Skip to main content

Advertisement

SpringerLink
Log in

Intravenous lidocaine vs. NSAIDs for migraine attack in the ED: a prospective, randomized, double-blind study

  • Clinical Trial
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Purpose

Although different forms of lidocaine are used for migraine attack headaches, the effect of intravenous lidocaine is still limited. This study aimed to investigate the effects of intravenous lidocaine infusion for the treatment of migraine attack headaches.

Methods

A hundred patients with migraine attacks, aged between 18 and 65, were randomly divided into two groups. The lidocaine group (n = 50) received a 1.5 mg/kg lidocaine bolus and a 1 mg/kg infusion (first 30 min), followed by a 0.5 mg/kg infusion for a further 30 min intravenously. The non-steroidal anti-inflammatory drug (NSAID) group (n = 50) received 50 mg dexketoprofen trometamol and saline at the same volume as the lidocaine at the same time intervals intravenously. The Visual Analog Scale (VAS) pain scores, additional analgesia requirement, side effects, and revisits to the emergency department were recorded.

Results

The VAS score was significantly lower in the lidocaine group than in the NSAID group for the first 20th and 30th minutes (p = 0.014 and p = 0.024, respectively). There was no difference between the VAS scores for the remaining evaluation times (p > 0.05). In terms of secondary outcomes, rescue medication requirement was not different between the two groups at both the 60th and 90th minutes (p > 0.05). However, the number of patients revisiting ED within 48–72 h was statistically less in the lidocaine group than in the NSAID group (1/50 vs. 8/50; p = 0.031).

Conclusion

Intravenous lidocaine may be an alternative treatment method for patients with migraine attack headaches in the emergency department.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Becker WJ (2015) Acute migraine treatment in adults. Headache 55(6):778–793. https://doi.org/10.1111/head.12550

    Article  PubMed  Google Scholar 

  2. Robblee J, Grimsrud KW (2020) Emergency department and inpatient management of headache in adults. Curr Neurol Neurosci Rep 20(4):7. https://doi.org/10.1007/s11910-020-01030-w

    Article  PubMed  Google Scholar 

  3. Ong JJY, De Felice M (2018) Migraine treatment: current acute medications and their potential mechanisms of action. Neurotherapeutics 15(2):274–290. https://doi.org/10.1007/s13311-017-0592-1

    Article  CAS  PubMed  Google Scholar 

  4. Bilhimer MH, Groth ME, Holmes AK (2020) Ketamine for migraine in the emergency department. Adv Emerg Nurs J 42(2):96–102. https://doi.org/10.1097/tme.0000000000000296

    Article  PubMed  Google Scholar 

  5. Benish T, Villalobos D, Love S, Casmaer M, Hunter CJ, Summers SM, April MD (2019) The THINK (Treatment of Headache with Intranasal Ketamine) trial: a randomized controlled trial comparing intranasal ketamine with intravenous metoclopramide. J Emerg Med 56(3):248-257.e241. https://doi.org/10.1016/j.jemermed.2018.12.007

    Article  PubMed  Google Scholar 

  6. Beaussier M, Delbos A, Maurice-Szamburski A, Ecoffey C, Mercadal L (2018) Perioperative use of intravenous lidocaine. Drugs 78(12):1229–1246. https://doi.org/10.1007/s40265-018-0955-x

    Article  CAS  PubMed  Google Scholar 

  7. Ates İ, Aydin ME, Ahiskalioglu A, Ahiskalioglu EO, Kaya Z, Gozeler MS (2020) Postoperative analgesic efficacy of perioperative intravenous lidocaine infusion in patients undergoing septorhinoplasty: a prospective, randomized, double-blind study. Eur Arch Otorhinolaryngol 277(4):1095–1100. https://doi.org/10.1007/s00405-020-05801-6

    Article  PubMed  Google Scholar 

  8. Forster C, Vanhaudenhuyse A, Gast P, Louis E, Hick G, Brichant JF, Joris J (2018) Intravenous infusion of lidocaine significantly reduces propofol dose for colonoscopy: a randomised placebo-controlled study. Br J Anaesth 121(5):1059–1064. https://doi.org/10.1016/j.bja.2018.06.019

