New migraine procedure SphenoCath proving effective for some

is a neurological disorder affecting approximately one billion people worldwide. While many cases can be managed with lifestyle changes and oral medications, a significant proportion of people with experience inadequate relief from standard treatments. A growing range of procedures and specialist options are now available, offering hope for those with refractory or chronic migraine.

First-Line Oral Treatments

Before considering procedural options, standard treatments should be optimised:

• Acute treatments: simple analgesics (paracetamol, , aspirin) for mild attacks; triptans (sumatriptan, rizatriptan, zolmitriptan) for moderate-to-severe attacks. CGRP receptor antagonists (gepants: ubrogepant, rimegepant) are a newer acute option with no risk of medication-overuse .
• Preventive treatments: beta-blockers (propranolol, metoprolol), anticonvulsants (topiramate, valproate), tricyclics (amitriptyline), and CGRP monoclonal antibodies (erenumab, fremanezumab, galcanezumab) for those with four or more migraine days per month.

The Sphenopalatine Ganglion Block (SPG Block)

The sphenopalatine ganglion (SPG) is a nerve cluster located behind the nasal cavity that plays a role in migraine pain transmission. SPG blocks deliver local anaesthetic to this ganglion to interrupt pain signals. The SphenoCath is a device that allows SPG block delivery through the nostril without a needle — a small catheter is inserted along the floor of the nose to the SPG site and a small volume of anaesthetic is instilled. The procedure takes approximately five to ten minutes and can be performed in an outpatient setting.

Clinical studies suggest that SPG block via SphenoCath or similar devices provides significant pain reduction for a proportion of patients with acute migraine and may reduce attack frequency when repeated over several sessions. It is not effective for all patients, and results vary. It is generally considered after adequate trials of standard oral treatments.

Clinical guidance from NIH^[1] stresses matching home care to symptom severity and seeking urgent review when red-flag signs appear.

Botulinum Toxin (Botox) Injections

OnabotulinumtoxinA (Botox) is approved for chronic migraine (15 or more days per month) in many countries. Approximately 31 injections are administered across the head and neck every 12 weeks. Approximately half of eligible patients experience a significant reduction in days. It is well tolerated and can be continued indefinitely as long as benefit is maintained.

Neuromodulation Devices

• Transcranial magnetic stimulation (TMS): a hand-held device that delivers a magnetic pulse to the occipital cortex. Approved for both acute and preventive in some countries.
• Transcutaneous supraorbital neurostimulation (Cefaly): a forehead electrode device providing electrical stimulation of the supraorbital nerve. Available for both prevention and acute treatment.
• Non-invasive vagus nerve stimulation (gammaCore): neck stimulator with evidence for cluster headache and some data in migraine.

For verification and deeper reading, Mayo Clinic^[2] offers independent, evidence-based information you can cross-check with your own clinician.

When to Seek Specialist Review

• More than four migraine days per month
• Two or more adequate oral treatments have failed
• Overuse of acute medications (more than 10 days per month)
• Migraine significantly affecting work, study, or quality of life