Publication:

An update on the diagnosis, treatment, and management of sphenopalatine neuralgia

This report intends to summarize the underlying pathophysiology, relevant symptoms, appropriate diagnostic workup, necessary imaging, and medical and surgical treatments of Sphenopalatine neuralgia (SN). This was done through a comprehensive literature review of peer-reviewed literature throughout the most relevant databases. Dr. Greenfield Sluder first observed that a number of his patients had atypical headaches that caused referred pain to the head and neck regions. The current understanding of the pathophysiology of SN states that irritation of the pterygopalatine ganglion secondary to inflammatory processes of the posterior ethmoid and sphenoid sinuses causes symptoms including unilateral persistent headache that begins lateral to the nose or near the eye and radiates across the face. Diagnosis is typically clinical; however, this is challenging due to lack of a definitive diagnostic criteria. Dr. Sluder originally treated his patients with 20-67% cocaine that was injected into the pterygopalatine ganglion to relieve the pain. Today, we use 88% phenol applied to the nasal mucosa. The most definitive way to both diagnoses and treat SN is the injection of cocaine or 88% phenol into the sphenopalatine region. The aim of the study was to update providers on the important clinical signs of SN and the important distinction between the clinically distinct conditions of sphenopalatine neuralgia and cluster headache. This report also outlines the treatment options to address this condition.