Summary: Infusion of the local anesthetic Lidocaine may provide relief to chronic migraine sufferers who do not respond to other medications.
Infusions of the local anesthetic lidocaine may provide some pain relief to chronic migraine sufferers who have not responded to other treatments, reports a study in the journal Nature. Regional Anesthesia and Pain Medicine.
Intravenous infusions of local anesthetics such as lidocaine have been suggested as a possible treatment option in patients with poor quality of life due to treatment-resistant chronic migraine.
The aim is to ‘break the cycle’ of pain, but few studies have examined the effectiveness of this treatment beyond immediate pain relief.
In this retrospective study, the authors analyzed hospital records of 609 patients presenting with refractory chronic migraine and treated with lidocaine infusions to evaluate the short- and medium-term benefits of this approach.
Patients included in the analysis experienced at least 8 debilitating headache days per month for at least 6 months and were unresponsive or conflicted with the seven drug classes for migraine.
Patients received infusions of lidocaine for several days along with other aggressive drug treatments for migraine, such as ketorolac, magnesium, dihydroergotamine, methylprednisolone, and neuroleptics.
Most patients (87.8%) experienced rapid pain relief. At admission, the median score given by patients was 7.0, which dropped to 1.0 at discharge from hospital.
Patients who came to their follow-up appointments about a month after discharge also reported that the number of headache days they experienced decreased. The 266 patients who came to these appointments, which took place between 25 and 65 days after discharge, said their headache days had decreased from an average of 26.8 to 22.5 in the last month.
Some patients experienced nausea and vomiting during treatment, but all side effects experienced were mild.
This is an observational study and therefore cannot explain why, and the authors also highlight some limitations. Most importantly, not all patients completed follow-up visits, but they added that from their experience these are likely well-responder patients.
Additionally, some patients were included in the analysis more than once because they were admitted more than once, and it is possible, although unlikely, that the hospitalization itself contributed to pain relief.
“Continuous infusions of lidocaine were associated with improvement in acute pain in most patients and a reduction in both mean pain and a reduction in the number of headache days per month extending to up to 1 month. Most patients were acute responders, 43% of whom sustained improvement at 1 month and sustained response,” the authors wrote. “
“Lidocaine may be a viable treatment option for refractory chronic migraine patients who have failed other treatments. A prospective, randomized, double-blind trial is needed to confirm these results.”
About this migraine research news
Writer: press office
Communication: Press Office – BMJ
Picture: image public domain
Original research: Open Access.
“Lidocaine infusions for refractory chronic migraine: a retrospective analysis.Eric S Schwenk et al. Regional Anesthesia and Pain Medicine
Lidocaine infusions for refractory chronic migraine: a retrospective analysis.
The quality of life of patients with resistant chronic migraine is low. Intravenous infusions are indicated to rapidly break the pain cycle. Lidocaine infusions may be effective, but the evidence is limited.
The records of 832 hospital admissions involving continuous multi-day infusions of lidocaine for migraine were reviewed. All patients met the criteria for resistant chronic migraine. During hospitalization, patients were given additional migraine medications, including ketorolac, magnesium, dihydroergotamine, methylprednisolone, and neuroleptics. The primary outcome was change in headache pain from baseline to hospital discharge. Secondary outcomes measured at the post-discharge office visit (25–65 days after treatment) included headache pain and number of headache days, and the percentage of sustained responders. Percentage of acute responders, plasma lidocaine levels, and adverse drug effects were also determined.
In total, 609 patients met the admission criteria. The mean age was 46±14 years; 81.1% were women. The median pain rating decreased from 7.0 (5.0–8.0) at baseline to 1.0 (0.0–3.0) at the end of hospitalization (p<0.001); 87.8% of the patients were acute responders. Mean pain (N=261) remained below baseline at office visit 1 (5.5 (4.0–7.0); p<0.001). Forty-three percent of patients responded consistently at 1 month. Headache days (N=266) decreased from 26.8±3.9 at baseline to 22.5±8.3 at post-discharge office visit (p<0.001). Nausea and vomiting were the most common side effects and all were mild.
Lidocaine infusions may be associated with short-term and medium-term pain relief in resistant chronic migraine. Prospective studies should confirm these results.