IV Lidocaine May Be Safe, Efficacious for Pediatric Status Migraine

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The average length of time for to achieve 50% pain reduction was 16.3±12.9 hours.
The average length of time for to achieve 50% pain reduction was 16.3±12.9 hours.

Intravenous (IV) lidocaine may be safe and effective for the treatment of children and adolescents with status migraine, according to a study published in Pediatric Critical Care Medicine. Prospective studies are needed to further investigate effectiveness, safety, and duration of effects of the treatment after discharge.

This study included 26 participants with status migraine whose average age was 14.9±2.4 years and who were hospitalized for a mean of 4.6±1.5 days. The average length of time for to achieve 50% pain reduction was 16.3±12.9 hours, and the average time for complete resolution of pain was 19.3±19.3 hours. There was a 90.3% rate of pain resolution (95% CI, 75.1% to 96.6%), with 51.6% of study participants experiencing a relapse (95% CI, 34.8% to 68%). 

Participants reported a mean pain score of 1±1.6 at discharge, with the mean highest and lowest pain scores decreasing over 5 days of therapy (Day 1: mean highest pain score, 5.1±1.9 to 1.0±1.4; mean lowest pain score: 2.1±2.4; Day 5: mean highest pain score, 1.0±1.4; mean lowest pain score: 0). High pain score by day varied significantly (P <.01) via one-way analysis.

A bolus was used to administer lidocaine (2.9±0.18 mg/kg) to 80.6% of participants, with the rest receiving infusion (ranging from 1.29±0.2 mg/kg/hr to 1.56±0.27 mg/kg/hr). The range of lidocaine drip was 1.125 mg/kg/hr to 2.25 mg/kg/hr. One participant's lidocaine was interrupted due to chest pain and anxiety.

The study researchers conclude that “[in] the appropriate patient population, IV lidocaine may be a safe and effective treatment for children and adolescents with status migraine. Larger prospective studies need to be done not only to evaluate safety and efficacy but also the analgesic longevity of IV lidocaine post discharge.”

Reference

Ayulo MA Jr, Phillips KE, Tripathi S. Safety and efficacy of IV lidocaine in the treatment of children and adolescents with status migraine [published online June 19, 2018]. Pediatr Crit Care Med. doi: 10.1097/PCC.0000000000001629

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