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. 2018 Feb 13;19(1):14. doi: 10.1186/s10194-018-0843-5

Table 2.

Summary of studies evaluating topical intranasal administration of LA in pain disorders of the head and face

Author Drug Concen-tration Volume Condition RCT Effect Nr of patients Technique Ref.
Sluder Cocaine 4–70% A drop Meckel’s ganglion neuralgia No Positive effect in a series of patients 5 Applicator, surgery [7]
Alcohol A drop
formaldehyde 0,4% N/S
Silver nitrate 2% N/S
Barre Cocaine 5–10% N/S CH No Positive effect in a series of patients 11 Barre’s techniquea [20]
Kittrelle Cocaine 5% CH (NTG-induced) No > 75% reduction in headache intensity within 3 min, in 4 of 5 patients with lidocaine 5 Barre’s techniquea [12]
lidocaine 4% 1 ml
Hardebo Cocaine 10% 0,3 ml CH No Lidocaine and cocaine equally effective 24 Nasal droper [27]
Lidocaine 4% 0,5–0,8 ml
Robbins Lidocaine 4% 4–6 sprays CH No 54% mild to moderate relief after treatment 30 Spray [26]
Kudrow Lidocaine 4% 0,4 ml Migraine No Migraine attacks aborted in 12 of 23 patients 23 Barre’s techniquea [38]
Maizels Lidocaine 4% 0,5 ml Migraine Yes 55% of patients that received lidocaine had at least 50% reduction of headache within 15 min (primary endpoint) 81 Barre’s techniquea [4]
Maizels Lidocaine 4% 0,5 ml Migraine Yes Randomized trial with open-label follow-up. Controlled trial: 35.8% of patients had headache relieved to mild or none 15 min. After treatment. 131 Barre’s techniquea [5]
Maizels Lidocaine 4% 0,5 ml Migraine No Prevention of the development of headache following aura. 1 Barre’s techniquea [39]
Saberski Lidocaine 20% N/S Postherpetic neuralgia No Decrease of the pain (therapy repeated 11 times) 1 Applicator dipped in anaesthetic [40]
Costa Lidocaine 10% 1 ml CH (NTG-induced) Yes All patients responded to both anaesthetics with complete cessation of induced pain (31.3 ± 13.1 min for cocaine and 37.0 ± 7.8 for lidocaine. For saline, pain severity increased initially and resolved with a latency of 59.3 ± 12.3 min. 15 Cotton swab under rhinoscopy [34]
Cocaine 10% 1 ml
Blanda Lidocaine 4% 1 ml Migraine Yes The study was negative for the main outcome measure (decrease of ≥50% of initial pain score or an absolute pain score ≤ 2.5 cm at 5 min. 49 Barre [29]
Windsor Lidocaine 2% 1–2 ml Herpes keratitis No Relief of pain in one case report 1 Applicator developed by the authors [15]
Chae Lidocaine 2% N/S Post-traumatic headache No Reduction of VAS scale within 15 min in both patients (from 8/10 to 0/10 in the first and from 10/10 to 2/10 in the second) 2 N/S [41]
Cohen Lidocaine 4% N/S Postdural puncture headache No Relief of pain in a series of patients 13 Applicator saturated [42]
Bakbak Lidocaine 10% 2 ml CH No Relieve of pain and autonomic symptoms 1 Cotton-tipped applicator [43]
Pfaffenrath Lidocaine 6% 0,1 ml Migraine Yes Primary endpoint not met: proportion of pain-free patients two hours after treatment. Improvement of several secondary endpoints. 140 Spray [30]
Ketorolac 0,1 ml
Candido Ropivacaine 0,5% 0,5 ml 1 TN, 1 CM, 1 post-herpetic neuralgia No All 3 patients reported pain relief within the first 15 min. Post-treatment. 3 Tx360® [44]
Dexamethasone
Cady Bupivacaine 0,5% 0,3 ml Chronic migraine Yes Reduction of pain compared to placebo at 15 min, 30 min and 24 h compared to placebo (primary endpoint). Decreased HIT-6 score compared to placebo at 1 and 6 months. 38 Tx360® [30]
Mohammadkarimi Lidocaine 10% 1 puff Acute headache Yes Significant reduction of mean pain scores at 1 min (primary endpoint). The effect was sustained at 30 min 90 Spray [37]
Cohen Lidocaine 5% N/S Postdural puncture headache No Relief of pain in a series of patients 32 Applicator saturated [45]
Cady Bupivacaine 0,5% 0,3 ml Chronic migraine Yes Primary endpoint: statistically significant reduction of NRS scores. A comparison of the number of headache days during the baseline period and 1 month post-treatment was not significant. 38 Tx360® [32]
Schaffer Bupivacaine 0,5% 0,3 ml Acute headache Yes Primary endpoint (50% reduction in pain at 15 min) negative. 93 Tx360® [31]
Androlaukis Bupivacaine 0,5% 0,6 ml Hemicrania continua No Reduction in average intensity and frequency of headaches and autonomic symptoms. 1 Tx360® [3]
Dance Lidocaine 4% N/S Migraine (pediatric patients age 7–18) No Reduction of pain scores (only abstract available). 85 Allevio® [46]

LA local anesthetic, SPF sphenopalatine foramen, RCT randomized clinical trial, CH cluster headache, N/S not specified, TN trigeminal neuralgia, CM chronic migraine, NTG nitroglycerine

aBarre’s technique: the patient lies supine with extended neck (45 degrees) and head rotated 30 degrees ipsilateral to the pain. After the desired volume of anesthetic is applied, the patient should stay in the described position for 30 s. [35, 7, 12, 13, 15, 20, 26, 27, 2932, 34, 3746]