Journal of neurology · 2026
Potential sphenopalatine ganglion block efficacy as an alternative to epidural bloodpatch for post-dural puncture headache: a monocentric french study.
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Daudon Alice, Koessler Stefanie, Kremer Laurent, de Seze Jérôme, Bigaut Kévin
Аннотация
BACKGROUND: Post-dural puncture headache (PDPH) is a common complication of lumbar puncture caused by cerebrospinal fluid leakage and intracranial hypotension. Epidural blood patch (EBP) is considered the gold standard treatment but remains invasive. Sphenopalatine ganglion block (SPGB), a non-invasive technique, has shown promising results in recent studies, but it was not evaluated as an alternative of EBP. This study aimed to evaluate the effectiveness of SPGB in PDPH by determining whether it could reduce the need for EBP in clinical practice.
METHODS: We conducted a prospective monocentric cohort study including patients meeting ICHD-3 criteria for PDPH with significant pain or functional impairment. SPGB was performed using lidocaine 5% administered via an atomization device (MADgic™). Pain intensity was measured using a visual analog scale (VAS) at predefined intervals up to 24 h. In cases of SPGB failure, EBP was performed. Demographic and procedural variables were recorded. SPGB was considered clinically relevant if it prevented at least 50% of EBPs; 14 patients were required to achieve 90% power with alpha risk of 5%.
RESULTS: Fourteen patients (mean age 31.9 years; 78% women) were analyzed. SPGB was performed a median of 3 days after PDPH onset. Five patients (36%) required subsequent EBP, meaning 64% were successfully managed with SPGB alone, exceeding the predefined efficacy threshold. VAS scores showed significant pain reduction from 45 min post-procedure, sustained at 24 h. A trend toward association between traumatic needle use and SPGB failure was observed (80% vs. 22%, p = 0.091). Throat numbness was more frequent in responders (p = 0.014). No serious adverse events occurred; tolerability was rated good to moderate.
CONCLUSION: SPGB appears safe, well tolerated, and effective in a substantial proportion of PDPH cases, potentially reducing the need for EBP. Based on these findings, we proposed an algorithm for PDPH management. Larger comparative studies are needed to establish definitive treatment recommendations.
METHODS: We conducted a prospective monocentric cohort study including patients meeting ICHD-3 criteria for PDPH with significant pain or functional impairment. SPGB was performed using lidocaine 5% administered via an atomization device (MADgic™). Pain intensity was measured using a visual analog scale (VAS) at predefined intervals up to 24 h. In cases of SPGB failure, EBP was performed. Demographic and procedural variables were recorded. SPGB was considered clinically relevant if it prevented at least 50% of EBPs; 14 patients were required to achieve 90% power with alpha risk of 5%.
RESULTS: Fourteen patients (mean age 31.9 years; 78% women) were analyzed. SPGB was performed a median of 3 days after PDPH onset. Five patients (36%) required subsequent EBP, meaning 64% were successfully managed with SPGB alone, exceeding the predefined efficacy threshold. VAS scores showed significant pain reduction from 45 min post-procedure, sustained at 24 h. A trend toward association between traumatic needle use and SPGB failure was observed (80% vs. 22%, p = 0.091). Throat numbness was more frequent in responders (p = 0.014). No serious adverse events occurred; tolerability was rated good to moderate.
CONCLUSION: SPGB appears safe, well tolerated, and effective in a substantial proportion of PDPH cases, potentially reducing the need for EBP. Based on these findings, we proposed an algorithm for PDPH management. Larger comparative studies are needed to establish definitive treatment recommendations.