Objective.-To report the consistent effect of intranasal lidocaine 4% on pr
eventing headache following aura in one individual.
Background,-A treatment that could prevent the headache which follows an au
ra would be an important advance in the treatment of migraine. No migraine
abortive treatment has been shown to have such an effect.
Methods.-A 15-year-old adolescent boy with a history of recurrent headache
since aged 2, fulfilling the criteria for migraine with aura, was seen in c
onsultation. Intranasal lidocaine 4% was used during the aura phase to prev
ent the headaches.
Results.-Before using intranasal lidocaine, the patient invariably experien
ced a migraine following a typical visual aura. The episodes occurred appro
ximately weekly, with a stable pattern for several years. When given during
the aura, intranasal lidocaine prevented the headache following the aura,
and remained successful on all but two occasions over 1 1/2 years of use (a
pproximately 75 episodes). There was no effect on the duration of the aura
itself.
Conclusions.-Intranasal lidocaine consistently prevented the development of
headache symptoms following aura in this individual. Such an effect sugges
ts a role for the sphenopalatine ganglion in the development of migraine pa
in.