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Emergency Medical Minute


Aug 25, 2017

Author: Don Stader, M.D.

Educational Pearls

  • Cluster headaches are usually intense, unilateral,  and involve the periorbital area.
  • CN V (Trigeminal) provides sensory and autonomic innervation the face and eyes, which play roles in headache pathology.
  • Cluster headaches can be treated with high flow oxygen, but a new treatment involves blocking the sphenopalatine ganglion (SPG) with lidocaine. Because sensory and autonomic branches of the trigeminal traverse the SPG, lidocaine will effectively treat a cluster headache.
  • To block the ganglion, intranasal lidocaine may be used, or a Q-tip soaked in 4% lidocaine can be applied to the most posterior aspect of the pharynx for 10-15 minutes.