Background The pterygopalatine fossa (PPF) is a compartment with rich autonomic and somatic innervation of the head, making it a crucial target for pain management interventions. Among the various techniques described, the suprazygomatic approach to the PPF may be one of the safest. However, the application of fluoroscopy to guide this approach has not been previously reported.

Methods To the best of our knowledge, this is the first report in the literature describing a fluoroscopy-guided suprazygomatic approach to the PPF block. This brief technical report provides a step-by-step description of the technique and presents five cases demonstrating its implementation.

Results Five cases were successfully performed using the fluoroscopy-guided suprazygomatic approach for the management of primary and secondary headache disorders. The findings demonstrate that the technique is feasible, safe, and effective.

Conclusions The fluoroscopy-guided suprazygomatic approach to the PPF offers a viable alternative to traditional methods and deserves further consideration in clinical practice.