BACKGROUND: The sphenopalatine ganglion (SPG) plays a pivotal role in the modulation of craniofacial pain. SPG blocks have been explored for various headache types; however, their efficacy in subarachnoid hemorrhage (SAH)-associated headaches remains underreported.

CASE REPORT: A 26-year-old woman with a history of chronic migraine and B-cell acute lymphoblastic leukemia presented with severe holocranial headache and focal seizures following a central nervous system relapse and thrombocytopenia-induced bihemispheric SAH. Initial pharmacological management included hydromorphone, pregabalin, and amitriptyline. A bilateral transnasal SPG block was performed, followed by a fluoroscopy-guided SPG block, resulting in a significant reduction in pain intensity, from a numeric rating scale score of 10/10 to 3/10.

CONCLUSIONS: SPG blocks show promising potential in the management of persistent headaches following SAH. An initial noninvasive transnasal approach, followed by more invasive techniques when necessary, may provide substantial pain relief and improve patient quality of life. Further research is needed to validate these findings and optimize treatment protocols.

KEYWORDS: Sphenopalatine ganglion block, pain management, secondary headaches, subarachnoid hemorrhage