Lidocaine injection linked to better outcomes in adolescent migraine

Key takeaways:

• Adolescents with migraine were given lidocaine cream, lidocaine injections and saline injections.
• At 24 hours, more participants given lidocaine had pain relief and freedom compared with saline.

SAN DIEGO — For younger people with migraine, lidocaine injections were linked to better outcomes compared with saline injections, according to a speaker at the American Headache Society Annual Scientific Meeting.

“There have been a number of other studies which have reported a benefit for inpatient status migrainosus or as a transitional or preventive treatment for migraine,” Christina L. Szperka, MD, MSCE, pediatric neurologist and director of the pediatric headache program at Children’s Hospital of Philadelphia, told attendees. “There’s a lot of open-label data to see benefit or to see what else we could do.”

Szperka and colleagues initiated a clinical trial that, from an initial screening of 438 children and adolescents, included 58 participants (mean age 16.0±1.8 years; 75.8% girls) weighing under 25 kg who were diagnosed with migraine with an acute flare-up of symptoms for 3 months or less. All patients were unresponsive to previously administered medications.

Participants were initially given a lidocaine cream. If any reported pain freedom or declined further interventions at 30 minutes post-administration (appx. 42%), then nothing further was done. For the remainder, a series of either saline or lidocaine injections followed.

The primary outcome for the study was change in pain reduction score (0 to 10) at 30 minutes for both saline and lidocaine, with secondary outcomes being pain relief, pain freedom and freedom from migraine-associated symptoms at 24 hours.

If the patient subsequently reported feeling better after the injections, there was no further intervention; however, if there was no pain relief, additional standard care such as circumferential nerve blocks or IV medication was allowed.

Results showed that mean pain reduction score at 30 minutes was 2.3±1.9 for those given lidocaine and 1.1±1.9 for those given saline, with 20 of 29 participants in the lidocaine group and 10 of 29 in the saline group experiencing a two-point pain reduction. Five of 29 participants in the lidocaine group and two of 29 in the saline group experienced pain freedom.

There was a significant gap between pain of injection score between lidocaine (3.2±2.9) and saline (5.4±2.7).

At 24 hours without additional treatment, seven of 29 participants in the lidocaine group and one of 29 in the saline group experienced pain relief descending from moderate or severe to mild or none; 14 of 29 in the lidocaine group and six of 29 in the saline group experienced freedom from migraine-associated symptoms while four of 29 in the lidocaine group and none of 29 in the saline group reported pain freedom.

The most common adverse effect of treatment was anxiety, recorded in 57 of 58 participants, which was elevated with the long wait between injections.

“I’m still working on the data,” Szperka noted. “I want to look at things like does it matter if (the headaches) were chronic versus episodic. Thinking about, was 30 minutes was the right time point, do we see a difference earlier?”