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Background and Aims Post-dural puncture headache (PDPH) is a feared complication of neuraxial anaesthesia that limits patients` postoperative mobility and ability to follow daily activities due to significant discomfort, which often leads to a prolonged hospital stay. Treatment for PDPH is sometimes challenging. Use of an epidural blood patch is the gold standard but sphenopalatine ganglion block (SPGB) is a less invasive technique with similar capacity for pain relief.

Methods A 29-year-old female patient received a lumbar epidural catheter for spontaneous birth and on the same day presented with typical symptoms of PDPH. Under conservative treatment with paracetamol, ibuprofen and caffeine, the pain (NRS score 6/10) was still persistent. Nevertheless, she was dismissed home on her own request the next day. Three days later she presented again with persistent pain (NRS score 8/10). An intranasal SPGB was performed using swabs and 2% lidocaine, which resulted in immediate pain reduction (NRS 3/10). However, six hours later the pain returned (NRS 6/10). Another intranasal SPGB was performed using a mucosal atomization device (MAD) and 2% lidocaine, which again resulted in pain reduction (NRS 3/10). Further SPGB was refused and a blood patch was successfully performed, leading to total pain relief (NRS 0/10).

Results SPGB reduced the pain intensity but was not completely successful. However, whether this was due to the lidocaine concentration used or the delayed time of application remains unclear.

Conclusions SPGB is a viable non-invasive bedside technique that provides good pain relief. Immediate performance of SPGB using 2–4% lidocaine seems to be the most promising strategy.