Lidocaine injection linked to increased pain relief in youths with acute migraine

Key takeaways:

• The study included 58 young persons with migraine flares lasting 24 hours to 3 months.
• A majority of those given lidocaine injection reported partial relief in pain location and severity.

DENVER — Lidocaine injection in the occipital region for young persons with acute migraine significantly increased pain relief compared with saline injections, according to research presented at the American Academy of Neurology annual meeting.

“Peripheral nerve blocks, injections of local anesthetics over branches of the occipital and/or trigeminal nerves, have been associated with benefit for pediatric headaches in case series,” Christina L. Szperka, MD, MSCE, a pediatric neurologist and director of the pediatric headache program at Children’s Hospital of Philadelphia, and colleagues wrote. “(They) are used by 80% of pediatric headache specialists but have not been tested in a randomized pediatric trial.”

Szperka and colleagues conducted a randomized control trial to examine the efficacy of greater occipital nerve blocks with lidocaine compared with treatment with saline in younger persons with acute migraine.

Their double-blind study included 58 children and adolescents (mean age, 16±1.8 years; 75.8% girls), with a migraine flare lasting between 24 hours to 3 months and prior insufficient response to other treatments for status migrainosus.

All participants had lidocaine cream applied for 30 minutes as a run-in step and could decline injections if there was sufficient evidence of benefit from cream alone. The injection medication was block randomized by episodic chronic migraine.

The primary outcome was difference of change in pain score between lidocaine and saline injection groups.

The lidocaine cream lead-in resulted in mean decrease in pain score of 0.2±0.9 points on a scale of 0 to 10, with all participants proceeding to randomized injection.

Data also showed a mean decrease of 2.3±1.9 points on a scale of 0 to 10 for the injection cohort, while the saline injection group reported a mean decrease of 1.1±1.9 points. A total of 22 of 29 patients who received an injection reported at least partial relief in severity or location of pain compared with 14 of 29 in the saline group.

“Greater occipital nerve injections with lidocaine resulted in a significantly larger drop in pain score compared to saline injections for youth with status migrainosus,” Szperka and colleagues wrote.