New procedure at Baptist Hospital may be answer for patients suffering from migraines

A new procedure at Baptist Hospital in Beaumont may be the answer for people suffering from migraine headaches. While the nerve block procedure is not a cure for headaches, it has been quite successful for many Southeast Texas patients since it was introduced at the hospital in September of last year, said Dr. Robert Morrison, an interventional radiologist at Baptist.
The Sphenopalatine Ganglion (SPG) block is a procedure to stop pain transmission through anesthesia to the nerve. An anesthetic agent is administered to the collection of nerves in the ganglion through the least invasive way to access the SPG — through the nose.
“The sphenopalatine ganglion is a group of nerve cells that live at the skull base right behind the nose,” Morrison explained. “It’s a cluster of nerves that does a lot of things, but one of the things that it has shown to be is a contributor to chronic migraine headaches. … The nerves in the sphenopalatine ganglion are always excited, and it’s very easy for them to get flipped over in this kind of hyper-excited state and trigger a migraine headache.”
Morrison said that historically, SPG block was accomplished with a long needle through the face. The Food and Drug Administration (FDA) also approved BOTOX to treat migraine headaches in 2010. Both methods involve needles, however, which obviously can cause discomfort for the patient.
“It’s been shown that this area (behind the nose) is a source of migraine headaches, but it’s been an area that has been tricky to get to,” Morrison said. “There’s some new equipment that has entered the marketplace that allows us to just put a thin, rubber catheter up your nose and, due to where this sphenopalatine ganglion lives, we can (administer) some lidocaine numbing medicine basically through the nose with this special catheter.”
Morrison uses fluoroscopy for imaging guidance during the procedure. Fluoroscopy allows the visualization of real-time imaging to direct the catheter into the SPG.
“That allows us to then anesthetize the nerve bundle,” Morrison said. “We can do it quickly, safely and effectively without having to put a needle in the patient’s skin.”
The procedure only takes about 10-15 minutes, he said. The patient is awake during the process.
“There’s very little risk,” Morrison added. “Mostly just a transient alteration in the sense of taste or a kind of numbness feeling in the back of their throat. That’s pretty much it.”
Clint Vannoy, clinical coordinator for the EMS Program at Lamar Institute of Technology, recently had the procedure performed. Vannoy, 43, said he has suffered from migraines since a diving accident when he was 5 years old.
“I cracked my skull open,” said Vannoy, a Woodville native who now resides in Beaumont. “That triggered the beginning of it. I remember waking up crying and hurting and my parents didn’t really know what was going on. It was just severe pain. I didn’t get really get a diagnosis until I was 20 probably. … Since the accident, I’ve gotten really bad migraines.”
Vannoy said he averaged 8 migraines a month before the SPG block procedure.
“They last somewhere between 2-3 days a piece,” he said. “There are probably about 15-16 days out of a month that I’ve got a migraine.”
Vannoy tried everything, from taking pain medication to blood pressure pills to seizure medications.
“I go to a neurologist in Houston that has tried every gamut of medications possible,” he said. “I have never found anything that works, and everything I’ve tried has crazy side effects.”
Vannoy said he even went as far as Thailand and Japan to try to find an Eastern medicine approach to the problem, but nothing worked.
The idea of having needles pushed into his face wasn’t appealing to Vannoy either, but when he heard about the SPG block procedure, he decided to give it a try.
Following his SPG block procedure in June, Vannoy expressed to Vital Signs during our July 10 interview that he has “not had a migraine since.”
“This is the first time in 35 years that I’ve went this long without one,” he said.
Vannoy said he is no longer regularly absent from work or has to spend time in isolation, hoping his migraines will go away.
“It’s one of those things where you are in the fetal position on a couch in a dark room as cold as you can get it just trying to block out all the light and sound,” Vannoy said. “Even when they go away, there’s still another day or two of what I call concussion days, which is the remnants of it where you feel like you got hit in the head with a baseball bat.”
Vannoy underwent the SPG block procedure during his lunch break and returned to work immediately after with no complications. He said it was an in-and-out procedure.
Since it is not a permanent cure for migraines, how long will it last?
“It doesn’t get rid of the migraine headache forever, but what it’s designed to do is it basically resets the neurochemical imbalance in the sphenopalatine ganglion,” Morrison said. “Basically by anesthetizing them with the lidocaine, we’re just resetting the system so that we’re ratcheting them back down to a more baseline, normal level. So it takes them longer and longer to get back to that excitable state. Everyone is different, but typically a lot of patients will experience significant relief in their migraine headaches for 3-4 months, and then they can come back in and have a repeat SPG block done at that time.”
It’s kind of like a maintenance program that helps prolong a patient’s symptom-free state, Morrison said.
Rebecca Venable, a 61-year-old Orange native now residing in Beaumont, has suffered from migraines for almost 30 years. She started having them after her hysterectomy.
“The first time I had one, I thought I was having an aneurism. That’s how bad it felt,” she said. “I have sensitivity to light and sound. I have to get in a cold, dark room and put an icepack on my neck and an icepack on my forehead.”
Venable said the reoccurrences vary.
“I’ve gone months without having one and then have had 10 in one month,” she said. “There’s no reason or rhyme to it. It gets disappointing when you make plans and you have to cancel them. It depresses me. … You can’t be around anybody because you’ve got to have quiet. I can’t be around my grandchildren.”
Venable, who has tried tryptamine-based drugs to treat her migraines, decided to try the SPG block procedure Tuesday, July 11. Vital Signs observed the procedure, which seemed to be quick and painless for Venable, who even said, “It was nothing.”
Venable, who had a migraine when she showed up to the hospital, said her headache was immediately gone, and she no longer felt depressed. After following up with Venable a week later, we discovered that she was still migraine free and felt great.
“I haven’t had a headache all week and have not taken anything,” she said.
According to the article “Impact of migraine headache in the United States” by Jennifer H. Lofland, the project director and associate professor for the Department of Health Policy at Thomas Jefferson University in Philadelphia, the direct treatment costs associated with migraines have been estimated at approximately $1 billion per year in the United States. However, the total economic impact of migraines is far greater. Migraine headaches costs U.S. employers approximately $13 billion per year as a result of missed work days or reduced productivity on the job, according to the article.
Migraine headaches affect approximately 9 percent of the U.S. population, Lofland writes, and it is approximately 3 times more common among women than among men, and also more common among whites than other racial groups.
Although Morrison, who said Baptist is the first and currently the only hospital in Southeast Texas to offer the SPG block, he said while he couldn’t share a specific success rate for the procedure, he did say most have found it to be helpful.
“I’m not saying this will be 100 percent successful for everybody, but it sure does seem to be successful for most people,” he said.
Morrison said candidates can be referred by their primary care physician or neurologist or can even be self-referred if they know they have chronic migraine headaches. He said that it is safe for children suffering from migraines as well.
“We’d be happy to see them in our clinic and evaluate them and see if they’re an appropriate fit for this procedure,” he said.
For more information or to schedule an appointment, call (409) 212-5825.

Photo by Kevin King - Dr. Morrison uses fluoroscopy for imaging guidance during an SPG block procedure on Rebecca Venable at Baptist Hospital.

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