    Article  CAS  PubMed  Google Scholar 

  9. Ates I, Aydin ME, Albayrak B, Disci E, Ahiskalioglu EO, Celik EC, Baran O, Ahiskalioglu A (2020) Pre-procedure intravenous lidocaine administration on propofol consumption for ERCP: a prospective, randomized, double-blind study. J Gastroenterol Hepatol. https://doi.org/10.1111/jgh.15356

    Article  PubMed  Google Scholar 

  10. Akhgar A, Pouryousefi T, Nejati A, Rafiemanesh H, Hossein-Nejad H (2020) The efficacy of intravenous lidocaine and its side effects in comparison with intravenous morphine sulfate in patients admitted to the ED with right upper abdominal pain suspected of biliary colic. Am J Emerg Med. https://doi.org/10.1016/j.ajem.2020.04.010

    Article  PubMed  Google Scholar 

  11. Chinn E, Friedman BW, Naeem F, Irizarry E, Afrifa F, Zias E, Jones MP, Pearlman S, Chertoff A, Wollowitz A, Gallagher EJ (2019) Randomized trial of intravenous lidocaine versus hydromorphone for acute abdominal pain in the emergency department. Ann Emerg Med 74(2):233–240. https://doi.org/10.1016/j.annemergmed.2019.01.021

    Article  PubMed  PubMed Central  Google Scholar 

  12. Johnson M, Strait L, Ata A, Bartscherer A, Miller C, Chang A, Stain SC, Tafen M (2020) Do lidocaine patches reduce opioid use in acute rib fractures? Am Surg 86(9):1153–1158. https://doi.org/10.1177/0003134820945224

    Article  PubMed  Google Scholar 

  13. Miller ACC, Faza C, Bigalli AAC, Khan AM, Sewell KA, King A, Vahedian-Azimi A, Zehtabchi S (2020) Intravenous amide anesthetics to treat pain associated with renal colic in the emergency department: a systematic review. Arch Acad Emerg Med 8(1):e27

  14. Kandil E, Melikman E, Adinoff B (2017) Lidocaine infusion: a promising therapeutic approach for chronic pain. J Anesth Clin Res 8(1) https://doi.org/10.4172/2155-6148.1000697

  15. Karadaş Ö, Gül HL, Inan LE (2013) Lidocaine injection of pericranial myofascial trigger points in the treatment of frequent episodic tension-type headache. J Headache Pain 14(1):44. https://doi.org/10.1186/1129-2377-14-44

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Avcu N, Doğan N, Pekdemir M, Yaka E, Yılmaz S, Alyeşil C, Akalın LE (2017) Intranasal lidocaine in acute treatment of migraine: a randomized controlled trial. Ann Emerg Med 69(6):743–751. https://doi.org/10.1016/j.annemergmed.2016.09.031

    Article  PubMed  Google Scholar 

  17. Williams DR, Stark RJ (2003) Intravenous lignocaine (lidocaine) infusion for the treatment of chronic daily headache with substantial medication overuse. Cephalalgia 23(10):963–971. https://doi.org/10.1046/j.1468-2982.2003.00623.x

    Article  CAS  PubMed  Google Scholar 

  18. Matharu MS, Cohen AS, Goadsby PJ (2004) SUNCT syndrome responsive to intravenous lidocaine. Cephalalgia 24(11):985–992. https://doi.org/10.1111/j.1468-2982.2004.00886.x

    Article  CAS  PubMed  Google Scholar 

  19. Berk T, Silberstein SD (2018) The use and method of action of intravenous lidocaine and its metabolite in headache disorders. Headache 58(5):783–789. https://doi.org/10.1111/head.13298

    Article  PubMed  Google Scholar 

  20. Bell R, Montoya D, Shuaib A, Lee MA (1990) A comparative trial of three agents in the treatment of acute migraine headache. Ann Emerg Med 19(10):1079–1082. https://doi.org/10.1016/s0196-0644(05)81507-0

    Article  CAS  PubMed  Google Scholar 

  21. Masic D, Liang E, Long C, Sterk EJ, Barbas B, Rech MA (2018) Intravenous lidocaine for acute pain: a systematic review. Pharmacotherapy 38(12):1250–1259. https://doi.org/10.1002/phar.2189

    Article  CAS  PubMed  Google Scholar 

  22. Ayulo MA Jr, Phillips KE, Tripathi S (2018) Safety and efficacy of IV lidocaine in the treatment of children and adolescents with status migraine. Pediatr Crit Care Med 19(8):755–759. https://doi.org/10.1097/pcc.0000000000001629

