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Abstract Details

Acute migraine anesthetic nasal spray treatment during the COVID-19 pandemic
Headache
Headache Posters (7:00 AM-5:00 PM)
086

The SPG is a nerve bundle that lies in the pterygopalatine fossa with important parasympathetic outflow to the craniofacial structures. It is a known target for the acute treatment of migraine. Anesthetic blocking of the SPG may modulate sensory processes in the trigeminal nucleus caudalis, possibly reducing central sensitization of pain in headache. Blocks can be done via needle injection or catheter device insertion to deliver anesthetic to the SPG. During clinic closures due to COVID-19, visits were shifted to telemedicine and there was an increasing need for treatments that would minimize office and emergency room visits.

To determine the efficacy and safety of a self-administered nasal spray targeting the sphenopalatine ganglion (SPG) for acute migraine treatment during the COVID-19 pandemic.

At the start of the pandemic, a nasal spray anesthetic targeting the SPG was prescribed to patients with migraine. Patients were prescribed 1% lidocaine, 2% lidocaine, or 0.5% ropivacaine spray. They were instructed to deliver 0.1cc per dose spray in each nostril and lie back with their head tilted towards the ipsilateral side, for use up to 5 times monthly as needed. A retrospective chart review of 53 patients receiving this treatment was conducted. Analysis included headache improvement and reported side effects.

Overall 76% of patients reported headache improvement acutely. Further, response to all 3 formulations demonstrated majority improvement (89% with 1% lidocaine, 68% with 2% lidocaine, and 81% with 0.5% ropivacaine). Few side effects were reported, only a brief episode of epistaxis in one patient on the 5th usage and transient headache exacerbation in one other patient.

Self-administered anesthetic nasal spray targeting the SPG is likely an effective and safe home acute treatment for migraine attacks. This treatment was of particular benefit for patients during pandemic clinic closures.

Authors/Disclosures
Sarah Molly Bobker, MD
PRESENTER
Dr. Bobker has nothing to disclose.
Annika Ehrlich, NP (UCSF Headache Center) Ms. Ehrlich has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbvie Pharmaceuticals. Ms. Ehrlich has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Theranica. Ms. Ehrlich has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Eli Lilly. Ms. Ehrlich has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Abbvie. Ms. Ehrlich has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for Headache Cooperative of the Pacific. Ms. Ehrlich has received personal compensation in the range of $500-$4,999 for serving as a Meditation teacher with Miles for Migraine. Ms. Ehrlich has a non-compensated relationship as a Working Group Member with Alliance for Patient Access that is relevant to AAN interests or activities. Ms. Ehrlich has a non-compensated relationship as a Board member with Alliance for Headache Disorders Advocacy that is relevant to AAN interests or activities. Ms. Ehrlich has a non-compensated relationship as a Medical reviewer (volunteer) with Migraine Again that is relevant to AAN interests or activities.
Henna Sawhney, MBBS Dr. Sawhney has nothing to disclose.
Cassandra Recchioni Cassandra Recchioni has nothing to disclose.
Morris Levin, MD, FAAN (UCSF Department of Neurology) Dr. Levin has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Supernus, Upsher Smith, Biohaven, Revance, Percept, Theranica, Allergan, Alder, Currax. Dr. Levin has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Theranica. Dr. Levin has received personal compensation in the range of $500-$4,999 for serving as an officer or member of the Board of Directors for Headache Cooperative of the Pacific. Dr. Levin has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Attorney . Dr. Levin has received stock or an ownership interest from Percept. Dr. Levin has received publishing royalties from a publication relating to health care.
Nina Yakovlevna Riggins, MD, FAAN Dr. Riggins has received personal compensation in the range of $500-$4,999 for serving as a Consultant for GLG Gerson Lehrman Group . Dr. Riggins has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Theranica. Dr. Riggins has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for NeurologyLive. The institution of Dr. Riggins has received research support from ElectroCore (GammaCore). The institution of Dr. Riggins has received research support from Miles for Migraine. The institution of Dr. Riggins has received research support from Eli Lilly. Dr. Riggins has received publishing royalties from a publication relating to health care. Dr. Riggins has received publishing royalties from a publication relating to health care. Dr. Riggins has a non-compensated relationship as a PI on research study with TheraSpecs that is relevant to AAN interests or activities. Dr. Riggins has a non-compensated relationship as a Advisory Board with NeurologyLive that is relevant to AAN interests or activities. Dr. Riggins has a non-compensated relationship as a Member of the Board with Miles for Migraine that is relevant to AAN interests or activities. Dr. Riggins has a non-compensated relationship as a PI in the study which used sphenocath device with Dolor Technologies that is relevant to AAN interests or activities. Dr. Riggins has a non-compensated relationship as a PI with Theranica that is relevant to AAN interests or activities.