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Original research
Lidocaine infusions for refractory chronic migraine: a retrospective analysis
  1. Eric S Schwenk1,
  2. Aaron Walter1,
  3. Marc C Torjman1,
  4. Sarah Mukhtar1,
  5. Harsh T Patel2,
  6. Bryan Nardone1,
  7. George Sun1,
  8. Bhavana Thota1,
  9. Clinton G Lauritsen3 and
  10. Stephen D Silberstein3
  1. 1 Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
  2. 2 Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
  3. 3 Neurology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Eric S Schwenk, Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA 19107, USA; prepdrum{at}gmail.com

Abstract

Introduction Patients with refractory chronic migraine have poor quality of life. Intravenous infusions are indicated to rapidly ‘break the cycle’ of pain. Lidocaine infusions may be effective but evidence is limited.

Methods The records of 832 hospital admissions involving continuous multiday lidocaine infusions for migraine were reviewed. All patients met criteria for refractory chronic migraine. During hospitalization, patients received additional migraine medications including ketorolac, magnesium, dihydroergotamine, methylprednisolone, and neuroleptics. The primary outcome was change in headache pain from baseline to hospital discharge. Secondary outcomes measured at the post-discharge office visit (25–65 days after treatment) included headache pain and the number of headache days, and percentage of sustained responders. Percentage of acute responders, plasma lidocaine levels, and adverse drug effects were also determined.

Results In total, 609 patient admissions met criteria. The mean age was 46±14 years; 81.1% were female. Median pain rating decreased from baseline of 7.0 (5.0–8.0) to 1.0 (0.0–3.0) at end of hospitalization (p<0.001); 87.8% of patients were acute responders. Average pain (N=261) remained below baseline at office visit 1 (5.5 (4.0–7.0); p<0.001). Forty-three percent of patients were sustained responders at 1 month. Headache days (N=266) decreased from 26.8±3.9 at baseline to 22.5±8.3 at the post-discharge office visit (p<0.001). Nausea and vomiting were the most common adverse drug effects and all were mild.

Conclusion Lidocaine infusions may be associated with short-term and medium-term pain relief in refractory chronic migraine. Prospective studies should confirm these results.

  • Anesthesia, Local
  • Pain Management
  • Acute Pain
  • CHRONIC PAIN

Data availability statement

Data are available upon reasonable request. Data are available by reasonable request to interested parties with adequate time allowed for de-identification and sorting.

https://doi.org/10.1136/rapm-2021-103180

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    Data availability statement

    Data are available upon reasonable request. Data are available by reasonable request to interested parties with adequate time allowed for de-identification and sorting.

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    Footnotes

    • Twitter @ESchwenkMD

    • Contributors ESS helped with study design, data collection, data analysis, writing the manuscript, and is the author responsible for the overall content of the manuscript. AW helped with study design, data collection, data analysis, and writing the manuscript. MCT helped with data collection, data analysis, and writing the manuscript. SM helped with data collection, data analysis, and writing the manuscript. BN helped with data collection and writing the manuscript. GS helped with data collection and writing the manuscript. BT helped with data collection and writing the manuscript. HTP helped with data collection and writing the manuscript. CGL helped with study design and writing the manuscript. SDS helped with study design and writing the manuscript. ESS is the author responsible for all content.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests SDS has been a consultant, advisory panel member, or received honoraria from AbbVie, Amgen, Aeon BioPharma, Axsome Therapeutics, Curelator, Epalex, GlaxoSmithKline Consumer Health Holdings, electroCore Medical, Impel NeuroPharma, Lilly USA, Medscape, Lundbeck, Nocera, Pulmatrix, Revance, Salvia, Bioelectronics, Satsuma Pharmaceuticals, Teva Pharmaceuticals, Theranica, Thermaquil, and Trillen Medical.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.