100 Migraine Drugs, A to Z: lidocaine

Lidocaine (Xylocaine) is an old local anesthetic used by surgeons, dentists, and other doctors to numb parts of the body. Lidocaine drops given into the nostrils were compared to saline drops for the acute treatment of migraine attacks in a double-blind placebo-controlled 113-patient trial by Dr. Morris Meizels and his colleagues. This study showed that lidocaine nose drops were much more effective than saline drops, but relieved migraines in only about one third of patients. Another, but smaller (49 patients) study did not find a difference between lidocaine and saline.

I’ve had a handful of patients with difficult to control migraines respond to an intravenous infusion of lidocaine and one of these patients continues to do well with a monthly infusion of lidocaine. There have been no double-blind studies of intravenous lidocaine for migraines, but an observational study of 68 hospitalized patients who failed to respond to other treatments, suggests that this treatment can be effective for some patients.

Intravenous administration of lidocaine is usually done in a hospital or an outpatient facility that has cardiac monitoring because lidocaine can cause arrhythmias (irregular heart beat). Otherwise, lidocaine is safe and well tolerated.

The widest use of lidocaine in migraine is for nerve blocks. An occipital nerve block has been scientifically proven to relieve an acute migraine attack. Combining blocks of occipital nerves (in the back of the head) with a block of supraorbital nerves (in the forehead) has been also shown to be more effective than injections of saline. We often add blocks of the temporal branches of the trigeminal nerve (in the temples) when a patient has pain in those areas.

Nerve blocks sometimes help stop a persistent migraine when other treatments fail. It is also a very good option for pregnant women who cannot or would rather not take any medicine by mouth.