Lidocaine-Based Treatments Offer Another Option for Severe Migraines

Another Option for SevereMigraines: Lidocaine-Based Treatments Offer Fresh Possibilities

For patients living with severe,treatment-resistant migraines, the lack of effective relief can be profoundlydisabling. Emerging evidence is renewing interest in two therapeutic uses oflidocaine, an older local anesthetic. We already use it for nerve blocks tonumb branches of the trigeminal and occipital nerves, which can stop a migraineattack. It can also be used by injection in other targeted ways.

Intravenous Lidocaine

For patients with prolonged,intractable migraines (often classified as status migrainosus or refractorymigraine), intravenous lidocaine infusions can provide meaningful clinicalbenefit. In February 2026, the American Society of Regional Anesthesia and PainMedicine updated its guidelines to include IV lidocaine as a recommendedinpatient option.

A large study analyzing morethan 600 inpatient cases found that nearly 88% of patients experiencedsubstantial pain improvement during hospitalization. Even more notably, 43%maintained relief one month post-discharge. Treatment typically involves a carefullymonitored, continuous infusion over several days, with ECG and laboratorymonitoring to ensure safety.

At standard infusion doses in amonitored setting, side effects are generally mild and reversible, mostcommonly transient nausea, lightheadedness or dizziness, a “spacey” or sedatedfeeling, perioral or facial tingling, and metallic taste or tinnitus. Thesesymptoms usually resolve with slowing or stopping the infusion.

A New Direction: MiddleMeningeal Artery Infusion

A complementary, moreexperimental approach targets the middle meningeal artery (MMA), which suppliesthe brain’s covering and is increasingly recognized as a key player in migrainepathophysiology. An interventional neuroradiologist or a neurosurgeon candeliver a small dose of lidocaine directly into this arterial territory,precisely where migraine-driven neurogenic inflammation may occur. This is doneunder mild sedation through a catheter inserted into an artery in the wrist orgroin.

Preliminary outcomes arepromising. In a 2025 pilot study involving eight patients with severe,refractory migraines, five achieved at least a 50% reduction inmigraine-related disability at three months following treatment. Half of theparticipants improved from severe disability to virtually no disability.Strikingly, three of four patients previously dependent on opioid analgesicswere able to discontinue them altogether.

No significant adverse eventswere observed, and many patients reported immediate headache relief thatpersisted well beyond lidocaine’s expected pharmacologic effect. This suggestsa possible reset of central pain processing mechanisms.

The potential side effects ofMMA lidocaine infusion include vascular injury or spasm, which can causelocalized headache, vessel dissection, or transient neurologic symptoms;allergic or systemic lidocaine reactions such as lightheadedness or dizziness;and catheter-related complications such as infection, bleeding, or hematoma atthe access site.

For patients who have exhaustedstandard preventive and abortive strategies and who continue to have persistentsevere pain, these specialized treatments may offer another option. As with allinterventional approaches, risks and benefits should be weighed carefully inconsultation with an experienced headache specialist.

‍