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Sphenopalatine Ganglion Stimulation - for cluster headache that has stopped responding.

For chronic and refractory cluster headache. SPG blocks as first step, SPG stimulator implantation for the right candidates. Consultant headache neurologist, MDT decision, image-guided procedure - never a shot in the dark.

See indicative pricing
A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Indicative pricing

What SPG procedures cost privately in the UK.

Indicative ranges across our headache-neurology and neuromodulation network.

In short

An image-guided SPG block: £1,600–£3,200, day-case, with same-week diary review.

Procedure Indicative range
Headache neurology consultation £350–£550
MRI brain (headache protocol) £400–£750
SPG block (image-guided) £1,600–£3,200
Series of 3 SPG blocks £4,200–£8,500
Radiofrequency SPG lesion £3,500–£6,500
SPG stimulator implantation £28,000–£45,000
Device programming session £220–£450

Prices vary by clinic, imaging modality (fluoroscopy vs CT), whether steroid is added, and whether stimulator implantation is included. Stimulator implantation ranges reflect device costs.

The problem

The right diagnosis, the right sequence, and no shortcuts.

SPG procedures are only for cluster headache that has genuinely failed proper medical treatment. We start with a headache-neurology review, then work through the sequence.

  • Diagnosis first, procedure last

    Not every one-sided headache is a cluster. A headache neurologist confirms the diagnosis before any injection or implant.

  • Medical ladder before neuromodulation

    Verapamil, lithium, oxygen and sumatriptan are tried at proper doses first. SPG procedures are for genuine failure, not intolerance to trying.

  • MDT decision for the stimulator

    Implantation is discussed at MDT - neurology, neurosurgery or pain, and psychology - because the device is with you for years.

When it helps

When SPG stimulation is the right step.

The situations we see most, plus the red flags that mean this is not the right treatment yet - or ever.

  • Chronic cluster headache

    Attacks for more than a year without remission of at least three months, on maximum verapamil.

  • Episodic cluster in a long bout

    A prolonged bout not responding to prednisolone taper and standard abortives - SPG block as a bridge.

  • Verapamil intolerance

    Cardiac side effects (bradycardia, hypotension) blocking effective doses - SPG procedures as alternative preventer strategy.

  • Sumatriptan overuse

    Where high-frequency sumatriptan use is unsustainable and oxygen is not enough - SPG block or stimulator to reduce reliance.

  • Refractory hemicrania continua

    Off-label use where indomethacin is not tolerated or does not fully work.

  • Paroxysmal hemicrania

    Off-label option where indomethacin fails or is contraindicated.

  • After failed occipital nerve stimulation

    Occasionally offered where occipital nerve stimulation has been tried and failed.

  • Red flag: new one-sided headache with red flags

    A brand-new headache with fever, weight loss, jaw claudication, visual loss, or neurological signs needs urgent workup - not an SPG referral.

Options

SPG block, radiofrequency, or implanted stimulator - different tools.

What each option involves - awake block, radiofrequency lesion, or full implantable stimulator with hand-held activator.

  • Transnasal SPG block

    Local anaesthetic applied to the mucosa overlying the ganglion via a nasal catheter - awake, no imaging, quick.

  • Fluoroscopy-guided infra-zygomatic block

    A fine needle passed under the zygomatic arch to the ganglion under X-ray guidance - the workhorse block.

  • CT-guided block

    Higher precision for anatomically difficult cases - same principle as fluoroscopy but more anatomical detail.

  • Radiofrequency SPG lesion

    A heat lesion applied to the ganglion under image guidance - longer-lasting than a block, more involved.

  • Pulsed radiofrequency

    A gentler radiofrequency technique aimed at modulating rather than lesioning the ganglion.

  • Miniature implanted stimulator

    A small electrode placed at the ganglion via a keyhole intra-oral or infra-zygomatic approach under GA, activated by a hand-held remote.

  • Botulinum toxin (off-label at SPG)

    Rare but occasionally used in refractory cluster in specialist centres.

  • Combined with medical treatment

    SPG procedures are never a replacement for good medical treatment - verapamil, lithium, oxygen and triptans continue alongside.

