Stellate Ganglion Block for Long COVID: What the Research Shows

Long COVID continues to affect millions of people worldwide, with symptoms that can persist for months or even years after the initial infection. Fatigue, brain fog, headaches, dizziness, and sleep disruption are among the most common complaints, and for many patients, standard treatments have provided limited relief. As researchers look for better solutions, the stellate ganglion block (SGB) has emerged as one of the more promising options being studied for long COVID symptom management.

Schedule a consultation at Kentuckiana Pain Specialists to discuss whether stellate ganglion block may help with your long COVID symptoms.

At Kentuckiana Pain Specialists, Dr. Ajith Nair has been performing stellate ganglion blocks for decades as part of the practice’s pain management programs. The clinic offers a dedicated Post-COVID Symptom Relief program using SGB. This article reviews the current clinical research on SGB for long COVID, explains why researchers believe it works, and helps you understand what the evidence says so far.

What Is a Stellate Ganglion Block?

A stellate ganglion block is an injection of local anesthetic near the stellate ganglion, a cluster of sympathetic nerves located on either side of the neck at the level of the sixth and seventh cervical vertebrae. These nerves are part of the body’s sympathetic nervous system, which controls involuntary functions like heart rate, blood vessel constriction, sweating, and the “fight or flight” stress response.

When a local anesthetic is injected around the stellate ganglion, it temporarily blocks sympathetic nerve signals in the head, neck, arms, and upper chest. The procedure takes about 15 minutes and is performed using ultrasound or fluoroscopic guidance for precision. SGB has been used safely in pain management since the 1920s, originally to treat conditions like complex regional pain syndrome (CRPS), phantom limb pain, and vascular disorders. Its application to long COVID is newer, but the procedure itself is well established. You can learn more about how SGB works and signs of a successful block in our related guide.

Why Researchers Think SGB May Help Long COVID

The connection between SGB and long COVID centers on a concept called sympathetic nervous system dysregulation, also known as autonomic dysfunction. Many researchers now believe that SARS-CoV-2 infection can leave the sympathetic nervous system in a state of chronic overactivation. This “stuck in overdrive” state may explain many of the persistent symptoms that define long COVID.

When the sympathetic nervous system stays activated beyond the initial infection, it can cause a cascade of problems:

• Elevated heart rate and blood pressure fluctuations (often diagnosed as POTS, or postural orthostatic tachycardia syndrome)
• Chronic fatigue as the body expends energy maintaining a heightened stress response
• Brain fog and difficulty concentrating due to altered blood flow and neuroinflammation
• Sleep disruption from an inability to shift into a relaxed parasympathetic state
• Gastrointestinal changes including nausea and appetite disturbances

The theory behind SGB for long COVID is that temporarily blocking the stellate ganglion can “reset” the overactive sympathetic response. By interrupting the dysfunctional nerve signaling, SGB may allow the nervous system to return to a more balanced state. A 2026 systematic review published in Current Pain and Headache Reports noted that clinicians should consider SGB as an option “particularly for individuals with prominent autonomic dysfunction, such as tachycardia, dizziness, dyspnea, gastrointestinal changes, and brain fog.”

What the Clinical Studies Show

Research on SGB for long COVID is still in its early stages, but several studies have reported encouraging results. Here is a summary of the key findings published through 2025.

Systematic Review of Seven Studies (2026)

The most recent overview is a systematic review published in April 2026 in Current Pain and Headache Reports. Researchers at Temple University searched two major medical databases and identified seven studies that met their inclusion criteria. The review found consistent short-term improvements across multiple symptom areas, including fatigue, cognitive dysfunction, sleep disruption, and pain. The authors concluded that “stellate ganglion block is a promising treatment that appears to generate substantive benefit for many of the symptoms seen in long COVID.”

The review also noted important limitations: the studies had small sample sizes, lacked control groups, and used different follow-up periods. The researchers emphasized the need for larger, randomized controlled trials to establish long-term effectiveness.

Retrospective Cohort Study: 52 Patients (2025)

A retrospective cohort study from Boston examined 52 patients with long COVID (also called post-acute sequelae of SARS-CoV-2, or PASC) who received SGB between September 2022 and September 2024. On average, patients underwent three SGB injections. The study found that most patients reported improvement in their long COVID symptoms after treatment. The symptoms that showed the most improvement were brain fog, fatigue, dizziness, and headache. About one quarter of patients reported at least one side effect, though these were mostly short-lived.

Pilot Study: Effectiveness and Safety (2024)

A pilot study published in the Psychopharmacology Bulletin in 2024 by Levey and colleagues examined the effectiveness and safety of SGB in patients with long COVID. The study found that SGB treatment was associated with meaningful symptom reduction and was well-tolerated. While the sample size was small, the results were consistent with findings from other groups and helped build the case for larger trials.

Autonomic Neuroscience Chart Review (2024)

A retrospective chart review published in Autonomic Neuroscience in August 2024 documented reductions in long COVID symptoms after SGB. The study specifically tracked changes in fatigue, cognitive function, and autonomic symptoms. Results showed measurable improvement in most patients, adding to the growing body of evidence supporting SGB as a treatment option for this population.

Considering SGB for your long COVID symptoms? Contact Kentuckiana Pain Specialists to learn about the Post-COVID Symptom Relief program.

Which Long COVID Symptoms May Respond to SGB?

