Sphenopalatine ganglion block for postdural puncture headache: A review of current evidence

Postdural puncture headache (PDPH) is a significant complication of neuraxial procedures. Although conservative treatments and the invasive epidural blood patch (EBP) are currently standard approaches, the sphenopalatine ganglion (SPG) block is emerging as a promising, less-invasive alternative. The pathophysiology of PDPH involves cerebrospinal fluid leakage, resulting in reduced intracranial pressure and compensatory cerebral vasodilation, which is partially mediated by SPG stimulation. The SPG block aims to interrupt this vasodilation using local anesthetics, thereby alleviating headache symptoms.

To provide a comprehensive overview of current evidence regarding the use of the SPG block in treating PDPH, explores the anatomical and physiological basis of this intervention, describes various administration techniques for administering the block, and critically assesses the efficacy and safety data from clinical studies.

A systematic literature search was conducted on PubMed and the Cochrane Database to identify systematic reviews and meta-analyses published up to April 2025, using the keywords "sphenopalatine ganglion block" and "post-dural puncture headache".

The SPG block is a simple, noninvasive, and effective bedside procedure. Clinical studies have demonstrated that it provides rapid pain relief, with high success rates and an onset of action typically within 10-30 minutes. The most used technique is the transnasal approach, which is associated with minimal and transient adverse effects such as nasal discomfort and bitter taste.

Although EBP remains the preferred treatment for severe PDPH, the SPG block is a viable alternative for mild-to-moderate cases, often allowing patients to postpone or avoid EBP. Comparative studies suggest that SPG block has a quicker onset than EBP, though in some cases, it provides shorter duration relief. Overall, the SPG block is a safe, effective, and readily accessible treatment for PDPH. Its minimally invasive nature and high success rate in providing rapid pain relief make it an excellent first-line alternative to more invasive procedures. Further large-scale, standardized randomized controlled trials are required to optimize protocols and fully integrate the SPG block into mainstream clinical practice.