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Home Instructions for Intranasal Lidocaine / Sphenopalatine Ganglion Block

Home Instructions for Intranasal Lidocaine/
Sphenopalatine Ganglion Block
Dr. Morris Maizels

Your pharmacist should dispense to you a bottle of 2% viscous lidocaine – please be sure it says “viscous” on the bottle.

The lidocaine works best used as early as possible in the headache attack. It seems to work best for headaches that are primarily behind the eyes or in the temples, rather than in the back of the head.

Draw up about 1.0 ml of viscous lidocaine into a 1 ml syringe. It does not matter if there are air bubbles mixed in the syringe.

The lidocaine goes into the nostril on the same side as the headache. If the headache is on both sides of your head, you will be injecting the lidocaine into both sides.

If you have an aura before your headache. For most people, the aura is on the side opposite the headache. If that is true for you, inject the lidocaine on the side opposite to your aura (on the side the headache will develop) as soon as the aura starts.

Lie down on your side curled up like a baby sleeping on its side, with your shoulder on the back of a firm pillow, and your head tilted back and rotated so you are looking up ~30 degrees.

Put the syringe into the lower nostril, as far as it will comfortably go, with the tip pointing towards the outer (lateral) wall of the nostril. Inject the contents of the syringe, and then sniff the medicine so that you feel it goes to the back of the nostril, but not into the throat. If you feel burning or numbness into the eye, or if the eye tears, you know you have gotten the medicine where it needs to be. Stay lying down with your head turned for 2 – 3 minutes.

If your headache is on both sides, roll over and repeat the procedure on the other side. Stay lying down for 2-3 minutes on this side.

When you sit up, whatever medicine has not been absorbed will roll back into your throat. It will taste bitter and may make your throat numb. Don’t eat or drink until the numbness has gone away – otherwise you might swallow food or liquid into your windpipe.

You may repeat the lidocaine as often as 4 times/day.
If the lidocaine relieves the headache but the headache returns, you can repeat the lidocaine within 1 hour.

If you are somewhere that you cannot lie down – you can try injecting the lidocaine and sniffing it, but it might not get to the right location (see picture).

Please keep track on the headache calendar each time you have a headache, and each time you use the lidocaine.
Anatomy of sphenopalatine ganglion.

Proper position for SPG block. Shoulder resting on the back of a folded pillow. Head is tilted back and rotated 30-45 degrees. Tip of 1 ml syringe is pointed to the outer wall of the nose, on the side of the headache. Inject the contents of the syringe. Sniff sharply so that the gel goes to the back of the nose. Some might run into the throat. Stay lying down for 2 minutes. If the headache is on both sides, roll to the other side and repeat .

While not ideal, the lidocaine can also be instilled while sitting up. Tilt the head back as far as it will comfortably go. Turn the head to the side. Inject 1 ml of lidocaine. Sniff it to the back of the nostril. Stay in this position for 2 minutes. If the headache is on both sides, repeat on other side.

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