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Patients suffering from refractory chronic migraine could see their pain fade thanks to a new treatment: lidocaine. A hope for these pains hitherto very difficult to take care of.
This intravenous infusion of the local anesthetic seems to offer some relief to patients suffering from incurable daily migraines. In total, nearly 88% of patients showed pain reduction. The results were published recently in the journal Regional Anesthesia & Pain Medicine.
Lidocaine, a promising new therapy?
Migraine is a complex disease involving genetic and environmental factors. To treat it, different treatments are possible, but not all of them work. Some patients (1 to 2%) suffer from chronic migraines refractory to available treatments, in which the pain “self-maintains” to the point of having an impact on all areas of daily life.
In this new study, the researchers highlight the effectiveness of lidocaine in the face of these “chronic refractory migraines”.
In total, nearly 609 medical records of migraine patients were analyzed. Most were women with an average age of 46, hospitalized at the Jefferson Headache Center. All had moderate to severe headaches that were refractory to the seven classes of migraine medication currently available. They suffered from painful migraine at least 8 days per month for at least 6 months.
Refractory chronic migraine: lasting improvement for 43% of patients
In this trial, volunteers received continuous intravenous infusions of lidocaine for 5-7 days along with other migraine treatments: magnesium, methylprednisolone, ketorolac (NSAIDs) and neuroleptics.
Each pain was recorded and measured using an 11-point self-rating scale, with 10 points being the highest and 0 being painless.
Results ? The treatment reduced the mean pain score from 7 at admission to 1 at discharge. Thus, almost 88% of patients showed a pain reduction of at least 2 points in hospital.
In addition, 43% of the volunteers showed a lasting improvement in pain intensity, one month after hospitalization. During post-hospitalization follow-up consultations one month after leaving the hospital, patients also attest to a reduction in the number of migraine days (from 26.8 to 22.5 days).
“For these patients, lidocaine can help break the cycle of continuous pain.“said study author Dr. Eric Schwenk, director of orthopedic anesthesia at Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia.
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Effectiveness to be confirmed over the long term
In terms of side effects, nausea and vomiting occurred in approximately 17% of patients. Overall, however, lidocaine was well tolerated, although a stay longer than five days in hospital was not possible for many patients.
But for Dr Dominique Valade, neurologist and head of the Headache Emergency Center at Lariboisière Hospital, the effects of this treatment have yet to be proven:
“Lidocaine works by injection during the emergence of tension headaches, which are headaches of mild to moderate intensity. On the other hand, no study in my opinion, reports the positive effect of lidocaine in migraine disease”.
Further studies are therefore needed to determine the long-term impact of this intravenous treatment on different types of migraine.