PONOS CLINIC · SPECIALIST PAIN CARE
Sphenopalatine ganglion (SPG)
Indications and specialist care pathway.
From clinical assessment to diagnostic tests and, in selected cases, neuromodulation. Transmucosal test · Imaging · Pulsed radiofrequency
Request an assessmentThe care pathwayView the full image
What is the sphenopalatine ganglion?
The sphenopalatine ganglion (SPG), also known as the pterygopalatine ganglion, lies within the pterygopalatine fossa, deep behind the facial skeleton. It is a parasympathetic ganglion closely connected to the maxillary division (V2) of the trigeminal nerve.
Connections between the trigeminal system and autonomic pathways help explain why some headache disorders combine pain with tearing and nasal congestion. These symptoms alone, however, do not establish an indication for treatment.
The first step is to define the diagnosis and distinguish between the different forms of trigeminal and craniofacial pain.
A real procedure
Pulsed radiofrequency neuromodulation of the sphenopalatine ganglion, performed under fluoroscopic guidance in a selected case.
The dedicated page describes technique, selection criteria, risks and follow-up without conflating these with the diagnostic pathway outlined here.
Learn more about pulsed radiofrequency →When the SPG enters the clinical pathway
The SPG is considered only when the diagnosis and clinical picture suggest a possible role for trigeminal-autonomic pathways. It is not a first-line treatment and not every form of facial pain is an indication for intervention.
Features that may justify SPG assessment
- persistent or refractory craniofacial pain
- autonomic features associated with the pain
- failure of or intolerance to appropriate treatments
- a clinical pattern compatible with possible SPG involvement
Features that are not sufficient on their own
- tearing or nasal congestion alone
- a generic diagnosis of “facial pain”
- a single transient response to a block
- the mere availability of an interventional technique
PONOS Clinic
Clinical experience
Assessment of the sphenopalatine ganglion at PONOS Clinic is carried out by Dr Evangelos Panagiotakos MD, anaesthetist and interventional pain specialist.
The assessment integrates clinical history, available documentation, attack pattern, treatments already tried and, when indicated, diagnostic tests and dedicated imaging.
Procedural experience does not replace patient selection: the diagnosis determines whether the SPG represents a plausible target.
SPG pathway map
A progressive pathway in which each step is used only when it adds clinically useful information.
Clinical evaluation
Diagnosis, pain characteristics, previous treatments, available documentation and possible features of trigeminal-autonomic involvement.
Transmucosal test
A local anaesthetic test may be used to observe the clinical response. It is not a stand-alone diagnosis and does not reliably predict the outcome of later procedures.
Imaging and anatomy
Available imaging is reviewed before any percutaneous approach. Dedicated CT imaging is considered only when it provides useful anatomical information for planning.
Neuromodulation and follow-up
In selected patients, pulsed radiofrequency under image guidance may be considered, followed by clinical reassessment. Learn more.
Scientific references
Selected references for further reading on the anatomical rationale and interventional techniques discussed on this page.
- Ho KWD, Przkora R, Kumar S. Sphenopalatine ganglion: block, radiofrequency ablation and neurostimulation – a systematic review. J Headache Pain. 2017;18:118. (Systematic review)
- Tolba R, Weiss AL, Denis DJ. Sphenopalatine Ganglion Block and Radiofrequency Ablation: Technical Notes and Efficacy. Ochsner J. 2019;19:32–37. (Technical review)
- May A et al. European Academy of Neurology guidelines on the treatment of cluster headache. Eur J Neurol. 2023;30:2955–2979. (Guideline)
These references cover different techniques and populations. Evidence relating to nerve blocks, radiofrequency and neurostimulation should not be treated as interchangeable.
Frequently asked questions
Are tearing and nasal congestion enough to indicate treatment?
No. Autonomic symptoms must be interpreted alongside the diagnosis, clinical history and response to appropriate treatments.
Does the transmucosal test guarantee the result of radiofrequency?
No. It provides clinical information that must be interpreted in context; it does not reliably predict the outcome of subsequent procedures.
Is a CT scan always necessary?
No. Imaging is selected according to individual anatomy and the information needed for planning.