A block of the cervical sympathetic chain in the lower neck, performed under ultrasound. Used where the sympathetic nervous system is driving head, face or upper-limb pain.
What the stellate ganglion is
The stellate ganglion is a collection of sympathetic nerve cell bodies at the base of the neck, around the sixth and seventh cervical vertebrae. It supplies sympathetic innervation to the head, neck, and arm. Blocking it interrupts that outflow temporarily.
What it is used for here
- Cluster headache and other trigeminal autonomic headaches, where sympathetic involvement is part of the syndrome.
- Complex regional pain syndrome of the upper limb, and other sympathetically maintained pain.
- Persistent facial pain that has not responded to a trigeminal block.
Why ultrasound matters here
The target sits among the carotid artery, the internal jugular vein, the vertebral artery, the thyroid and the oesophagus. A landmark-only technique cannot see any of them. Ultrasound shows the vessels and the soft tissue in real time and lets the needle be steered around them, which is why it has become the standard approach for this block.
What to expect afterwards
A successful block produces a set of temporary, expected signs on the treated side: a drooping eyelid, a smaller pupil, a warm flushed face, nasal congestion and a bloodshot eye. Together these are called Horner’s syndrome, and rather than being a complication they are the confirmation that the block worked. They wear off with the anesthetic.
Hoarseness and a lump-in-the-throat sensation are common for a few hours. You should not eat or drink until that has resolved.