Assessment of the Efficacy of the Transnasal Sphenopalatine Ganglion Block in the Treatment of Chronic Daily Headache in Children and Adolescents.

using a Questionnaire that includes the following : Numerical Rating Scale (NRS), patients are asked to circle the number between 0 and 10, that fits best to their pain intensity . Zero usually represents 'no pain at all' whereas the upper limit represents 'the worst pain ever possible.

Patient Global Impression of Change scale ( PGIC) is a rating scale offered through a questionnaire that is most commonly used in clinically important changes after treatments and it has been used extensively in studies of musculoskeletal conditions. The patient is asked to describe changes in limitation, symptoms, emotions and overall quality of life related to the treatment received. Below is the scale that will be used:

1. 'no change or condition got worse' = 0%;
2. 'almost the same, hardly any change at all'=17%;
3. 'a little better, but no noticeable change'=34%;
4. 'somewhat better, but the change has not made any real difference'=50%;
5. 'moderately better, and a slight but noticeable change' = 67%;
6. 'better and definite improvement that has made a real and worthwhile difference

Measure Yourself Medical Outcome Profile (MYMOP2 ) is a 'patient-centred' outcome scale where patients are asked to nominate one or two symptoms (physical or mental) of a specific problem they need assistance with and consider the severity of these symptoms over the last week.

Aims to measure the outcomes that the patient considers the most important. The patient chooses one or two symptoms for which they are seeking help and that they consider most important. They also choose an activity of daily living that is limited or prevented by these symptoms. These choices are written down in the patient's own words and the patient scores them for severity over the past week on a seven-point scale. Lastly, wellbeing is scored on a similar scale. On follow-up questionnaires, the wording of the previously chosen symptoms is unchanged. Follow-up questionnaires will be admin

Functional Disability Inventory (FDI) was developed to measure physical functioning in school-aged children and adolescents. This measure relates to the ability to perform a range of everyday physical activities and has been well-established with different populations.

The total FDI score is a sum of all of the items. Clinical reference points were developed to identify 3 categories of disability in pediatric chronic pain:

• no/minimal disability (0 -12)
• moderate disability (13-29)
• severe disability (>30)

Pediatric Migraine Disability Assessment (PedMIDAS) was developed to assess migraine disability in pediatric and adolescent patients

It has been tested and validated for ages 4 to 18. The score is a simple composite of the total of six questions. If a range is provided, use the high end of the range or ask the family to provide a single number - both methods show equal validity. If the answer is blank or is a phrase (i.e., "few" or "couple"), they need to be asked to provide a number. The PedMIDAS grading scale is as follows:

• Little or none disability (0-10)
• Mild disability (11-30)
• Moderate disability (31-50)
• Severe disability (>50)

Pittsburgh Sleep Quality Index (PSQI) We evaluate sleep quality using PSQI. The scale counts 19 items assessing sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medications, and daytime dysfunction. Point values of each item in of the seven subscales are summed and then combined as indicated to generate a subscale score. These totals are summed to create the global PSQI score. Scores range from 0-5 indicates good quality of sleep.

Patients will be encouraged to continue with their previous treatments and will not be asked to stop taking any medications in order to participate in this study. However, they will be allowed to reduce the doses or, eventually, to stop the use of analgesic medication under medical supervision.

The number and class of analgesics taken will be collected at baseline, at the end of the treatment, and 1 and 3 months after the end of the treatment.

The less the Analgesics medications used the Better .