Supraorbital and sphenopalatine-ganglion stimulation

Domain IX · Biomedical, neuro & digital · 2012

What it is

What these are. These are two neuromodulation devices for primary headache disorders. In both, a neurologist or headache service, not the psychotherapist, prescribes, implants, supervises or recommends the device.

Format

• Team's tasks: diagnosis, patient selection (migraine expertise for e-TNS; a multidisciplinary refractory-headache team for SPG stimulation), written information, and consent that covers uncertainty and other options.
• Format: usually 1–3 sessions on top of existing therapy.

Who practises it, and how they are trained or regulated

• Version followed: the official regulatory and guidance descriptions as of October 2026. For external trigeminal (supraorbital) stimulation these are the FDA De Novo authorisation of March 2014 and the FDA 510(k) clearance of Cefaly Dual for over-the-counter use, K201895 (29 September 2020), plus NICE IPG740 (26 October 2022). For sphenopalatine ganglion (SPG) stimulation they are NICE IPG527 (26 June 2015) and its…
• Regulatory status (checked October 2026).

Evidence status, as the guide reports it

• SPG stimulation: the implant operation, then a period when most adverse events appear. In the NICE evidence most occurred within 30 days and usually resolved.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Stopping or overusing in secret. Shame about 'not doing it right'.
• Diary keeping that turns into hypervigilance about pain. Shorten the diary if this happens.
• All-or-nothing hopes ('this is my last chance'). Commercial claims treated as established fact.
• Clients who minimise side effects to avoid losing the device. Mood dropping when relief is less than hoped.
• Use that goes beyond the labelling. Use of the device instead of seeking care for a new or changed headache.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.