Pain caused by migraine headaches is one of the most intractable problems seen by physicians. Now a new procedure that delivers the anesthetic lidocaine (Xylocaine) directly into the back of the nasal cavity appears to hold the promise of significant relief. Researchers report early findings suggesting a single outpatient treatment reduces migraine pain approximately 35 percent for up to a month following the procedure. The small study is ongoing.
The study’s lead author is Dr. Kenneth Mandata, a vascular and interventional radiologist at Albany Medical Center in Albany, New York. He describes the technique is “a minimally invasive option,” and “a clear simple alternative” to treatments commonly used. He says the nasal spray option is “safe, convenient, and innovative.”
The study involved 112 patients whose ages average about forty-five. All the patients suffered from migraine headaches or cluster headaches, an intensely painful, cyclically occurring type of headache. Prior to their participation, patients indicated their pain levels as measured on a standardized scale from 1 to 10. The average pain score was higher than eight.
During the treatment, a catheter the size of a strand of spaghetti was inserted through the patient’s nostril and into the nasal passage, where a dose of lidocaine was delivered to the nerve center known as the sphenopalatine ganglion. The treatment was repeated in the opposite nostril. The patients participated in “image guided therapy,” and none of them required sedation for the procedure.
Mandata explained the targeted nerve bundle “resembles a complex highway crossing with many [nerve] signals and exits going in all directions.” The treatment short-circuits the nerve bundle’s headache-causing pathway. On the day after the procedure, patients’ average migraine pain levels were reduced from just over 8 to just over 4. A week later, pain scores rose only slightly, and patients reported an average of just over 5 on the pain scale a month post-procedure.
Seven patients, about 6 percent, did not report any benefit from the treatment. Nevertheless, researchers reported 88 percent of the patients in the study needed less standard pain relief medication after the procedure.
Researchers say this procedure would need to be repeated periodically. The team is continuing to follow up with patients for six months following treatment.
The findings are meeting with a warm reception from physicians such as Dr. Richard Lipton, director of the Montefiore Headache Center in New York City. He says the findings are “very dramatic,” and continued:
Unmet treatment needs in chronic migraine are huge, as is the overuse of medications. When a body gets used to having a chronic headache suppressor, the patient can experience a rebound in the absence of that suppressor. So developing an effective treatment that can reduce the need for acute medicine would be very valuable. These results sound very promising. Of course, it remains to be seen if the demonstrated benefit already seen holds up over a longer period of time, and with a bigger group of patients.
No private corporate funding was utilized for the study. Dr. Mandata and his team are scheduled to present their findings to the Society of Interventional Radiology annual meeting in Atlanta. The researchers will then seek to publish the study in a peer-reviewed journal.