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Table 1 Summary of evidence level and grade of recommendation for SPG block, radiofrequency ablation and neurostimulation

From: Sphenopalatine ganglion: block, radiofrequency ablation and neurostimulation - a systematic review

Medical condition Application/ Medication used in controlled studies Number of controlled studies Highest level of evidence Grade of recommendation
SPG block
 Cluster headache Cotton swab/cocaine or lidocaine 1 2b B
 Second-division trigeminal neuralgia Lidocaine spray 1 2b B
 Reducing the needs of analgesics after endoscopic sinus surgery Needle injection, transnasal and palatal approach/lidocaine,bupivacaine, levobupivacaine, tetracaine 6 1b B
 Reducing the pain associated with nasal packing removal after nasal operation Needle injection, infrazygomatic approach/lidocaine 1 3b B
 Migraine Tx360 device/ bupivicane 1 2b B
 Postdural puncture headache, sphenopalatine maxillary neuralgia, facial neuralgia, sympathetic neuralgia, post-traumatic atypical facial pain, atypical odontalgia, pain from midline granuloma, herpetic keratitis, hemifacial headache,paroxysmal hemicrania, nasal pain, hemicrania continua, trigeminal neuropathy, cancer pain, seizures associated nasal pathology, arthritic pain and muscle spasm, intercostal neuritis, persistent hiccups, ureteral colic, dysmenorrhea, peripheral painful vascular spasm, complex regional pain syndrome and hypertension Various protocols 0 4 C
 Myofascial pain Cotton-tipped applicator, nasal spray/lidocaine 2 2b Not recommended
SPG radiofrequency ablation
 Cluster headache Infrazygomatic approach/80 °C, 60s ×2 0 (1 cohort study) 2b B
 Sluder’s neuralgia, posttraumatic headache, chronic head and face pain, atypical trigeminal neuralgia, atypical facial pain, chronic facial pain secondary to cavernous sinus meningioma, trigeminal neuralgia, SPG neuralgia due to herpes zoster Various protocols 0 4 C
SPG neurostimulation
 Cluster headache Customized to each patient, mean frequency 120.4 ± 15.5 Hz, pulse width 389.7 ± 75.4 μs, intensity 1.6 ± 0.8 mA 1 1b B
 Idiopathic facial pain, migraine Various protocols 0 4 C