Sphenopalatine ganglion block for postdural puncture headache: A review of current evidence

Table 3 Detailed efficacy and findings from included reviews

Ref.	Key focus	Main conclusion and finding	Key interventions with positive outcomes	Key interventions with no significant effect
Basurto Ona et al[15], 2015	Pharmacological treatment	However, evidence for the benefits was limited due to the small sample size and bias in the studies; some drugs were promising in reducing pain scores	Caffeine: Reduced PDPH persistence compared to placebo; gabapentin: Better VAS scores vs placebo/ergotamine; hydrocortisone: Better VAS scores than conventional treatment/placebo; theophylline: Better VAS scores than acetaminophen/conservative treatment	Sumatriptan and ACTH: No relevant effect on pain scores
Barati-Boldaji et al[16], 2023	Aminophylline/theophylline (Tx and prevention)	Therapeutic use significantly reduced pain scores (moderate evidence); prophylactic use did not significantly reduce the PDPH risk (very low evidence)	Aminophylline/theophylline: Effective for pain relief compared to placebo or conventional therapy	Aminophylline: Not effective for prevention
Chang et al[17], 2021	GON block (treatment)	GONB was effective for short-term pain relief at 1, 6, and 24 hours and reduced intervention failure	Greater occipital nerve block (GONB): Effective for pain relief; steroid co-administration may extend this effect	N/A
Giaccari et al[18], 2021	Nerve blocks (treatment)	Peripheral nerve blocks (SPG, GON, and LON) were effective, safe, and significantly reduced pain scores	SPG, GON, LON blocks: Effective analgesic options	N/A
Zhao et al[19], 2023	Pharmacological prevention (obstetric)	Propofol, ondansetron, and aminophylline were the most effective in reducing PDPH incidence; propofol and ondansetron also reduced PONV	Propofol (PPF), ondansetron (OND), and aminophylline (AMP) are effective; gabapentin/pregabalin (GBP/PGB): Effective at 48 hours	Dexamethasone, hydrocortisone: No superiority over placebo; no therapy reduced headache severity
Dwivedi et al[20], 2023	SPG block (treatment)	SPG block was effective for immediate, short-term pain relief (up to 6 hours) vs conservative treatment and lignocaine puffs	Transnasal SPG block: Effective for short-term relief	It was not superior to the sham or GON blocks; effects were not sustained beyond 6 hours
Alatni et al[3], 2024	Multi-modal (Tx and prevention)	Various effective strategies have been summarized, and EBP remains the gold standard; nerve blocks are effective and less invasive	Oral pregabalin and intravenous (IV) aminophylline are effective for the treatment and prevention of migraine headaches; IV Mannitol, IV hydrocortisone, neostigmine + atropine, SPG/GON blocks: Effective; fibrin glue, smaller needles: Effective prevention; EBP: Gold standard	Neuraxial morphine, epidural dexamethasone: Questionable for prevention

VAS: Visual analogue scale; GONB: Greater occipital nerve block; PDPH: Postdural puncture headache; ACTH: Adrenocorticotropic hormone; N/A: Not applicable; SPG: Sphenopalatine ganglion; LON: Lesser occipital nerve; PPF: Propofol; OND: Ondansetron; AMP: Aminophylline; GBP: Gabapentin; PGB: Pregabalin; PONV: Postoperative nausea and vomiting; EBP: Epidural blood patch.