Cocaine as an Abortive Agent in Cluster Headache

Barre, Felix

doi:10.1111/j.1526-4610.1982.hed2202069.x

Cited by 72 publications

(49 citation statements)

References 14 publications

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“…[11][12][13] It is hypothesized that the mechanism for these agents is by local anesthesia with the blockage of neural transmission of the vidian nerve, the sphenopalatine ganglion (SPG), or the maxillary division of the trigeminal nerve. 14 The other possible mechanism for cocaine is the sympathomimetic effect.…”

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confidence: 99%

Intranasal Lidocaine for the Treatment of Migraine Headache: A Randomized, Controlled Trial

Blanda

Rench

Gerson

et al. 2001

Academic Emergency Medicine

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Abstract. Objective: To evaluate the effect of intranasal lidocaine for immediate relief (5 minutes) of migraine headache pain. Methods: A randomized, double-blind, placebo-controlled clinical trial at two university-affiliated community teaching hospitals enrolled patients 18-50 years old with migraine headache as defined by the International Headache Society. Patients who were pregnant, lactating, known to abuse alcohol or drugs, or allergic to one of the study drugs, those who used analgesics within two hours, or those with a first headache were excluded. Statistical significance was assessed by using chi-square or Fisher's exact test for categorical variables and Student's t-test for continuous variables. Patients rated their pain on a 10-centimeter visual analog scale (VAS) prior to drug administration and at 5, 10, 15, 20, and 30 minutes after the initial dose. Medication was either 1 mL of 4% lidocaine or normal saline (placebo) intranasally in split doses 2 minutes apart and intravenous prochlorperazine. Medications were packaged so physicians and patients were unaware of the contents. Successful pain relief was achieved if there was a 50% reduction in pain score or a score below 2.5 cm on the VAS. Results: Twentyseven patients received lidocaine and 22 placebo. No significant difference was observed between groups in initial pain scores, 8.4 (95% CI = 7.8 to 9.0) lidocaine and 8.6 (95% CI = 8.0 to 9.2) placebo (p = 0.75). Two of 27 patients (7.4%, 95% CI = 0.8, 24.3) in the lidocaine group and three of 22 patients (13.6%, 95% CI = 2.8 to 34.9) in the placebo group had immediate successful pain relief (p = 0.47), with average pain scores of 6.9 (95% CI = 5.9 to 7.8) and 7.0 (95% CI = 5.8 to 8.2), respectively. No difference in pain relief was detected at subsequent measurements. Conclusion: There was no evidence that intranasal lidocaine provided rapid relief for migraine headache pain in the emergency department setting.

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confidence: 99%

Intranasal Lidocaine for the Treatment of Migraine Headache: A Randomized, Controlled Trial

Blanda

Rench

Gerson

et al. 2001

Academic Emergency Medicine

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“…The simplest method of targeting the sphenopalatine ganglion is the self-introduction of an intranasal, cotton-tipped applicator coated with either cocaine or lidocaine. When treated with intranasal cocaine, 11 out of 11 patients studied by Barre reported a greater than 65% reduction in headache intensity [18]. Ten out of 11 patients reported an 80% reduction in the intensity of their cluster headache within 2 min and 30 s. A subsequent but smaller study by Kittrelle showed similar results with the intranasal droplet application of lidocaine [19].…”

Section: Review Of Clinical Datamentioning

confidence: 77%

“…Yet, despite almost a century of therapeutic interest, clinical data is scarce and the optimal technique of SPGB has yet to be determined. Noninvasive methods of blockade including intranasal application of cocaine [18,34], alcohol [17], and lidocaine [19,20] have yielded promising results. Other more invasive techniques such as radiofrequency ablation and pulsed radiofrequency have produced positive results.…”

Section: Review Of Clinical Datamentioning

confidence: 99%

Sphenopalatine Ganglion Block in the Management of Chronic Headaches

Mojica

2017

Curr Pain Headache Rep

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Studies have demonstrated that SPG blockade and neurostimulation can provide pain relief in patients with cluster headaches, migraines, and other trigeminal autonomic cephalalgias. Patients with these conditions showed varying levels and duration of pain relief from SPG blockade. The efficacy of SPG blockade could be related to the different techniques targeting the SPG and choice of therapeutic agents. Based on current studies, SPG blockade is a safe and effective treatment for chronic headaches such as cluster headaches, migraines, and other trigeminal autonomic cephalalgias. Future studies are warranted to define the optimal image-guided technique and choice of pharmacologic agents for SPG blockade as an effective treatment for chronic headaches related to activation of the sphenopalatine ganglion.

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“…Parenteral dihydroergotamine also was described by Horton [11•] in 1952 and more recently (1986) in its intranasal form [14]. In later years, local anesthetic agents such as lidocaine and cocaine have been used in intranasal applications [15,16].…”

Section: History Of the Treatment Of Cluster Headachementioning

confidence: 98%

History of cluster headache

Gordon

2005

Current Science Inc

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Possibly because of the manifestation of severe debilitating pain, cluster headache has been identified in early publications, described in exquisite detail by authors dating as far back as 1641. These early descriptions focused on the symptoms of the episodes rather than the periodicity of their occurrence. Similar to most medical conditions described without anatomic or clearly defined pathophysiologic basis, cluster headache often was named for its clinical manifestations, or less helpfully, by the names of the authors of its descriptive publications. It was only in 1952 that the condition was named for its peculiar tendency to occur in clusters over a period of weeks rather than being a chronic, recurrent, episodic condition similar to migraine. Despite having such an interesting mix of autonomic and physical features, this observation seems to be most instrumental in divulging the true pathogenesis of this disease and correctly localizing its origin anatomically in the hypothalamus.

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Cocaine as an Abortive Agent in Cluster Headache

Cited by 72 publications

References 14 publications

Intranasal Lidocaine for the Treatment of Migraine Headache: A Randomized, Controlled Trial

Intranasal Lidocaine for the Treatment of Migraine Headache: A Randomized, Controlled Trial

Sphenopalatine Ganglion Block in the Management of Chronic Headaches

History of cluster headache

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