SOUTH LAKE TAHOE, CALIF. – The next time you see a patient with a migraine headache, you might want to try intranasal lidocaine, Dr. John Richards said at an emergency medicine conference sponsored by the University of California, Davis.
“It's a very easy block, and it doesn't involve a needle,” said Dr. Richards of the department of emergency medicine at the UC Davis Medical Center, Sacramento. “So it's worth a try.”
The literature on lidocaine treatment for migraine is not extensive, and at least one study found it to be of no benefit. But in some studies, lidocaine successfully resolved the migraine in 30%–50% of patients, with a relapse rate of about 20%.
Dr. Richards said he has had good experience with lidocaine. “I've had success with it for migraines, cluster headaches, and just headaches in general,” he said.
With cluster headaches, there usually is not complete relief, “but it does help them quite a bit,” he said.
The technique for treatment is to apply 4% lidocaine jelly to a long cotton swab, then aim the swab straight down the nasal canal all the way until it stops, on the side of the headache, or bilaterally if the headache is bilateral. The target is the sphenopalatine ganglion, which is located in the pterygopalatine fossa, posterior to the middle turbinate and inferior to the maxillary nerve. “It is covered by a small amount of mucous membrane [1.5 mm thick], so it is actually pretty easy to get to,” Dr. Richards said.
A second technique is to lay the patient back, with the head over the edge of the table at a 45-degree angle, and administer lidocaine drops, which will pool in the appropriate area. In one successful randomized trial, 10 drops were used, and the patients remained in their positions for 30 minutes, he said.