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New Procedure May Bring Migraine Relief

Migraineurs and those who suffer from cluster headaches may find relief from the pain with the help of a new procedure that uses lidocaine, a common topical anesthetic.

When evaluating the treatment, called image-guided, intranasal sphenopalatine ganglion (SPG) blocks, researchers inserted a spaghetti-sized catheter through the nasal passages of patients and administered 4% lidocaine to the sphenopalatine ganglion, a nerve bundle just behind the nose associated with migraines. This procedure was assisted with fluoroscopy, a type of imaging that could be compared to an X-ray movie.

Before treatment, the 112 patients in the study reported an average pain score of 8.25 on a scale of 1 to 10 with scores greater than 4 at least 15 days per month. The day after the SPG block, patients reported pain scores that were nearly cut in half and averaged 4.1. Thirty days after the procedure, pain scores were still decreased and averaged 5.25. Additionally, 88 percent of patients indicated that they required less or no migraine medication for ongoing relief.

“Administration of lidocaine to the sphenopalatine ganglion acts as a ‘reset button’ for the brain’s migraine circuitry,” said Kenneth Mandato, MD, the study’s lead researcher and an interventional radiologist at Albany Medical Center. “When the initial numbing of the lidocaine wears off, the migraine trigger seems to no longer have the maximum effect that it once did. Some patients have reported immediate relief and are making fewer trips to the hospital for emergency headache medicine.”

Dr. Mandato believes patients can have the SPG block repeated, if needed. To further study SPG blocks, Mandato will track how the 112 patients have responded six months after treatment. He is also considering conducting a double-blind, prospective study to more rigorously evaluate the effectiveness of SPG blocks in treating chronic migraines.

NHF board member Mark W. Green, MD, professor of neurology at Icahn School of Medicine at Mount Sinai in New York, questioned the practicality of this treatment, even if replicated, as this is a radiological procedure and the frequency of treatment required to manage chronic headaches was not addressed.

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