Nose Drops of Anesthetic Ease Migraines, Study Finds
An inexpensive solution of nose drops containing a local anesthetic can bring almost immediate relief to the majority of the millions of people who suffer from migraines every year, according to a group of Woodland Hills physicians.
A few drops of a lidocaine solution placed in the nose relieved migraines in 55% of patients in five to 15 minutes, Dr. Morris Maizels and his colleagues at the Southern California Permanente Medical Group report today in the Journal of the American Medical Assn.
The lidocaine mixture costs only a few cents, compared to $35 for an injection of the highly touted migraine reliever sumatriptan. And unlike sumatriptan, the scientists report, the mixture has no major side effects.
Lidocaine, commonly used for treating sunburns and hemorrhoids, obviously needs to be tested for a longer period of time and in a much larger number of patients than the 81 studied at Permanente, Maizels noted.
“But the speed with which this works, sometimes in seconds, and the lack of serious side effects, would make this an important new treatment,” he said.
Said Simi Valley Police Officer Sterling Johnson, who received the treatment from Maizels: “I don’t know how it works, but it is absolutely amazing.”
Other headache specialists had a mixed view of the results, however. “It’s a breakthrough because it is cheap, simple, effective therapy,” said Dr. David Kudrow of the California Medical Clinic for Headache in Encino.
But Dr. Neil Raskin of UC San Francisco found the results “not terribly impressive.” Most important, he noted, the Permanente team did not attempt repeated use of the drug in the same patients. “We got even more impressive results when we first started using lidocaine to treat cluster headaches,” he said, but the drug became steadily less effective with each use as “patients developed tolerance to it.”
Although migraines are not life-threatening, they are severely disabling for the 23 million Americans who suffer them routinely. In addition to severe pain on one or both sides of the forehead, the symptoms typically include nausea and an aversion to light and sound. Untreated, the symptoms can last from two hours to two days, and many victims are unable to work or carry out other activities while suffering from them.
Maizels, a family practitioner, began studying migraine drugs because he suffers from the headaches himself. He got interested in lidocaine when a patient brought him a newspaper clipping about its use for cluster headaches, a different type of headache that is not related to migraines.
The drug anesthetizes a nerve in the nose called the sphenopalatine ganglion that is believed to help cause cluster headaches, but that has never been shown to have a role in migraines, he said.
He tried lidocaine on himself and found that it worked. He also gave it to nurses and other clinic personnel who suffered migraines, and they got relief, so he decided to do a clinical trial.
The team enrolled 81 patients who came into the Woodland Hills emergency room with migraines between December 1994 and October 1995. Two-thirds of the patients were randomly selected to receive a 4% solution of lidocaine, while the others received only salt water.
Although neither doctors nor patients were supposed to know which drug a patient received, patients actually did know because of the numbing effects of the lidocaine, Maizels acknowledges. Because patients often respond more positively when they know they are receiving the drug, that knowledge introduces the “possibility of bias” in the study, said Dr. Ninan T. Matthew, director of the Houston Headache Clinic. Some of the patients had also taken other drugs before coming to the emergency room, he said, which complicates the interpretation of the results.
Twenty-nine of the 53 patients (55%) who received lidocaine had at least a 50% reduction in their headaches, compared to only six of the 28 (21%) who received the placebo. That compares to about 65% who receive similar results from sumatriptan.
A significant number of patients who benefited from the drug suffered a relapse, but the relapse rate was comparable to that of other migraine drugs now used routinely. Among those who received relief, 42% had a relapse, often within an hour. The researchers have not yet explored whether additional doses will control the relapse.
In the placebo group, 83% of those who responded suffered a relapse. About 40% of patients who respond to sumatriptan also suffer a relapse after an average of nine hours.
The only side effects of lidocaine were a burning or numbness around the nose and eye and a bitter taste if it was accidentally swallowed. “One patient actually spit it back at me,” Maizels said. Sumatriptan, in contrast, can trigger heart attacks in patients who are at high risk for them. Lidocaine is “totally safe,” Raskin said.
The 52-year-old Johnson, a member of his department’s SWAT team, said that job and personal pressures occasionally trigger severe, disabling migraines. He said other drugs he has tried knock him out so that he can’t respond to an emergency call.
The first time he tried lidocaine on the recommendation of Maizels, the migraine subsided in three to five minutes, he said. Johnson was not one of the trial subjects, so he was able to reapply the drug. The headache “just went away,” he added. “No one was more amazed than I was.”
He has since used lidocaine three more times and “it worked absolutely perfectly,” he added.
Virtually everyone agrees that lidocaine must be tested in much larger numbers of people, Maizels said, and the effects of repeated use must be probed.
“Unless there is a larger series of patients . . . I don’t think it can be recommended [yet] as a major breakthrough in headache treatment,” said Matthew, president-elect of the International Headache Society.
And it is not going to be for everybody, Maizels said. Patients who should not take it include those who have severe headaches more than once a week, those who take medicine daily to treat headache, and those who need narcotics to treat their headaches. Such patients, Maizels said, typically have some other condition on top of their headache and “are not going to respond to it.”
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Anatomy of a Migraine
A new study suggests that placing a few drops of the local anesthetic lidocaine in the nose can bring immediate relief to 55% of migraine sufferers.
MAJOR SYMPTOMS
Also, 20% to 30% of migraine sufferers experience an aura, characterized by flashing lights and zigzag lines in their field of vision before the onset of a migraine.
Throbbing pain on one or both sides of the head.
Nausea and vomiting.
Aversion to light and noise.
DURATION
Two to 48 hours.
MIGRAINE SUFFERERS
* As many as 17% of American women
* 6% of American men
Source: National Headache Foundation
