MIGRAINE: Managing the Postdrome Phase or Migraine Hangover with SASPGB

Authored by: Ira L Shapira DDS, D,ABDSM, D,AACFP, D,ABIPM

Migraine Suffering is an enormous issue controlled by the Trigeminal Nervous System and the associated Autonomic Nerves. The Trigeminal input to the brain is over 50% of the total input to the brain after amplification in the Reticular Activating System.

The Limbic System is where we feel all emotions. Pain is also perceived in our Limbic System. Suffering is most certainly controlled in the Limbic System and is rooted in the Amygdala.

The Amygdala is our mainframe computer for Fear and Threat issues. It puts are "Fight or Flight" reflex into overdrive by acting on the Hypothalamus and then to every distant part of our nervous and endocrine systems. According to Jon T. Willie, M.D., Ph.D., neurosurgeon and director of the laboratory for behavioral neuromodulation at Emory University in Atlanta. “If you have an emotional experience, the amygdala seems to tag that memory in such a way so that it is better remembered.”

Unfortunately, pain is an emotional response and hence the memory of both pain and the fear related to pain are inexorably linked. So are all the other Emotional Memories that can act as triggers. Sight, Smell, Taste, Vision inputs as well can all be involved turning on the "Fight or Flight" reflex. Suffering during Migraine and Migraine Postdrome may be related to a combination of emotional memories as well as neurovascular issues.

It is likely the Amygdala is key to repressed memories that are associated with painful emotions. The Amygdala may well be where our brain decides to keep these memories buried.

Preventing the Migraine Postdrome might require the burying of certain memories in our Amygdala or in digging them out and revealing them to our conscious selves. Either of these actions come at a price.

SASPGB is an acronym for Self-Administered SphenoPalatine Ganglion (Pterygopalatine Ganglion, Nasal Ganglion, Sluder's Ganglion, Meckel's Ganglion) Blocks or simply SPG Blocks.

The Sphenopalatine Ganglion Block is used to treat a wide variety of tension headaches, migraines, sinus headaches, stress related headaches as well as anxiety and panic attacks. Recent research has shown it can quickly turn off the symptoms and can also be used to prevent all of these issues.

SASPGB or Self-Administration empowers patients with a preventive tool of awesome results. Like all tools or treatments it does not work for everyone but is life changing for many. It can be utilized prophylactically to prevent onset of symptoms, during a severe attack for quick relief of symptoms and to control postdromal symptoms.

The use of Sphenopalatine Ganglion Blocks was first documented by Dr Greenfield Sluder in 1908.

Dr Sluder was an Otorhinolaryngologist who wrote two books on the Sohenopalatine Phenomena and Nasal Neurology and was the Chair of Otorhinolaryngology at Washington University Medical School.

In 1929 Dr Hiram Byrd published a paper on Sphenopalatine Phenomena describing the effects of 10,000 Sphenopalatine Ganglion Blockade on 2000 patients with almost universal positive and sometimes incredible results with virtually no negative side effects.

These amazing blocks almost became part of "Forgotten Medicine" as the pharmaceutical age of medicine arrived but were saved by a popular book "Miracles on Park Avenue" published in 1986 and written by Benjamin Gerber who detailed the medical practice of Dr Milton Reder an Octogenerian New York City Otolaryngologist whose entire practice consisted of doing Sphenopalatine Ganglion Blocks. SPG Blocks are often known as "The Miracle Blocks" because of Dr Reder who treated thousands of patient, including the rich and famous from across the US and from around the world.

This author first learned of these blocks when a patient brought me a copy of the book and asked if I could find a doctor who could do these blocks. There was no one in Illinois but I personally leaned from Dr Jack Haden a Kansas City TMJ Disorder Specialist.

The Sphenopalatine Ganglion (SPG) is the largest Parasympathetic Ganglion of the Cranium and one of four Parasympathetic Ganglia located on the Trigeminal Nervous System. The Trigeminal Nerves are the largest, by far, of the 12 cranial nerves.

The SPG also contains Sympathetic Fibers that come from the Superior Cervical Sympathetic Ganglion. These fibers arise from all the Cervical Sympathetic Ganglia and from the Stellate Ganglion. Recent research has shown that a Stellate Ganglion shot can sometimes cure PTSD. SASPGB blocks these same nerves and may be helpful for PTSD and is helpful for anxiety and panic attacks.

SASPGB is the Self-Administration of Sphenopalatine Ganglion Blocks by transnasal application of a cotton-tipped catheter to deliver anesthetic to the medial mucosal wall of the Pterygopalatine Fossa. SASPGB offers a continual capillary feed of lidocaine or other anesthetic to this area that overlays the SPG. It is also possible to inject the SPG or use "squirt gun" catheters like the Sphenocath or TX360. The ability to Self-Administer is what sets this technique apart because the patient can utilize it prophylactically or at the first sign of a problem. It can sometimes provide relief in minutes rather than hours. It tends to avoid the postdrome phase for most patients.

The majority of patients can learn this procedure in a single office visit and after initial training can self-administer the blocks for less than $1.00 in supplies per bilateral application. Ideally, patients have best results with a visit to the office however during COVID-19 Dr Shapira has taught the procedure utilizing telemedicine.

There are several patient testimonial videos at: https://www.bing.com/search?q=spg+video+testimonials&form=QBLH&msbsrank=0_0__0&sp=-1&pq=spg+video+testimonials&sc=0-22&qs=n&sk=&cvid=6BA9627B80644600BC87FED1BF048274

I have discussed this subject in detail in my article in CRANIO Journal which can be found at: https://www.sphenopalatineganglionblocks.com/spg-blocks-and-neuromodulation/

My office website is www.ThinkBetterLife.com and appointments can be made by e-mail. If you call the office it is generally taken by an answering service and my Team will respond.

Ira L Shapira DDS, D,ABDSM, D,AAIPM, FICCMO, MICCMO

Past Chair, Alliance of TMD Organizations

Diplomat, Academy of Integrative Pain Management

Diplomate, American Board of Dental Sleep Medicine

Diplomate, American Board Sleep and Breathing

Regent, Master & Fellow, International College of CranioMandibular Orthopedics

Board Eligible, American Academy of CranioFacial Pain

Professor Neuromuscular Orthodontics and CranioMandibular Orthopedics University of Castellon

Dental Section Editor, Sleep & Health Journal

CranioFacial Pain Section Editor, CRANIO: Journal of Craniomandibular and Sleep Practice

Member, American Equilibration Society

Member, Academy of Applied Myofunctional Sciences