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J Med Case Rep. 2012 Feb 15;6:64. doi: 10.1186/1752-1947-6-64.

Cluster headache with ptosis responsive to intranasal lidocaine application: a case report.

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1
Department of Ophthalmology, Selcuk University Selcuklu Medical Faculty, Konya, Turkey. drberkerbakbak@yahoo.com.

Abstract

INTRODUCTION:

The application of lidocaine to the nasal mucosal area corresponding to the sphenopalatine fossa has been shown to be effective at extinguishing pain attacks in patients with a cluster headache. In this report, the effectiveness of local administration of lidocaine on cluster headache attacks as a symptomatic treatment of this disorder is discussed.

CASES PRESENTATION:

A 22-year-old Turkish man presented with a five-year history of severe, repeated, unilateral periorbital pain and headache, diagnosed as a typical cluster headache. He suffered from rhinorrhea, lacrimation and ptosis during headaches. He had tried several unsuccessful daily medications. We applied a cotton tip with lidocaine hydrochloride into his left nostril for 10 minutes. The ptosis responded to the treatment and the intensity of his headache decreased.

CONCLUSION:

Intranasal lidocaine is a useful treatment for the acute management of a cluster headache. Intranasal lidocaine blocks the neural transmission of the sphenopalatine ganglion, which contributes to the trigeminal nerve as well as containing both parasympathetic and sympathetic fibers.

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