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

Table 4 Consolidated efficacy summary of major postdural puncture headache interventions

Ref.	Intervention	Primary use	Efficacy for PDPH prevention	Efficacy for PDPH treatment	Key findings and notes	Common/notable side effects
Alatni et al[3], 2024; Barati-Boldaji et al[16], 2023	Aminophylline/theophylline	Treatment and prevention	Mixed (not recommended): A meta-analysis found no significant benefit of prophylaxis (very low evidence)	Effective (recommended): Significantly reduced pain scores (moderate evidence); this effect is enhanced when combined with dexamethasone	Considered a primary pharmacological option for treating established PDPH; the efficacy of prevention is not well supported	No significant adverse events were reported in the studies
Basurto Ona et al[15], 2015	Caffeine	Treatment	It is not typically used for prevention	Effective (recommended): Reduces the persistence of PDPH and the need for rescue interventions compared to placebo	A classic and well-established treatment for PDPH	Well tolerated; no major side effects were reported in the review
Alatni et al[3], 2024; Basurto Ona et al[15], 2015; Zhao et al[19], 2023	Gabapentin/pregabalin	Treatment and prevention	Effective (potential): Pregabalin has a preventive effect; gabapentin/pregabalin reduced incidence at 48 hours	Effective (recommended): Superior to placebo and ergotamine + caffeine in reducing pain scores over several days	Oral pregabalin has been highlighted as being particularly effective for both treatment and prevention	Generally well tolerated; sedation was mentioned but not quantitatively synthesized
Zhao et al[19], 2023	Ondansetron (OND)	Prevention	Effective (recommended): Significantly reduces the cumulative incidence of PDPH	Not assessed for treatment in these reviews	It also significantly reduces the incidence of postoperative nausea and vomiting (PONV)	It may induce migraine headaches in patients with a history of migraine (case reports)
Zhao et al[19], 2023	Propofol (PPF)	Prevention	Most effective (recommended): Ranked as the most effective prophylactic drug for reducing incidence	Not assessed for treatment in these reviews	Also significantly reduces the incidence of postoperative nausea and vomiting (PONV)	Sedation, diplopia, and tinnitus were mentioned in individual studies
Basurto Ona et al[15], 2015; Zhao et al[19], 2023	Corticosteroids (dexamethasone, hydrocortisone)	Treatment and prevention	Not effective: Dexamethasone did not show superiority in prevention (hydrocortisone did not show any significant prophylactic effects)	Effective for treatment: Hydrocortisone (IV) combined with conventional treatment led to better pain scores	Hydrocortisone is effective for treatment but not for prevention; the utility of dexamethasone remains questionable	No clinically significant adverse events were reported
Chang et al[17], 2021	Greater occipital nerve block (GONB)	Treatment	N/A	Effective (recommended): Provides significant short-term pain relief (1 hour, 6 hours, 24 hours) and reduces intervention failure	A feasible, less invasive alternative to EBP; steroid coadministration may prolong analgesic effects	No major adverse events were reported. Minor local discomfort
Dwivedi et al[20], 2023	Sphenopalatine ganglion block (SPGB)	Treatment	N/A	Effective (short-term): Superior to conservative care for immediate pain relief (up to 6 hours); not superior to sham or GONB	The effects are immediate but short-lived; it was not superior to the other nerve blocks	Nasal discomfort, throat numbness, and unpleasant taste (minor and transient)
Alatni et al[3], 2024	Epidural blood patch (EBP)	Treatment	N/A	Highly effective (gold standard): The ultimate solution for patients failing medical therapy	It rapidly decreases headache intensity; approximately 20% may require a second procedure; it is more invasive than pharmacological or nerve block options	Risks associated with neuraxial procedures (e.g., infection, repeat dural puncture)
Alatni et al[3], 2024	Fibrin glue	Prevention	Effective (promising): Significantly reduced PDPH incidence and duration in the reviewed evidence	N/A	A novel preventive strategy has been noted for its promising safety and affordability	Not explicitly stated; however, the reviewed evidence noted a good safety profile

PDPH: Postdural puncture headache; OND: Ondansetron; PPF: Propofol; PONV: Postoperative nausea and vomiting; N/A: Not applicable; GONB: Greater occipital nerve block; EBP: Epidural blood patch; SPG: Sphenopalatine ganglion; SPGB: Sphenopalatine ganglion block.