Cluster Headache—Acute and Prophylactic Therapy

Avi Ashkenazi, MD; Todd Schwedt, MD


Headache. 2011;51(2):272-286. 

In This Article


Data on the efficacy of locally applied lidocaine on acute CH attacks are derived from several non-controlled studies and 1 randomized controlled trial.[25–28] Kittrelle et al examined the effect of lidocaine, applied topically to the sphenopalatine fossa, on acute CH attacks.[25] Four of the 5 treated patients experienced rapid relief from pain and associated symptoms of nitrate-induced CH attacks. The treatment was also effective for spontaneous attacks. In another study, Hardebo and Elner examined the effect of lidocaine 4%, self-applied using a nasal dropper through the nostril ipsilateral to the pain, on CH pain and associated symptoms.[26] Twenty-four patients were studied, with moderately positive results. Robbins examined the effect of intranasal lidocaine, administered through a spray bottle, on pain in 30 men with ECH.[27] Patients treated 2 consecutive CH attacks. Results were modest, with 27% reporting on "moderate relief," 27% on "mild relief," and 46% on no relief. In a placebo-controlled study, Costa et al examined the efficacy of lidocaine 10%, applied bilaterally to the sphenopalatine fossa via a cotton swab using anterior rhinoscopy, on nitroglycerin-induced CH attacks.[28] Lidocaine application resulted in elimination of pain in all (15) patients. However, there was a considerable delay (of 37 minutes on average) between the time of lidocaine application and pain relief (the corresponding time interval for placebo was 59 minutes).

In summary, intranasal lidocaine is at best moderately effective in the treatment of acute CH attacks. It should not be used as a first-line therapy for this indication. This treatment may be used as adjunctive therapy in some patients whose attacks do not completely respond to other, more effective, therapies.


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