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Lignocaine for acute migraine


Clinical bottom line

Intranasal and intravenous lignocaine can relieve acute migraine attacks. However, based on existing research it is unlikely that this offers any benefit over more standard treatments, and these should therefore be used in preference.

Lignocaine and other local anaesthetic-type drugs which block sodium channels have been used to relieve chronic clinical pain. Lignocaine is an amide type local anaesthetic, and has been studied in the treatment of acute migraine attacks.

Systematic review

Kalso E, Tramèr MR, Moore RA, McQuay HJ. Systemic local anaesthetic type drugs in chronic pain: a qualitative systematic review. Eur J Pain. 1998; 2: 3-14.

  • Date review completed: September 1996
  • Number of trials included: 3
  • Number of patients: 182
  • Control group: placebo or active control
  • Main outcomes: findings from original trials
Inclusion criteria were randomised controlled trials of local anaesthetic-type drugs for migraine; pain outcomes.


Three trials of 182 patients were included.

One trial of intranasal lignocaine (20-80 mg) with 81 patients showed significantly better pain relief than placebo.

Two trials looked at intravenous lignocaine. One trial of intravenous lignocaine (1 mg/kg) was no better than placebo. The second trial of intravenous lignocaine (up to 2.7 mg/kg) was not as effective as intravenous chlorpromazine, but as effective as intravenous dihydroergotamine.

Adverse effects

Minor local adverse effects were reported for intranasal and intravenous lignocaine, but there were no drug-related withdrawals.

Related topics

  • Identifier CP079 - 1904 LIGNOCAINE FOR ACUTE MIGRAINE: Jul-99