Infusions of the local anaesthetic lidocaine may give pain relief to persons with chronic migraine who have not responded to previous therapies, according to a new research.
The study’s findings were published in the journal ‘Regional Anesthesia & Pain Medicine.’ Intravenous infusions of a local anaesthetic, such as lidocaine, have been proposed as a feasible therapy option for those suffering from chronic migraine that is difficult to manage.
The goal is to “stop the cycle” of pain, but few studies have looked at the treatment’s effectiveness beyond acute pain relief.
The authors evaluated the hospital records of 609 patients hospitalised with refractory chronic migraine and treated with lidocaine infusions in this retrospective analysis to assess the short- and medium-term advantages of this technique.
Patients in the study had at least 8 terrible headache days per month for at least 6 months and had failed to react to or had conflicts with the seven types of migraine treatment.
Patients were given lidocaine infusions over multiple days in addition to more strong migraine therapies such ketorolac, magnesium, dihydroergotamine, methylprednisolone, and neuroleptics. The majority of patients (87.8%) reported immediate pain alleviation. The median rating given by patients at the time of admission was 7.0, but at the time of hospital release, it had dropped to 1.0.
Patients attending follow-up sessions about one month following discharge reported a decrease in the frequency of headache days. The 266 patients who attended these consultations, which were held between 25 and 65 days following discharge, reported that the number of headache days in the previous month had decreased from a mean of 26.8 to 22.5.
During therapy, several individuals reported nausea and vomiting, although all side effects were minor. Because this is an observational research, it cannot establish causality, and the authors also point out several limitations. Most crucially, not all patients returned for follow-up appointments, but in their experience, these were likely to be patients who reacted well.
Furthermore, because some patients were admitted on many occasions, they were included in the study more than once, and while this is improbable, it is conceivable that hospitalisation itself contributed to pain reduction.
The authors conclude, “Continuous lidocaine infusions were associated with improvement in acute pain in most patients and a decrease in both average pain and the number of headache days per month that extended out to 1 month. Most patients were acute responders, 43 per cent of whom maintained improvement at 1 month and were sustained responders.”
They add, “Lidocaine may be a viable treatment option for patients with refractory chronic migraine who have failed other treatments. A prospective, randomized, double-blind trial is needed to confirm these results.”
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