Lidocaine infusions for refractory chronic migraine: a retrospective analysis - PubMed
Source : https://pubmed.ncbi.nlm.nih.gov/35609890/
1 Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA [email protected]. 2 Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA. 3 Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA. 4 Neurology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Conclusion: Lidocaine infusions may be associated with short-term and medium-term pain relief in refractory chronic migraine. Prospective studies should confirm these results.
• Source: Regional Anesthesia & Pain Medicine
• Conclusion: “Lidocaine infusions may be associated with short-term and medium-term pain relief in refractory chronic migraine. Prospective studies should confirm these results.”
• In this retrospective study, American researchers included 609 hospital admissions involving continuous multiday lidocaine infusions for migraine. Patients were all class IV or most severe disease.
• In total, 87.8% of patients were acuate responders, and the median and average pain ratings dropped. At 1 month, 43% of patients experienced sustained response. Headache days dropped from 26.8 days at baseline to 22.5 days post-discharge. Adverse effects were mild and included nausea/vomiting.
• According to the authors, “Our results support the use of lidocaine infusions in a challenging population with rCM [refractory chronic migraine] and can help those treating challenging patients with headache have informed discussions about likelihood for relief and expected duration of relief. It is important to note that because of the severity of the disease process in these patients, using typical outcome measures such as improvement in pain of at least 50% at a time point of 3 months might not be practical and could result in underutilization of effective treatments. Patients in class IV as described above have virtually constant migraine pain and for many even temporary relief can allow resumption of normal activities.”
• There was no association between lidocaine plasma levels and pain ratings and between total lidocaine dose and change in pain. The authors hypothesized that minimum effective plasma level for lidocaine has yet to be elucidated, and some patients could respond even with decreased plasma levels.
• Limitations of the current study include patients lost to follow-up, multiple admissions per patient, and lack of data on preventive measures.