Title : Intra-arterial infusions of lidocaine for chronic headache management
Abstract:
Background: Chronic and refractory headache syndromes, including migraine, cluster headaches, and trigeminal autonomic cephalalgias, are debilitating conditions that often fail to respond to conventional pharmacologic therapy. Intra-arterial therapies represent an emerging interventional radiology (IR) approach that targets the vascular supply to pain-generating structures, aiming to disrupt aberrant nociceptive signaling. These procedures allow for targeted delivery of therapeutic agents—such as anesthetics or vasodilators—directly to implicated arteries, potentially reducing systemic side effects while providing significant symptomatic relief.
Materials and Methods: Candidates for intra-arterial headache therapies typically include patients with chronic headaches refractory to oral, intravenous, or nerve block treatments. Under fluoroscopic or angiographic guidance, selective catheterization is performed into target vessels, most commonly branches of the external carotid artery (e.g., middle meningeal, occipital, or superficial temporal arteries). The chosen therapeutic agent is infused slowly while monitoring for neurological changes and hemodynamic stability. Most procedures are conducted in an outpatient setting, with a short observation period post-intervention.
Results: Published clinical reports and case series describe meaningful pain relief in a significant proportion of patients, with some experiencing decreased headache frequency and severity lasting weeks to months. The therapeutic benefit varies depending on the underlying headache type and agent used. Side effects are generally mild and transient, including dizziness, localized numbness, or transient hypotension. Complications, though rare, may include vascular spasm or non-target effects. Repeat treatments are possible for recurrent cases, and cumulative benefits have been observed.
Conclusion: Intra-arterial therapies offer a promising, minimally invasive option for the management of refractory headache syndromes. By delivering targeted agents to specific vascular territories, these techniques may provide rapid and sustained relief while limiting systemic exposure. As clinical evidence expands, intra-arterial interventions may play an increasingly important role within a multidisciplinary headache management strategy, emphasizing careful patient selection, anatomical expertise, and procedural precision.
