To examine the safety and efficacy of Sphenopalatine Ganglion (SPG) block in post-stroke headache.

Recent literature suggests that post-stroke headache occurs in 4%-6% of ischemic stroke patients with tension-type features being the leading cause. Due to their side effect profile, drugs such as triptans and ergotamines have contraindications in this population. Additionally, there is not enough clinical data to safely support the use of gepants in the acute stroke population. Lasmiditan has limited use due to 8 hours driving restriction. Thus, abortive headache treatments are often limited to opioids and butalbital combinations. SPG block is a non-invasive procedure where an anesthetic agent is injected into the nares, reaching the SPG in order to relieve pain and autonomic features. Robust literature has shown SPG block is effective in acute migraine; however, the use of SPG block in post-stroke headache has not been reported.

We performed a retrospective analysis at the University of Utah Health and queried charts of patients with a diagnosis of post-stroke headache confirmed by a neurologist who received at least one SPG block procedure between January 2000 to October 2021.

We identified over 550 unique patients with a possible post-stroke headache diagnosis who received at least one SPG block. Average age is 56.9±15.9 (range from 19 to 96), with 55% female (n=301). At baseline, we will identify patient’s headache subtype, frequency, previous treatment, demographic data, and clinical data. We will compare patient’s pre and post-procedure’s pain level and document relief of most bothersome symptom prior to treatment and at 30 minutes, 1 hour, and 2 hours post-treatment.

SPG block may be an efficacious treatment for post-stroke headache. As local anesthetic agents have a low side-effect profile and minimal risk of dependence; SPG block may be an important alternative to current treatment options including opioids, butalbitals, and lasmiditan.