There are a variety of anesthetic nerve blocks that have proven helpful for a subset of chronic facial pain sufferers.

Botox Injections

Some chronic facial pain patients have had success achieving pain relief with Botox (Botulinum toxin type a) injections. This is an off label use of the drug and will require more research before being approved as a neuropathic facial pain treatment.

Sphenopalatine Ganglion Block (SPG)

The SPG block is commonly performed by inserting long, hollow cotton swabs into the nostrils to deliver a numbing agent, such as lidocaine, to the nerve bundle behind the sinus cavity called the sphenopalatine ganglion. In another method, a catheter is inserted through the nostril and guided with the use of fluoroscopy to the ganglion where the numbing agent is delivered.

SPG is reported most often as a treatment for the trigeminal autonomic cephalgias (TACs), cluster headache, SUNCT, and paroxysmal hemicrania. “The SPG is crucial for mediating the cranial autonomic symptoms produced by primary headache disorders, particularly trigeminal autonomic cephalalgias.”1

A patient’s response to SPG is predictive of a patient’s response to ablative procedures such as radiofrequency lesioning.

sphenopalatine ganglion

Stellate Ganglion Block (SGB)

A stellate ganglion block (SGB) is an injection of local anesthetic in the sympathetic nerve tissue of the neck called the stellate ganglion, located on either side of the voice box. Other medications may also be used during the procedure, such as epinephrine or steroid medication to prolong its effects.

As a treatment for chronic facial pain, SGB is used to relieve postherpetic neuralgia (the pain of herpes zoster in the trigeminal nerve.)

Gasserion (Trigeminal) Block (a.k.a. Sweet Procedure)

Like the previous blocks, the gasserion block is employs anesthetic to prevent pain. In the case of the gasserian block block however, the target is the Gasserion (trigeminal) ganglion.

Occipital Nerve Block

Occipital Nerve Block, a treatment for Occipital Neuralgia, is performed with an injection of a steroid and local anesthetic into the occipital nerves in the back of the head can help relieve pain from occipital neuralgia.

occipital nerve block
Click to enlarge

Further Exploration

1. Thomas P. Bravo, MD and Rashmi B. Halker, MD Sphenopalatine Ganglion Block for Migraine? Headache and Migraine. News. April 07, 2015. Full Text
2. The University Pain Centre Maastricht. Gasserian Ganglion Block (Sweet procedure) Full text.

Rev. 09/19