Should SPG be the first line in headache management

In this lecture, Dr. Miles Day explores the role of the sphenopalatine ganglion (SPG) in treating facial pain and headaches—especially cluster and migraine headaches. Drawing from personal experience and medical literature, he reviews the anatomy and techniques for SPG blocks, RF, and neuromodulation. He emphasizes the importance of understanding the trigeminal system, SPG variability, and choosing the right approach—intranasal, infrazygomatic, or ultrasound-guided. He also highlights complications, coding issues, and a growing body of evidence supporting SPG-based interventions, including neurostimulation. This niche offers opportunities for pain physicians seeking to specialize in treating chronic craniofacial pain syndromes.