Lidocaine for Migraines

[SusanJean]

Has anyone here heard of using lidocaine (4 percent, compounded into a nasal spray) for use in the relief of pain from migraines?

Any info (clinical experience, personal experience, etc.) would be appreciated.

Thanks,

SJ

[sirI, MSN, APRN, NP]

has anyone here heard of using lidocaine (4 percent, compounded into a nasal spray) for use in the relief of pain from migraines?

any info (clinical experience, personal experience, etc.) would be appreciated.

thanks,

sj

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

[talaxandra]

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.

[yoga crna]

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

[SusanJean]

Thanks to all that have responded. My sister is getting this (as a new tx) from her doctor, but it was not making any sense to me. Since I suffer from the same type of headaches, I was very curious...ya never know what will work.

Again, thanks for the info.

SJ

[sirI, MSN, APRN, NP]

Thanks to all that have responded. My sister is getting this (as a new tx) from her doctor, but it was not making any sense to me. Since I suffer from the same type of headaches, I was very curious...ya never know what will work.

Again, thanks for the info.

SJ

You are welcome.

Siri

[lisanurse81]

My husband has had phenomonal relief or his cluster headaches with this, we use lidocaine gel on a q-tip inserted through nares to back of sinus cavity. I have also used this on occasion for severe headaches and it almost instantly reduces the pain.

If I have a headache that is very severe, I notice when I insert the q-tip with the lidocaine on it my nasal canal and sinus cavity is VERY sore. There will be one small area that is more painful than the rest, I try to target that area with the lidocaine.

Seems that the theory for the cause of the headache is from the nerve that runs through the back of the sinus becomes inflamed and once you treat the pain from that area the rest of the headache settles down. I do have to rest for a while after this, and I also take ibuprofen along with it. I feel back normal the next day.

[monkeybug]

I often get IVs of lidocaine for intractable migraines. Never heard of using it in nasal spray form, but it makes sense. At times during my many years as a patient I have been prescribed Stadol, ketamine, and DHE in nasal spray form.