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Ann Emerg Med. 2017 Jun;69(6):743-751. doi: 10.1016/j.annemergmed.2016.09.031. Epub 2016 Nov 23.

Intranasal Lidocaine in Acute Treatment of Migraine: A Randomized Controlled Trial.

Author information

1
Department of Emergency Medicine, Bitlis State Hospital, Bitlis, Turkey.
2
Department of Emergency Medicine, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey. Electronic address: nurettinozgurdogan@gmail.com.
3
Department of Emergency Medicine, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey.
4
Department of Emergency Medicine, Bandırma State Hospital, Bandırma, Turkey.

Abstract

STUDY OBJECTIVE:

The study aims to evaluate the efficacy and safety of intranasal lidocaine administration for migraine treatment.

METHODS:

This single-center, double-blind, randomized, controlled trial was conducted in a tertiary care emergency department. Included patients met the migraine criteria of the International Headache Society. Patients were randomized to intranasal lidocaine or saline solution; all participants received 10 mg of intravenous metoclopramide. Patient pain intensity was assessed with an 11-point numeric rating scale score. The primary outcome measure was the change in pain scores at 15 minutes; secondary outcomes were changes in pain intensity after pain onset and need for rescue medication.

RESULTS:

Patients (n=162) were randomized into 2 groups with similar baseline migraine characteristics and numeric rating scale scores. The median reduction in numeric rating scale score at 15 minutes was 3 (interquartile range [IQR] 2 to 5) for the lidocaine group and 2 (IQR 1 to 4) for the saline solution group (median difference=1.0; 95% confidence interval 0.1 to 2.1). The reduction in pain score at 30 minutes was 4 (IQR 3 to 7) for the lidocaine group and 5 (IQR 2 to 7) for the saline solution group (median difference=1.0; 95% confidence interval 0.1 to 2.1). Need for rescue medication did not differ between the groups, and local irritation was the most common adverse event in the lidocaine group.

CONCLUSION:

Although intranasal lidocaine was found no more efficacious than normal saline solution in our study, future studies should focus on patients who present earlier after headache onset.

[Indexed for MEDLINE]

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