Lidocaine for Migraines

Lidocaine IN can be cumbersome to use. The patient must remain flat for 30 minutes after instillation, with the head tilted back at least 45 degrees and rotated approximately 30 degrees to the affected side. In severe migrane attacks, this method was not really feasible in my experience.

Siri, CRNP, CLNC, RLNC

We use lignocaine as an infusion for patients with rebound headaches and chronic migraine, but that's more to support detox than an analgesic therapy.

I frequently do sphenopalatine blocks with lidocaine 4% on cotton applicators inserted through the nares. The patient's neck should be hyperextended and she should stay in this position for about 20 minutes. I use it for patients with severe migranes and have had a very high sucess rate. I also keep the room dark, play soft music, hold the patient's hand and try to have them do some slow yoga breathing. These blocks have been addessed in the anesthesia literature and are commonly used by CRNAs who do pain management.

I do think they work best before the migrane gets too severe, but it does help to stop the cycle. I have also used it on a friend who was having a severe sinus headache. She got good relief. With her, I used lidocaine with epinephrine and think some of the relief may have been from the epi. According to the literature, epi should not be used for relief of migranes, because of the pharmacologic vasocontriction effect.

Hope this helps.

Yoga CRNA

You are welcome.
Siri