This study aimed to: 1) evaluate the safety and effectiveness of the SPG block in reducing migraine/headache severity in pediatric ED patients, and 2) compare ED length of stay (LOS), hospital admission, and ED re-admission within 48 hours of initial presentation between SPG block and first-line IV medication combo (Ketorolac, Compazine, Benadryl, and normal saline bolus).

Migraines and acute headaches are common presenting complaints in the pediatric emergency department. The sphenopalatine ganglion (SPG) block is an alternative migraine treatment option in the adult population, but has been largely unstudied in the pediatric population. An initial study has shown it to be a safe alternative in pediatrics and was subsequently adopted by the pediatric ED as an alternative treatment for acute headache in children 7 years and older.

A retrospective chart review was performed for patients 7-18 years old presenting with acute headache between 2/1/19-2/29/20. 333 charts met inclusion criteria with 23 receiving SPG block. For patients with SPG block only, pre/post treatment pain scores were compared using the Wilcoxon signed rank test. Comparisons of ED LOS, hospital admission, and 48 hour re-admission rates between SPG block and IV medications were performed using the Wilcoxon signed rank test and Chi-square tests, as appropriate for the data distribution.  

Patients who only underwent an SPG block had a mean pain score reduction of 6.9 (95% CI 1.54-3.88, p=<0.0001) and no negative side effects were noted. The average ED LOS for the SPG block only was 46 minutes shorter than the first line IV medications (p=0.27). Rates of hospital admission and 48-hour re-admission did not vary between the two treatments.

The SPG block is an effective and safe way to treat headache in the pediatric ED setting. It can reduce ED LOS, however, there was no improvement in admission and 48 hour re-admission rates.