title: Evaluation of efficacy of intra-nasal lidocaine for headache relief in patients refer to emergency department.
abstract: BACKGROUND
  Headache is a common complaint for emergency visits. Common drugs used in relief of headache are opioids and their agonists and antagonists, ergot alkaloids, and nonsteroidal anti-inflammatory drugs (NSAIDs). Lack of appropriate medications or serious side effects of available drugs, motivated us to perform the study for evaluating the efficacy of intranasal lidocaine on different types of headache.
  
  
  METHODS
  A double-blind, randomized clinical trial (RCT) was performed among 90 adult patients with acute headache in Shahid Rahnemoon Emergency Center of Yazd city of Iran (45 patients in lidocaine group and 45 patients in placebo group). Patients with history of epilepsy, allergy to lidocaine, signs of skull base fracture, Glasgow Coma Scale (GCS) < 15, patients younger than 14 years and patients who had received any medication in previous 2 h were excluded. After checking vital signs and taking the demographic data, one puff of 10% lidocaine or normal saline (placebo) was sprayed into each nostril. Patients' headache severity measured by visual analog scale (VAS) before drug administration and at 1, 5, 15, and 30 min after intervention. Data were analyzed by Statistical Package for Social Sciences (SPSS) version 17 and statistical tests including t-test, repeated measures analysis of variance (ANOVA), Fisher's exact test, and Mann-Whitney test were performed. Descriptive variables were expressed by mean ± standard deviation (SD) and quantitative variables reported by frequency and percentages. P-values less than 0.05 were considered significant.
  
  
  RESULTS
  57.8% of patients were female. The mean age of patients was 35.32 years. According to sex and age, there was no significant difference between groups (P-values were 0.83 and 0.21; respectively). The mean base pain score was 6.97 in lidocaine group and 6.42 in placebo group which was not significantly different (P-value = 0.198). After intervention, the mean scores were significantly lower in lidocaine group than placebo group in all mentioned times (P-value < 0.001). The primary and secondary headaches had no significant difference in mean pain relief score in lidocaine group (P = 0.602).
  
  
  CONCLUSIONS
  Intranasal lidocaine is an efficient method for pain reduction in patients with headache. Regarding easy administration and little side effects, we recommend this method in patients referred to emergency department (ED) with headache.
authors.affiliation: Department of Emergency Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
authors.forename: Naser
authors.initials: N
authors.lastname: Mohammadkarimi
authors.affiliation: Department of Emergency Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
authors.forename: Mohammadali
authors.initials: M
authors.lastname: Jafari
authors.affiliation: Department of Neurology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Mellat
authors.affiliation: Department of General Practitioner, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
authors.forename: Ehsan
authors.initials: E
authors.lastname: Kazemi
authors.affiliation: Department of General Practitioner, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
authors.forename: Amir
authors.initials: A
authors.lastname: Shirali
keywords: Headache; intranasal; lidocaine
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