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 physicians.
A few drops of a lidocaine solution placed in the nose relieved migraines in 55 percent 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 Association.
The lidocaine mixture costs only a few cents, compared to $35 for an injection of the highly touted migraine reliever sumatriptan. And unlike the latter drug, the scientists report, it 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.
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.
But Dr. Neil Raskin of the University of California, 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 neither doctors nor the 81 patients enrolled in the trial were supposed to know which drug was administered, patients actually did know because of the numbing effects of the lidocaine, Maizels acknowledged.
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.
Twenty-nine of the 53 patients (55 percent) who received lidocaine had at least a 50 percent reduction in their headaches, compared to only six of the 28 (21 percent) who received a placebo. That compares to about 65 percent 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 percent had a relapse, often within an hour.