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Background and Aims Sphenopalatine ganglion block (SPGB) is normally used in post dural puncture headache treatment to avoid epidural blood patch (EBP). THE SPGB is a non-invasive intervention, safe and well-tolerated treatment. We describe a woman with post-traumatic bilateral frontal and a nuchal headache present in upright position and not in the reclining position for three months. The patient received four treatment of SPGB.

Methods The patient agreed to use her clinical dati. We describe the case of L.F., 33 year old Moroccan woman, with post-traumatic bilateral frontal and nuchal headache secondary to subdural hematoma and epidural cerebrospinal fluid collection from C2 to L3. The patient received SPGB every seven days. We used the SphenoCath device. SphenoCath was inserted into a single nostril and advanced to antero-superior nasal cavity. Two milliliters of 2% lidocaine was injected via the SphenoCath, then the catheter was removed.

Results After 5 minutes of SPGB, the patient was asked to sit up and presence of headache was assessed using numeric pain score (NRS) ( 0-no pain to 10–worst pain). The third block was performed with complete relief and without further recurrence. The first and second blocks however reduced the intensity of the pain. We still decided to do a fourth block.

Conclusions The role of the SPG block has come in the limelight in recent years. A blockade of SPG prevents activation of the trigeminal-autonomic reflex, blocking vasodilation peptides and the resultant neurogenic inflammation . These case highlight the effectiveness and safety of SPGB on immediate and sustained pain relief.