Lidocaine Infusions May Ease Tough-to-Treat Migraines

By Alan Mozes HealthDay Reporter

A multi-day intravenous infusion of the local anestheticlidocaineappears to offer somepainrelief to patients battling otherwise untreatable dailymigraines.

That's the takeaway from anew studythat examined the effectiveness oflidocaineinfusion treatment -- a much debatedtherapy that requires a hospital stay -- as a means to address "refractory chronicmigraines" (rCM).

rCM的诊断意味着patients have suffered at least eightmigrainesa month for a minimum of six months without responding to standard treatment andpreventionstrategies.

Those first-line treatments include standardpainkillers andbeta blockers;corticosteroids;antidepressants; anti-convulsants; calcium blockers;Botox injections, and/or noninvasive electrical stimulation.

"Lidocaine is a local anesthetic -- a numbing medicine -- but also reduces inflammation in studies," said study author Dr. Eric Schwenk, director of orthopedic anesthesia at the Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia.

The findings suggest that chronicmigrainepatients experiencedpainrelief for about a month after hospital treatment with IV medications including lidocaine, he said.

Between 1% and 2% of the population get the chronicmigraine headaches.

The researchers looked at hospital records for just over 600 patients, most of them women (average age: 46).

All had been admitted to a Philadelphia hospital between 2017 and 2020 for lidocaine infusion treatment, typically for five to seven days.

Prior to treatment, patients had experienced moderate to severeheadachesfor about 27 out of every 30 days. Eachmigraineattack was at least four hours long.

Upon admission, lidocaine infusions were initially started at 1 mg per minute, then increased up to 4 mg per minute. (Other IV medications were administered at the same time, includingketorolac-- anonsteroidal anti-inflammatory drug-- and thecorticosteroidmethylprednisolone.)

At a follow-up appointment 25 to 65 days later, patients reported that on average, they hadheadacheson 23 of the last 30 days -- four fewer than before treatment.

While the benefit may seem small, Schwenk said it still represented improvement for these patients who typically experienceheadachepainalmost constantly.

“对他们来说,利多卡因可能他lp break the cycle of continuous pain," he said.

Researchers also noted that about 88% of patients reported some degree of pain relief, with pain intensity plummeting from a self-reported score level of 7 at intake, down to 1 at discharge, out of 10.

As for side effects, Schwenk said that the most common issue wasnauseaandvomiting, which affected nearly 17% of patients.

"But lidocaine was well tolerated overall," he noted. "No serious adverse events occurred."

On the downside, however, an average hospital stay of more than five days may not be feasible for many patients, Schwenk noted.

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It also remains unclear just how lidocaine works to alleviate rCM. "Its mechanism of action inmigraineis unknown," he said.

Schwenk and his colleagues also noted that because of the nature of their look-back analysis, the study could not definitively prove that lidocaine was the direct cause of a reduction in rCM frequency. Asimilar studyearlier this year also evaluated the infusion therapy.

Dr. Teshamae Monteith, a fellow with the American Academy of Neurology, and chief of theheadachedivision at the University of Miami's Miller School of Medicine, reviewed the new findings.

She said she was "not surprised by the benefits of lidocaine," having used the treatment often for patients with these hard-to-treatheadachedisorders.

Monteith noted that the infusion therapy is already in use in manyheadachecenters and is "generally considered safe with side effects that are transient."

As to the source of the benefit, she said the therapy likely works by interrupting a major pain-signaling connection to the brain, a neural route known as the trigeminovascular pathway.

Nevertheless, Monteith emphasized the need for further study "to determine which patients are best candidates for intravenous lidocaine [and] long-term follow-up studies post-discharge."

The findings were published May 23 in the journalRegional Anesthesia & Pain Medicine.

更多的信息

The AmericanMigraineFoundation has more aboutmigraine headaches and their treatment.

SOURCES: Eric Schwenk, MD, associate professor and director, orthopedic anesthesia, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia; Teshamae Monteith, MD, fellow, American Academy of Neurology, and associate professor, clinical neurology, and chief,headachedivision, University of Miami Miller School of Medicine;Regional Anesthesia & Pain Medicine, May 23, 2022

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