Relief and Prevention of Post-Traumatic Headache Using Intranasal Delivery of Lidocaine for Youth (RAPPIDLY): A...

Post-traumatic headache (PTH) is prevalent following concussion, yet few evidence-based treatments exist. Intranasal lidocaine (INL) may help treat migraine; however, it has not been studied specifically for PTH in youth populations. The objectives are to describe the feasibility and acceptability of INL as a PTH treatment for youth in a concussion clinic, explore the change in pain score pre- and post-treatment, and describe patient characteristics and clinical covariates associated with the change in pain score. This feasibility study is a health record review of a concussion clinic in Ottawa, Ontario, Canada. Patients aged 13-30 years presenting with PTH were eligible. Clinicians completed standardized questionnaires that captured patient-reported outcomes. Feasibility was measured by the proportion of patients who accepted INL treatment and acceptability was determined by patient-reported side effects, tolerability, and satisfaction. Proportions with 95% confidence intervals were generated with a Wilson score. Pain scores were reported using the numeric rating scale, where a ≥ 2-point change is clinically significant. The difference in pain after INL was determined using the median and interquartile range. Seventy-seven patients were offered INL, and 57 patients (61% female, median age = 18 years [interquartile range {IQR}:15, 26]) accepted treatment (74%, 95% confidence interval [CI]: 63-83%). The median reported pre-treatment headache pain score was 5 (IQR: 5.0, 6.0) and post-INL pain score was 2 (IQR: 1.0-3.0), reflecting a median reduction from baseline of 3 points (IQR: -5.0, -2.0). No serious adverse events occurred. Mild side effects including throat irritation, numbness, or unpleasant taste were reported by 96% of patients (55/57). Participants reported that the procedure was tolerable (98%, 56/57) and expressed satisfaction (93%, 53/57). Post-INL, 88% (N = 50/57; 95% CI: 77-94) had a headache pain severity reduction of ≥2 points. INL for PTH is feasible in the outpatient setting and is well tolerated, with preliminary evidence of a clinically meaningful and immediate reduction in headache pain severity. Controlled trials are needed to determine INL efficacy for PTH.