Sphenopalatine Nerve Ganglion Block for Acute Benign Headaches in the Emergency Department: A Pilot Randomized Controlled Trial

300,000 Canadians a year visit an emergency department (ED) for headache. Most causes are primary headaches (i.e. not dangerous or benign). The main ED care is providing pain relief. This is often delayed given the state of crowding, the inability to take oral medications due to accompanying nausea/vomiting and the slow onset of oral medications. Most patients receive intravenous (IV) treatments which are usually delayed due to the need to have an IV started. An alternative is local anesthetic lidocaine intranasally to freeze the sphenopalatine nerve ganglion which is just under the mucosa surface. This ganglion is important in the process of pain and likely to stop a headache within minutes of administration. Intranasal lidocaine may reduce time to analgesia, decreasing patients’ pain and the time spent in the ED. A well-designed clinical trial is necessary to determine if a sphenopalatine ganglion block is effective for benign headache patients. Sphenopalatine ganglion blocks could be administered early. Standard treatments require IV access and are delayed, usually after physician assessment. The goal of this pilot trial will determine the feasibility and design of such a clinical trial.