Intranasal Capsaicin (IC) Rapidly Relieves the Pain of Migraine and Other Severe Headaches (P7.179)

Abstract

OBJECTIVE: Thirteen patient case-series treated with intranasal capsaicin (IC) for migraines, cluster headache and other severe frequent headaches. BACKGROUND: Intranasal Capsaicin (IC) administration is hypothesized to cause analgesia by calcium-mediated desensitization of the trigemino-vascular system. Effective for migraines and cluster headaches, IC has not been described in the treatment of other types of severe headaches. Less well understood is the natural history of treatment response and time to symptom relief. DESIGN/METHODS: Thirteen patients (6 men), ages 28-65, with headaches, (migraines without aura [6], cluster headache [1], post-traumatic headache [1], tension headache [4], medication overuse headache [1]) and related moderate to severe functional disability, were treated with IC. Current medications included naproxen, piroxicam, butalbital, sumatriptan, eletriptan, rizatriptan, verapamil, oxygen and prednisone (Cluster Headache). Post informed consent, an index episode of headache was treated with IC (50 μL, ipsilateral nose) without the use of concomitant medicine. Patients were instructed to use IC as early as possible, allowed to use repeat doses prn, and were asked to report efficacy (five point scale from no relief [1+] to complete pain relief [5+]), tolerability, and time to analgesia. RESULTS: Nine patients had complete (5+) pain relief, one reported (4+), two reported (3+) and one (2+) relief. All patients reported onset of relief in less than a minute post-dose and maximal analgesia inside of 3 minutes. Relief duration ranged from 30 minutes (cluster headache) to several hours. Adverse events included nasal sting (13/13), lacrimation (13/13) and sneezing (4/13). Sting intensity was rated as severe/prolonged in 3/13 patients. Sting duration ranged from 2 to 10 minutes. One patient declined IC for subsequent headaches due to low perceived efficacy. Subsequent dosing in twelve patients did not change the efficacy/tolerability parameters reported. CONCLUSIONS: IC may be an option for rapid analgesia in a range of headache disorders. Nasal sting was not a deterrent for use if IC was perceived effective. Study Supported by: VR1 Inc.

Disclosure: Dr. Alexianu has nothing to disclose. Dr. Chatterjee has received personal compensation for activities with VR1 Inc. as an employee. Dr. Chatterjee holds stock and/or stock options in VR1 Inc., which sponsored research in which Dr. Chatterjee was involved as an investigator.