Sphenopalatine Ganglion Block for Post-Dural Puncture Headache

Guideline Recommendations

The American College of Physicians and other multisociety international working groups recommend that sphenopalatine ganglion blocks should not be routinely used to treat post-dural puncture headache, with evidence grade I and level of certainty low 1, 2

The American Society of Anesthesiologists and other medical societies note that nasal sphenopalatine ganglion block is considered a potential aerosol-generating procedure and should be avoided in patients with suspected or confirmed COVID-19 due to transmission risk to healthcare workers 3, 4, 5

The American Academy of Neurology and other medical societies recommend first-line conservative management with multimodal analgesia, including acetaminophen and NSAIDs, with evidence grade B 1, 2, 6
The American College of Obstetricians and Gynecologists and other medical societies recommend caffeine up to 900 mg/day in the first 24 hours, with evidence grade B 1, 2, 6
The American Society of Anesthesiologists and other medical societies recommend adequate oral hydration, with IV fluids only if oral intake is inadequate, with evidence grade C 1, 6
The American Pain Society and other medical societies recommend short-term opioids if multimodal analgesia fails, with evidence grade C 1, 2
The American Society of Regional Anesthesia and Pain Medicine and other medical societies recommend greater occipital nerve blocks as a procedural intervention if conservative measures fail, with evidence grade C and level of certainty moderate 1, 2, 6
The American Society of Anesthesiologists and other medical societies recommend epidural blood patch as the definitive treatment for severe or refractory post-dural puncture headache 1, 6