifth cranial nerve) but more painful. It is a very rare condition. One may call it Sluder’s headache, as Dr.Sluder was the person who described this pain for the first time. It is also known as vidian nerve neuralgia since the vidian nerve is one of the nerves contributing to the formation of the sphenopalatine ganglion. It has a lot of similarities to other headache disorders known as cluster headaches, though they are not the same.

What Are the Causes of Sphenopalatine Ganglion Neuralgia?

Sphenopalatine ganglion, also known as Meckel’s ganglion or pterygopalatine ganglion, is a small bundle of nerves positioned behind the nose inside the skull. Several important nerves start from this ganglion. The exact reason behind sphenopalatine ganglion neuralgia is not known. Doctors think it may be due to abnormal functioning of the part known as the hypothalamus in the brain. Rarely have doctors noticed that sphenopalatine ganglion neuralgia might be genetically passed on from one generation to the next. Or due to the abnormal release of a substance known as histamine. Histamine is an inflammatory mediator released into the body. Hence an irritation due to the inflammatory process around the sphenopalatine ganglion may be a possible reason. This inflammation stimulates the dilation of blood vessels inside the brain and increases blood flow. As a result, some chemicals in the brain trigger a pain response.

What Are the Symptoms of Sphenopalatine Ganglion Neuralgia?

Symptoms vary slightly from person to person. The common symptoms are:

• Sudden onset of burning, achy persistent headaches.

• It happens on one side of the head, towards the lower part.

• Occurs continuously with bouts of cyclic increase in pains.

• Involving the eyes, temple, cheekbones, ears, back of the ear, back of the nose, jaws, teeth, palate, and sometimes spreading to the back of the neck, shoulders, and chest.

• It may last for about fifteen minutes to three hours daily.

• There may be periods of remission (ties without headaches) periodically between the headache episodes.

• One may have a sneezing, stuffy nose, runny nose, and watery eyes with redness.

• At the time of a pain attack, one may sweat profusely.

• Some may suffer altered taste sensations and itch in their hands.

What May Trigger an Episode of Sphenopalatine Ganglion Neuralgia?

A few possible triggers identified may provoke sphenopalatine ganglion neuralgia in an individual. They are:

1. Alcoholism.

2. Smoking.

3. Consumption of cocaine.

4. Emotional stress.

5. Damaged teeth, tooth decay, and infected gums, especially among the upper back teeth.

6. Cold weather.

7. A bent nasal septum.

8. Sinusitis (inflamed sinuses, air-filled bony cavities found on either side of the nose and forehead)

9. Recent surgeries involving the nose.

How Does the Doctor Diagnose Sphenopalatine Ganglion Neuralgia?

There are no specific diagnostic criteria currently existing for diagnosing sphenopalatine ganglion neuralgia. The doctor may listen to the symptoms, the pattern of headache, associated symptoms, and what turns out to be worse. One method to diagnose sphenopalatine ganglion neuralgia is injecting a dose of an anesthetic agent (numbing medicine) into the sphenopalatine region. And if it relieves the symptoms such as pain, one may conclude that the pain is due to sphenopalatine ganglion neuralgia. One may try to stimulate the sphenopalatine ganglion to see if it triggers the symptoms and is a part of the diagnosis.

What Is the Available Treatment for Sphenopalatine Ganglion Neuralgia?

Several treatment options are currently available for sphenopalatine ganglion neuralgia and similar headaches. It involves relieving the symptoms and reducing the frequency of headache episodes. Factors that trigger the sphenopalatine ganglion neuralgia also should be completely eliminated for better results with treatment. One may adopt the following treatment options:

• A sphenopalatine nerve block is performed by injecting anesthetics (numbing agents) into the sphenopalatine ganglion to resolve the pain. This process is useful for relieving other types of headaches, such as cluster headaches, migraines, trigeminal neuralgia, etc.

• An anesthetic medicine may be applied to the tip of a cotton tip applicator and inserted into the nostrils for relief.

• Injecting ninety-five percent alcohol combined with five percent phenol into the ganglion may relieve the pain. Drugs like Ergotamines are also used to reduce the onset of painful symptoms.

• One may prescribe anticonvulsive drugs such as Gabapentin, Carbamazepine, Oxcarbazepine, and Pregabalin, as they were found effective in treating sphenopalatine ganglion neuralgia.

• Surgical resection of the sphenopalatine ganglion may be done where the ganglion is surgically removed to eliminate the symptoms for satisfactory results.

• Stereotactic radiosurgery may give good results too. A pulsed radiofrequency treatment and radiofrequency ablation procedure were found to be highly effective in treating the condition. Here, controlled focused radiation is used to target the sphenopalatine ganglion guided with an imaging technique like computed tomography (CT). The tissues in the ganglion are heated up and destroyed by this technique.

• Attaching a sphenopalatine ganglion stimulator device under the skin may be helpful too. Here, the patients can send electrical signals to the ganglion using a remote control when the pain is about to start. This helps in pain reduction, eliminating the pain completely, as well as reducing the frequency of nerve pain attacks.

• Correction of septal defects where a bent or crooked nasal septum is surgically straightened to eliminate the pain episodes. Getting decayed and infected teeth treated with antibiotics may help with sphenopalatine ganglion neuralgia too. One may opt for a root canal treatment (removing the infected blood vessels and nerves from the root of the tooth and placing a filling material for protection) or pull out the tooth (dental extraction). If the gums are infected, they should be treated with suitable antibiotics and anti-inflammatory medications.

• If the sinuses are infected, causing sinusitis, antibiotics and pain-relieving medicines may help with the pain too.

Conclusion:

An otolaryngologist or physician is the right person to diagnose sphenopalatine ganglion neuralgia. Since many types of headaches and nerve pains of the head, face, and neck region share the same symptoms as that of sphenopalatine ganglion neuralgia, it is a very challenging condition to diagnose. Once the doctor is able to pin down the underlying cause that triggers the inflammation around the ganglion, one may do the needful to resolve it. It is mandatory to visit a dentist to fix problems inside the mouth. Also, get a crooked nasal septum straightened to avoid repeated congestion. One should discuss the symptoms with a physician to decide on a suitable treatment.