Intranasal lidocaine effective for acute migraine

  • Chi PW & al.
  • PLoS ONE
  • 1 Jan 2019

  • International Clinical Digest
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Takeaway

  • Adults with acute migraine treated with intranasal lidocaine had a greater reduction in pain intensity, a higher treatment success rate, and less need for rescue medication than controls.

Study design

  • Meta-analysis of 6 randomised controlled trials (n=613) assessed the efficacy and safety of intranasal lidocaine for treatment of migraines.
  • Primary outcome: pain intensity measured using visual analogue scale, numerical rating scale, or verbal rating scale.
  • Funding: National Institute for Health Research.

Key results

  • Intranasal lidocaine vs control group showed significant decrease in pain intensity (P<.05 at: style="list-style-type:circle;">
  • 5 minutes (standardised mean difference [SMD], −0.45); and
  • 15 minutes (SMD, −0.41).
  • Decrease in pain intensity was evident in comedication group without antiemetic vs with antiemetic (P<.05 style="list-style-type:circle;">
  • 5 minutes (SMD, −0.61); and
  • 15 minutes (SMD, −0.72).
  • Lidocaine vs control group noted:
    • higher success rates (risk ratio [RR], 3.55; P<.0001 and>
    • less frequent need for rescue medication (RR, 0.59; P=.004).
  • Lidocaine had no significant influence on relapse rates (RR, 0.89; P=.68).
  • Limitations

    • Local irritation influences the blinding of participants.

    Coauthored with Chitra Ravi, MPharm