    Article  PubMed  Google Scholar 

  23. Reutens DC, Fatovich DM, Stewart-Wynne EG, Prentice DA (1991) Is intravenous lidocaine clinically effective in acute migraine? Cephalalgia 11(6):245–247. https://doi.org/10.1046/j.1468-2982.1991.1106245.x

    Article  CAS  PubMed  Google Scholar 

  24. Kaube H, Hoskin KL, Goadsby PJ (1994) Lignocaine and headache: an electrophysiological study in the cat with supporting clinical observations in man. J Neurol 241(7):415–420. https://doi.org/10.1007/bf00900958

    Article  CAS  PubMed  Google Scholar 

  25. Orlando R, Piccoli P, De Martin S, Padrini R, Palatini P (2003) Effect of the CYP3A4 inhibitor erythromycin on the pharmacokinetics of lignocaine and its pharmacologically active metabolites in subjects with normal and impaired liver function. Br J Clin Pharmacol 55(1):86–93. https://doi.org/10.1046/j.1365-2125.2003.01718.x

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Daykin H (2017) The efficacy and safety of intravenous lidocaine for analgesia in the older adult: a literature review. Br J Pain 11(1):23–31. https://doi.org/10.1177/2049463716676205

    Article  PubMed  Google Scholar 

  27. Gungor F, Akyol KC, Kesapli M, Celik A, Karaca A, Bozdemir MN, Eken C (2016) Intravenous dexketoprofen vs placebo for migraine attack in the emergency department: a randomized, placebo-controlled trial. Cephalalgia 36(2):179–184. https://doi.org/10.1177/0333102415584604

    Article  PubMed  Google Scholar 

  28. Rodríguez MJ, Arbós RM, Amaro SR (2008) Dexketoprofen trometamol: clinical evidence supporting its role as a painkiller. Expert Rev Neurother 8(11):1625–1640. https://doi.org/10.1586/14737175.8.11.1625

    Article  CAS  PubMed  Google Scholar 

  29. Kelley NE, Tepper DE (2012) Rescue therapy for acute migraine, part 3: opioids, NSAIDs, steroids, and post-discharge medications. Headache 52(3):467–482. https://doi.org/10.1111/j.1526-4610.2012.02097.x

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Emergency Medicine, Ataturk University School of Medicine, Erzurum, Turkey

    Sultan Tuna Akgol Gur & Abdullah Osman Kocak

  2. Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, 25070, Erzurum, Turkey

    Elif Oral Ahiskalioglu, Muhammed Enes Aydin & Ali Ahiskalioglu

  3. Clinical Research, Development and Design Application and Research Center, Ataturk University School of Medicine, 25240, Erzurum, Turkey

    Elif Oral Ahiskalioglu, Muhammed Enes Aydin & Ali Ahiskalioglu

  4. Department of Anesthesiology and Reanimation, Erzurum State Hospital, Erzurum, Turkey

    Pelin Aydin

Authors
  1. Sultan Tuna Akgol Gur
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elif Oral Ahiskalioglu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Muhammed Enes Aydin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Abdullah Osman Kocak
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Pelin Aydin
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ali Ahiskalioglu
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

ST Akgol Gur, EO Ahiskalioglu: Planning, data collection, sample analysis, writing the first draft, evaluating and modifying the final manuscript. ME Aydin, AO Kocak: Data collection and evaluating subsequent drafts and the final manuscript. P. Aydin: Sample analysis, writing and the final manuscript. A. Ahiskalioglu: Writing and the final manuscript, supervisor.

Corresponding author

Correspondence to Elif Oral Ahiskalioglu.

Ethics declarations

Ethic approval and patient consent

This study was conducted at the Ataturk University Faculty of Medicine, Erzurum, Turkey. It was approved by the local ethics board approval (B30.2ATA.0.01.00/462) and followed the Helsinki statement, and signed consent was obtained from all participants before the experiment.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gur, S.T.A., Ahiskalioglu, E.O., Aydin, M.E. et al. Intravenous lidocaine vs. NSAIDs for migraine attack in the ED: a prospective, randomized, double-blind study. Eur J Clin Pharmacol 78, 27–33 (2022). https://doi.org/10.1007/s00228-021-03219-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00228-021-03219-5

Keywords

Search

Navigation