Diagnosis: Chronic Migraine
Treatment: Sphenopalatine ganglion (SPG) blocks
The insurer denied Sphenopalatine ganglion (SPG) blocks.
The determination is upheld.

This is a male patient with chronic migraines. The patient is not currently on a Food and Drug Administration (FDA) approved preventative therapy for migraine prevention. Sphenopalatine ganglion (SPG) blocks are requested for acute treatment of migraine. At issue is whether outpatient SPG (Sphenopalatine Ganglion block) is likely to be more beneficial than any standard treatment or treatments for the insured's life threatening or disabling condition or disease.

Large controlled trials or perspective studies are lacking to demonstrate the efficacy of sphenopalatine ganglion blocks for treatment of acute and/or chronic migraine. SPG blocks have not been compared to Food and Drug Administration (FDA) approved therapies such as analgesics, triptans, ditans for treatment of acute migraine. Thus, it cannot be stated that the SPG block is more beneficial than any standard treatment for the member's condition. Additionally, there is no literature supporting the proposed treatment plan for SPG blocks for three days in a row.

It is noted that the patient has tried and failed sumatriptan, naratriptan, and zolmitriptan. The member has had a partial response to rizatriptan. The patient has not tried and failed frovatriptan, eletriptan, or almotriptan. There is no documentation that the patient has tried and failed ergotamines, which are also approved for treatment of acute migraine. The patient has tried and failed the gepants, Ubrelvy and Nurtec oral disintegrating tablet (ODT). There is not documentation that the member has tried and failed Reyvow, a ditan drug that is FDA approved for treatment of acute migraine. Thus, it cannot be said that treatment with SPG blocks is likely to be more beneficial for treatment of the member's condition than FDA approved medications.