Disappointing Results from a Trial of Intranasal Bupivacaine for Headache

Prior research has shown intranasal lidocaine to be an effective treatment for migraine (NEJM JW Emerg Med Aug 16 1996). Now, investigators report results of a randomized, controlled, manufacturer-sponsored trial of intranasal bupivacaine for unselected headaches in 93 emergency department patients.

Patients with any acute headache of frontal or global location received 0.5% bupivacaine or saline placebo administered intranasally with a novel device that injects topical medicine directly onto the mucosa overlying the sphenopalatine ganglion. The main outcome, headache relief 15 minutes after treatment, did not differ between groups. However, at 24 hours, more patients in the bupivacaine group than the placebo group were headache free (72% vs…