Based on the studies published so far, the following symptoms have shown the most consistent improvement after stellate ganglion block:

Symptom Category	Specific Symptoms	Evidence Level
Cognitive	Brain fog, difficulty concentrating, memory problems	Reported in multiple studies; among the most commonly improved symptoms
Fatigue	Chronic fatigue, exercise intolerance, post-exertional malaise	Consistently reported across studies; frequently cited as top-improving symptom
Autonomic	Dizziness, heart rate changes, POTS-like symptoms	Strong theoretical basis; improvement reported in chart reviews and cohort studies
Neurological	Headaches, sleep disruption	Reported in systematic review and individual studies
Pain	Generalized body pain, nerve-related pain	SGB has a long track record for pain conditions; improvement reported for long COVID pain
Gastrointestinal	Nausea, appetite changes	Noted in studies tracking autonomic dysfunction improvements

Not every patient experiences improvement in every symptom, and the duration of relief varies. Some patients report lasting improvement after a single injection, while others benefit from a series of two to three blocks spaced one to two weeks apart. Researchers are still working to identify which patient subgroups are most likely to benefit. Patients with prominent autonomic dysfunction symptoms appear to be the strongest candidates based on current evidence.

What to Expect During the SGB Procedure

If you decide to try SGB for long COVID, the procedure is straightforward and performed on an outpatient basis. At Kentuckiana Pain Specialists, the process follows these steps:

1. Evaluation: Dr. Nair reviews your medical history, COVID history, and current symptoms. Not all long COVID patients are candidates for SGB, so a thorough assessment is part of the process.
2. Preparation: You will be positioned comfortably, and the skin over your neck is cleaned. The procedure area is numbed with a small amount of local anesthetic.
3. Guided injection: Using ultrasound or fluoroscopy for precision, the doctor places a thin needle near the stellate ganglion and injects local anesthetic. The injection itself takes about one minute.
4. Observation period: You rest in the clinic for 15 to 30 minutes. It is normal to notice some temporary changes on the treated side of your face, including a droopy eyelid, a smaller pupil, and reduced sweating. These are expected signs that the block reached the right nerves, and they typically resolve within four to eight hours.
5. Follow-up: Most patients can return to normal activities the same day. Your doctor will schedule a follow-up to evaluate your response and determine whether additional injections would be beneficial.

You can read more about the typical timeline and expected duration of relief in our article on how long a stellate ganglion block lasts.

Safety and Side Effects

SGB has a long safety record spanning over a century of clinical use. The most common side effects are temporary and expected. They include the Horner’s syndrome signs mentioned above (droopy eyelid, smaller pupil, reduced sweating on one side of the face), hoarseness from temporary effects on the recurrent laryngeal nerve, and a warm sensation in the arm on the treated side.

Serious complications are rare. The 2025 Boston cohort study found that about 25% of patients reported at least one side effect, but most were mild and resolved quickly. The 2026 systematic review concluded that SGB “has been used safely in pain management” and that the available studies did not report any serious adverse events related to the procedure.

Patients with bleeding disorders, active infections at the injection site, or certain cardiovascular conditions may not be appropriate candidates. A full medical evaluation before the procedure helps ensure safety.

Current Limitations and What Research Still Needs to Show

Honesty about the current state of the evidence is important. While the results so far are promising, several limitations exist:

• Small sample sizes: The largest published study included 52 patients. Most studies have fewer than 30 participants.
• No randomized controlled trials: None of the published studies compared SGB to a placebo injection or sham procedure. This means it is difficult to separate the effects of SGB from placebo effects or natural symptom improvement over time.
• Varied study designs: Different studies used different symptom measures, follow-up periods, and injection protocols, making direct comparisons challenging.
• Unknown long-term outcomes: Most studies tracked patients for weeks to a few months. Whether SGB provides lasting relief or requires ongoing treatment is not yet clear.
• Patient selection criteria are still being defined: Researchers have not yet identified which specific long COVID patients are most likely to benefit from SGB.

These limitations do not mean SGB is ineffective for long COVID. They mean that the evidence is still building. As the 2026 systematic review noted, “definitive evidence will require identification of optimal treatment protocols and clarification of which patient subpopulations would derive the greatest benefit from this procedure.”

Frequently Asked Questions

Is stellate ganglion block FDA-approved for long COVID?

SGB is not specifically FDA-approved for long COVID. It is an established medical procedure that has been used for decades to treat pain conditions and sympathetic nerve disorders. Its use for long COVID is considered “off-label,” which means the procedure itself is approved and well-studied, but its application to long COVID is based on emerging clinical evidence rather than a specific FDA indication.

How many SGB injections are needed for long COVID?

The number of injections varies by patient. Some individuals report significant improvement after a single block, while others benefit from a series of two to three injections spaced one to two weeks apart. The Boston cohort study found that patients received an average of three injections. Your doctor will evaluate your response to the first block to determine if additional treatments are warranted.

Does insurance cover SGB for long COVID?

Insurance coverage varies by plan and by the specific reason for the procedure. Coverage for SGB is more commonly approved for established pain conditions like CRPS. For newer applications like long COVID, coverage decisions are made on a case-by-case basis. The team at Kentuckiana Pain Specialists can help you check your coverage and understand your options.

How soon after a COVID infection can I get SGB?

SGB for long COVID is typically considered after symptoms have persisted for at least three months following a COVID infection, which aligns with the clinical definition of long COVID (also called PASC). Your doctor will evaluate whether your symptoms suggest autonomic dysfunction that might respond to SGB.

Can SGB help with long COVID anxiety and mood changes?

SGB has been studied for anxiety and PTSD independently of long COVID, and there is evidence that it can help calm the sympathetic stress response. Some long COVID patients in published studies reported improvements in anxiety and mood alongside physical symptoms. Because long COVID-related anxiety often stems from the same autonomic dysfunction that SGB targets, there is a reasonable basis for expecting benefit, though more research is needed.

Long COVID symptoms can disrupt every part of your daily life. Contact Kentuckiana Pain Specialists to learn if stellate ganglion block could be part of your recovery plan.