The SPG is a nerve bundle that lies in the pterygopalatine fossa with important parasympathetic outflow to the craniofacial structures. It is a known target for the acute treatment of migraine. Anesthetic blocking of the SPG may modulate sensory processes in the trigeminal nucleus caudalis, possibly reducing central sensitization of pain in headache. Blocks can be done via needle injection or catheter device insertion to deliver anesthetic to the SPG. During clinic closures due to COVID-19, visits were shifted to telemedicine and there was an increasing need for treatments that would minimize office and emergency room visits.

At the start of the pandemic, a nasal spray anesthetic targeting the SPG was prescribed to patients with migraine. Patients were prescribed 1% lidocaine, 2% lidocaine, or 0.5% ropivacaine spray. They were instructed to deliver 0.1cc per dose spray in each nostril and lie back with their head tilted towards the ipsilateral side, for use up to 5 times monthly as needed. A retrospective chart review of 53 patients receiving this treatment was conducted. Analysis included headache improvement and reported side effects.

Overall 76% of patients reported headache improvement acutely. Further, response to all 3 formulations demonstrated majority improvement (89% with 1% lidocaine, 68% with 2% lidocaine, and 81% with 0.5% ropivacaine). Few side effects were reported, only a brief episode of epistaxis in one patient on the 5th usage and transient headache exacerbation in one other patient.

Self-administered anesthetic nasal spray targeting the SPG is likely an effective and safe home acute treatment for migraine attacks. This treatment was of particular benefit for patients during pandemic clinic closures.