The effect of intranasal cocaine and lidocaine on nitroglycerin-induced attacks in cluster headache

A. Costa, E. Pucci, F. Antonaci, G. Sances, F. Granella, G. Broich, G. Nappi

Research output: Contribution to journalArticlepeer-review


The administration of nitroderivatives in cluster headache (CH) sufferers is the most reproducible experimental paradigm to induce spontaneous-like pain attacks. Previous uncontrolled studies have reported that the local use of anaesthetic agents in the area of the sphenopalatine fossa is able to extinguish nitroglycerin (NTG)-induced pain in CH. The present study, carried out according to a double-blind placebo-controlled design, included 15 CH patients, six with episodic CH (mean ±SD age of 36.8 ±5.6 years), and nine with chronic CH (37.8 ±10.4 years). Patients had undergone a standard NTG test (0.9 mg sublingually), during which the intensity of pain was scored using a visuoanalogic scale (VAS, range 0-10). Nine patients (two with the episodic form, seven with the chronic form) experienced a typical, spontaneous-like attack on the usual side, occurring in all cases within 45 min. In these patients, the test was repeated with an interval of 2 days, and once pain intensity reached 5 on the VAS, a 10% solution of cocaine hydrochloride (1 ml, mean amount per application 40-50 mg), or 10% lidocaine (1 ml), or saline was applied using a cotton swab in the area corresponding to the sphenopalatine fossa, trader anterior rhinoscopy. This was done in both the symptomatic and the non-symptomatic side, for 5 min. Treatments were always performed randomly, in separate sessions. All patients responded promptly to both anaesthetic agents, with complete cessation of induced pain occurring after 31.3±13.1 min for cocaine and 37.0±7.8 min for lidocaine (M±SD). In the case of saline application, pain severity increased thereafter, and extinction of the provoked attacks occurred with a latency of 59.3±12.3 min (P

Original languageEnglish
Pages (from-to)85-91
Number of pages7
Issue number2
Publication statusPublished - 2000

ASJC Scopus subject areas

  • Clinical Neurology


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