PainRelief.com: What should readers take away from your report?
Response: For patients with rCM, lidocaine is an option. While it has not been shown to provide long-term relief beyond 1 month, it can be considered as a treatment to stop the constant cycle of pain. Lidocaine infusions should only be administered by headache experts at experienced centers.
PainRelief.com: What recommendations do you have for future research as a result of this work?
Response: I believe that this study justifies the performance of a randomized, controlled trial comparing lidocaine to placebo. This type of study is the gold standard in our field and while our current study describes an association between lidocaine and pain relief, it cannot prove that lidocaine caused the pain relief because of the retrospective design.
PainRelief.com: Is there anything else you would like to add?
Response: I have no disclosures. Future research, as well as funding from government sources such as the NIH and DOD, should strongly consider including rCM patients in their studies and should set aside funds for this population because their degree of disability can be quite high in some cases and they consume substantial healthcare resources. Patients with rCM have largely been excluded from clinical trials in the past and as such many potentially effective therapies are not supported by strong evidence, limiting their availability and insurance coverage. In the hands of an experienced center like the Jefferson Headache Center, lidocaine infusions and other aggressive treatments can be very effective in many patients.
Schwenk ES, Walter A, Torjman MC, et al
Lidocaine infusions for refractory chronic migraine: a retrospective analysis
Regional Anesthesia & Pain Medicine 2022;47:408-413.
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