Intranasal Lidocaine for Treatment of Migraine

A Randomized, Double-blind, Controlled Trial

Maizels, Morris MD
Scott, Barbara MD
Cohen, Wendy MD
Chen, Wansu MS

From the Departments of Family Practice (Dr Maizels) and Urgent Care (Drs Scott and Cohen), Woodland Hills, and the Department of Research and Evaluation, Pasadena (Ms Chen), Southern California Permanente Medical Group.

JAMA: The Journal of the American Medical Association 276(4):p 319-321, July 24/31, 1996.

Objective

To evaluate the effectiveness of intranasal lidocaine for treatment of acute migraine headache.

Design

Prospective, randomized, double-blind, placebo-controlled trial.

Setting

Community urgent care department.

Patients

A total of 81 patients (67 women and 14 men; median age, 42 years; range, 19-68 years) with a chief complaint of headache who fulfilled criteria of the International Headache Society for migraine participated. Patients were excluded if headache had lasted more than 3 days or if the frequency of severe headache was more than once per week.

Intervention

Patients were randomized in a 2:1 ratio to receive a 4% solution of intranasal lidocaine or saline placebo, respectively.

Main Outcome Measures

The primary outcome measure was at least 50% reduction of headache within 15 minutes after treatment. Secondary measures include reduction in nausea and photophobia, use of rescue medication, relapse of headache, and change in headache disability scores.

Results

Of 53 patients who received intranasal lidocaine, 29 (55%) had at least a 50% reduction of headache compared with 6 (21%) of 28 controls (P=.004). Nausea and photophobia were significantly reduced (P=.03 and P=.001, respectively). Rescue medication for headache relief was needed in 15 (28%) of 53 patients in the lidocaine group vs 20 (71%) of 28 controls (P<.001). Among those with initial relief of headache, relapse of headache occurred in 10 (42%) of 24 in the lidocaine group vs 5 (83%) of 6 in the control group (P=.17), usually within the first hour after treatment.

Conclusions

Intranasal lidocaine provides rapid relief of headache in approximately 55% of ambulatory patients with migraine. Relapse of headache is common and occurs early after treatment.

JAMA.1996;276:319-321