Safety and recovery

What to expect afterwards - honestly.

SPG blocks are established and safe. Stimulator implantation is more involved - proper MDT, device counselling and long-term follow-up matter.

  • Blocks are usually low risk

    The commonest side effects are a brief bad taste, mild epistaxis, and short-lived numbness. Serious complications are rare.

  • Steroid where added carries small risk

    Rare local infection, transient blood-sugar rise, occasional flushing. We keep steroid to minimum useful doses.

  • Radiofrequency lesions can cause numbness

    A patch of numbness in the palate or upper cheek is not uncommon after lesioning - usually settles within weeks.

  • Stimulator implantation is real surgery

    GA, incisions, bleeding and infection risk. Device revision is not unusual over the years - plan for follow-up.

  • Response is not guaranteed

    Best estimates: around 60% of well-selected cluster patients get meaningful benefit from SPG procedures. That leaves 40% who do not.

  • Medical management continues

    Verapamil, lithium, oxygen and triptans stay in the picture. SPG procedures reduce reliance, not eliminate it.

  • Device programming takes time

    Getting the best stimulation settings can take several months of adjustment. Expect follow-up visits.

  • Battery and hardware issues

    Externally powered devices avoid battery replacements. Lead fractures and infections are uncommon but real.

  • Red flags after any procedure

    Sudden severe pain, fever, new neurological signs or visual loss need same-day review, not the next diary appointment.

Reading your notes

Your procedure note in four parts. Read the last one first.

Whether you had a block, a radiofrequency lesion or a stimulator implanted, the note keeps to the same shape.

A UK headache neurologist reviewing an SPG procedure note

A quiet reminder

Clinical language is precise - we translate it if you would like.

If you would like us to talk you through your notes before your review, just ask.

  1. 01 Header

    Diagnosis, indication and MDT decision

    Confirmed diagnosis, medications previously tried, and - for stimulator - the MDT recommendation.

  2. 02 Procedure

    Approach, imaging and technique

    Route (transnasal, infra-zygomatic, intra-oral), imaging modality, drugs used or device implanted.

  3. 03 Response

    Immediate effect and complications

    Attack aborted or not, side effects, any complication and its management.

  4. 04 Plan

    Programming, medications and follow-up

    Read this first: your programming schedule, ongoing medication plan, and next diary review.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

SPG procedures are often covered when medically indicated and after MDT approval. Stimulator devices sometimes need pre-authorisation.

Frequently asked

Everything patients ask about SPG procedures.

Quick answers on eligibility, evidence, cost, cover and recovery.

  • Who is a candidate for SPG stimulation?

    Adults with confirmed chronic or refractory cluster headache who have properly tried verapamil, lithium, high-flow oxygen and sumatriptan without adequate benefit. Diagnosis is by a headache neurologist, and stimulator implantation is only offered after MDT review.

  • What is the difference between an SPG block and SPG stimulation?

    A block is a one-off injection of local anaesthetic - sometimes with steroid - at the ganglion. It is diagnostic and short-term. SPG stimulation is a permanently implanted electrode you activate with a hand-held remote when an attack starts, giving durable, on-demand control.

  • How much does SPG treatment cost privately in the UK?

    An image-guided SPG block runs £1,600–£3,200; a series of three costs £4,200–£8,500. Radiofrequency lesions run £3,500–£6,500. Full SPG stimulator implantation runs £28,000–£45,000 including device costs.

  • Does NHS offer SPG stimulation?

    NHS access is limited to a small number of specialist headache centres and is decided case-by-case through headache MDT. Private access is faster and offers the same technology, but should still be reserved for genuinely refractory cluster headache.

  • How effective is SPG stimulation for cluster headache?

    The best data show around 60% of well-selected chronic cluster patients get clinically meaningful pain relief, with reduced attack frequency for many. It is not a cure, and it does not replace medical treatment - but for the right patient it is life-changing.

  • What is recovery like after implantation?

    Most patients go home the same day or after one night. There is often localised facial swelling and bruising for 1–2 weeks. Full activity in 4 weeks. Programming and refinement takes 3–6 months of periodic clinic visits.

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