Cluster headache. Local anesthetic abortive agents.

Area of Science:

• Neurology
• Pain Management
• Pharmacology

Background:

• Cluster headaches are intensely painful neurological events.
• Cocainization of the sphenopalatine fossa rapidly aborts acute cluster headaches.
• The mechanism of cocaine's action (sympathomimetic vs. local anesthetic) was previously unknown.

Purpose of the Study:

• To determine if local anesthetic effects are responsible for cocaine's cluster headache relief.
• To investigate lidocaine as a safe, nonaddicting alternative for cluster headache treatment.
• To elucidate the mechanism of action for cocaine in aborting cluster headaches.

Main Methods:

• A 4% lidocaine solution was applied to the sphenopalatine fossa in patients with cluster headache.
• Patients received lidocaine for both nitrate-induced and spontaneous cluster headache attacks.
• The study compared lidocaine's efficacy to cocaine's known effects.

Main Results:

• Four out of five patients experienced rapid relief from cluster headaches and associated symptoms after lidocaine application.
• Lidocaine proved effective in aborting both induced and spontaneous cluster headache attacks.
• The findings suggest an anesthetic, rather than sympathomimetic, action is responsible for pain relief.

Conclusions:

• Local anesthetic effects, not sympathomimetic actions, mediate cocaine's cluster headache abortive properties.
• Pain transmission in cluster headaches likely involves the sphenopalatine fossa.
• Topical lidocaine is a safe and effective agent for the rapid abortion of acute cluster headaches.