Topical Intranasal Anesthetic Block for Reducing the Pain of Botulinum Toxin Injections for Chronic Migraine

Topical Intranasal Anesthetic Block for Reducing the Pain of Botulinum Toxin Injections for Chronic Migraine: A Randomized, Double-Blind, Placebo-Controlled Crossover Pilot Study

People find the injections used in onabotulinumtoxinA (Botox®) uncomfortable. This study will test whether putting a small piece of cotton soaked with 4% lidocaine (a numbing medicine) inside the front of each nostril for 5 minutes before the injections reduces injection pain compared with cotton soaked in saline (salt water).

Inclusion Criteria:

• Aged ≥18 years
• Any gender
• Able to provide informed consent
• Meets clinical criteria for onabotulinumtoxinA for chronic migraine (minimum of 2 days of disability per month due to facial or headache pain, or 8 headache days per month, or more than 15 headaches per month)
• Scheduled for modified PREEMPT injections at the clinical site

Exclusion Criteria:

• Aged < 18 years
• Trigeminal neuralgia, cluster headache, or other primary headache disorders as dominant diagnosis
• Not able to provide informed consent
• Known allergy/hypersensitivity to lidocaine or amide anesthetics
• Pregnancy/lactation
• Inability to tolerate intranasal nasal cotton pledgets
• Significant nasal pathology at placement site