Intravenous Lignocaine Infusions for Severe Chronic Daily Headache

Objectives: To determine the safety and efficacy of intravenous lignocaine infusion in patients with severe chronic daily headache (CDH).

Design: Retrospective survey of consecutive patients.

Participants: 19 patients, 18 with rebound headache and three with status migrainosus. Two patients had both conditions at different times.

Setting: Neurology unit in a major metropolitan teaching hospital, 1994-1998.

Main Outcome Measures: Adverse events; headache resolution; long term efficacy.

Results: The 19 patients (16 women) received 27 lignocaine infusions. Seven minor adverse events were noted during four infusions. Twenty-two infusions were given for analgesic rebound headache in 18 patients, with headache resolution in 82% of infusions (17 of the 18 patients responded at least once). Four patients obtained lasting relief, six returned to their regular manageable pattern of migraine (in two of these patients CDH recurred after six months), four were lost to follow-up, and in four there was no long term benefit. Five infusions were given for status migrainosus in three patients, with four of these infusions successfully relieving the headache.

Conclusions: Intravenous lignocaine appears to be useful in the management of severe intractable CDH and status migrainosus.