Stellate Ganglion Block for POTS: What the Evidence Shows

What Is a Stellate Ganglion Block?

A stellate ganglion block uses an anesthetic to block the stellate ganglion, a cluster of sympathetic nerves at the base of the neck that relays sympathetic signals up toward the head and arm. The neck carries a lot of the wiring between body and brain (see how the neck affects the brain).

The block can be done with ultrasound guidance, which lets the doctor see the nearby arteries, the thyroid, the esophagus and the nerve roots. A 2014 review says that with this view, "the risk of vascular and soft tissue injury may be minimized."

What Are the Side Effects of a Stellate Ganglion Block?

A 2019 systematic review gathered published reports of SGB complications from 1990 to 2018 and found 260 cases in 67 articles. The most commonly reported body-wide effects were hoarseness and light-headedness, and the most common local one was a hematoma, a pocket of pooled blood. Rarer reports include seizures, a collapsed lung, 1 death from a large bleed in the neck that blocked the airway and 1 case of paralysis after an infection in the neck spine. The authors write that complications "have been reported with both landmark-based techniques and with imaging guidance using fluoroscopy or ultrasound," and most "occurred during or shortly after" the block. Because the review counts reported cases, it can't say how often each one happens.

Outside pain care, a 2023 scoping review found SGB can be considered for blunting the body's sympathetic stress response, improving poor blood flow to the arms and legs, and easing menopausal hot flashes, when standard care hasn't worked. People also use it for headaches and neck pain. In our team's experience, some providers moved from using it for headache to PTSD and then to POTS because of the arousal component.

Signal on Block in place

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What Does the Research Show for SGB in POTS?

We found 1 published study of SGB in POTS, a 2025 case report. The patient was a 41-year-old woman who'd had POTS for 15 years. At 9 weeks after the procedure, she "reported a pulse in the normal range under 100 beats per minute and 100% resolution of all symptoms that affected her quality of life." The authors call SGB "a novel therapeutic strategy."

That result comes from 1 patient with no control group, so it can't show how often SGB helps anyone else, and it reports nothing past 9 weeks. A PubMed search on November 6, 2026 pairing SGB with POTS, dysautonomia or orthostatic terms found 4 papers, and only this case report tested SGB in POTS.

What About PTSD and Long COVID?

PTSD has the strongest evidence, though it's still thin. A 2025 meta-analysis pooled only 2 randomized trials and 1 case-control study, found lower PTSD scores with SGB and called for more high-quality randomized trials. The main one is a 2020 sham-controlled trial in 113 active-duty service members found that symptom severity scores fell by an adjusted mean of 12.6 points with SGB, compared with 6.1 points with a sham treatment (P = .01). The authors write that "the mild-moderate baseline level of PTSD symptom severity and short follow-up time limit the generalizability of these findings," and they conclude that SGB "merits further trials as a PTSD treatment adjunct."

The long COVID research is smaller. A 2022 report described 2 long COVID patients treated with SGB and suggested dysautonomia plays a part in long COVID. A 2024 chart review by the same authors, at the clinic where they provide SGB, used patient surveys: people reported "striking reductions" in fatigue, memory problems, anxiety and depression, while loss of taste and smell "did not respond to treatment." It had no control group. A 2026 systematic review calls SGB "a promising treatment" for long COVID and adds that "the current literature has small, uncontrolled studies with heterogenous study designs and follow-up periods." A 2025 scoping review of every long COVID autonomic treatment studied so far, SGB included, found the studies small and uncontrolled, making it "unclear whether the observed pre-post changes were due solely to the administered treatments."

How Does Our Team See SGB?

Everything in this section is our team's view unless a study is named. The first question is whether the stellate ganglion is the problem, and in almost all cases our answer is no. The block takes away the normal input your body is using to solve whatever problem it thinks it's solving. Some people feel a little better because that signal is gone.

The main concern is brain blood flow. The sympathetic system is part of how the brain controls its own blood flow, and the block takes some of that control away. The vessels relax and stop adjusting, so brain blood flow rises and falls with whatever the heart puts out. Our team calls that pressure passive, meaning the brain's blood flow follows the heart's output instead of being held steady. If you already have a hard time getting blood to the brain (cerebral hypoperfusion), taking away that control system works against you, and our team usually works to make it work better. The block can ease symptoms for a while, but it doesn't give you as much of a chance of solving the problem over the long term.

There's another side. In high-anxiety, high-arousal, high-output states, the block can take some of that spasm away and give people relief. Some people with hyperadrenergic POTS feel that high-output state, and our team's question there is whether the surge is the problem or the body's attempt to protect brain blood flow. Arousal and POTS can be hard to tell apart (POTS vs anxiety).

The studies that measured brain blood flow after SGB mostly found changes their authors counted as a benefit. In a 2024 trial in stroke patients, flow speed in several brain arteries rose and vessel resistance fell after the block. A 2016 report after brain bypass surgery found more blood flow in the bypass artery. In 2 studies after a brain bleed, flow speed in the main brain artery was lower after the block, which the authors read as good news, since high speed there signals artery spasm. None of these studies was in POTS, and none tested whether the brain still holds its own blood flow steady, which is the part our team is concerned about.

Where Might SGB Fit, and What Should You Ask First?

In our team's view, SGB solves for 2 different sides of a spectrum, so the first question is which side you're on. If you're weighing SGB, these are the questions our team would want answered first:

• Which problem is the block meant to treat, high arousal or low brain blood flow?
• What will be measured before and after the block, and how will you both know whether it helped?
• What problem is your body's sympathetic output trying to solve, and can that problem be treated directly?

Our POTS treatment page covers the other options, from medications and beta blockers to brain-first rehab.