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.