Patient Position: Supine.

Indications: Pain syndromes involving the face and head including sphenopalatine neuralgia, sympathetically maintained pain, trigeminal neuralgia, migraine headaches, cluster headaches, atypical facial pain, cancer pain.

Needle Size: 21-gauge, 100-mm b-beveled needle or 20-gauge curved, blunt, 5-mm active tip, Racz-Finch Kit (RFK needle Radionics, Burlington, MA) is preferred; 16-gauge, 1.25-inch angiocatheter (introducer).

Medications: 1 to 2 mL of 2% lidocaine, 0.2% ropivacaine, 0.25% bupivacaine, or 0.25% levobupivacaine with or without 40 mg triamcinolone diacetate, 40 mg methylprednisolone, or 4 mg dexamethasone.

Anatomic Landmarks: The sphenopalatine ganglion lies in the pterygopalatine fossa adjacent to the middle turbinate.