Migraine treatment using X-ray guidance may hold potential for relief

Preventive treatment for migraines has eluded doctors for decades: In the last 50 years, no new treatment has been pinpointed to alleviate the debilitating condition, which affects nearly 18 percent of the U.S. population.

Now, a team of radiologists are reporting preliminary findings that may indicate promise for a common technique to mitigate severe headaches— and that the method has the potential to join the sparse list of temporary, first-line solutions for migraines. That list includes the nasal spray Imitrex, as well Botox and the use of antidepressants.

In an observational, retrospective analysis of 112 adults with either cluster headaches or migraines, radiologists at Albany Medical Center in New York paired well-known intranasal sphenopalatine ganglion (SPG) blockers, a method for treating migraines, with X-ray technology. Researchers used lidocaine— a topical numbing agent that has been used for decades in numerous medical procedures— to block electrical impulses and reset an abnormal the sphenopalatine ganglion nerve pathway that is thought to stimulate migraines.

In the 30-minute procedure, study authors used X-rays to apply a highly concentrated amount of lidocaine via a spaghetti-strand-size catheter inserted in the right and left nostrils of patients. Thirty days after the procedure, 88 percent of patients reported needing less or no migraine medication for ongoing relief. Patients reported their level of pain on a scale of 1 to 10, and they reported an average score of 8.25 prior to treatment. A rank of 10 indicated severe pain, and one indicated mild pain. At the 30-day mark, patients reported an average score of 5.25, a 36 percent decrease from pretreatment.

“It’s clearly going to be useful in the present and the future as a treatment option, but just like other treatments and medications, it’s not a permanent fix,” lead study author Kenneth Mandato, an interventional radiologist at Albany Medical Center, told FoxNews.com of his image-guided technique. “It’s not that we got rid of the migraine stimulus— we just tried to reset the way the body responds to the stimulus.”

At the onset of the study, 98 participants, or 87.5 percent, had migraines, while 14 participants, or 12.5 percent, had cluster headaches. Cluster headaches, one of the most painful types of headaches, occur rarely and in cyclical patterns, and can last from weeks to months before months- and years-long remission, according to the Mayo Clinic.

Mandato was inspired to conduct the study after a family friend’s child received lidocaine nasal spray to treat headaches and experienced instant relief. When Mandato researched the method on his own, he saw that intranasal application was common but that results of the procedure’s efficacy rates were sparse. To determine the true effectiveness of image-guided intranasal SPG blocks, Mandato noted that a double-blind, randomized and controlled study would need to be conducted next, but that his observations hold promise.

“I think basically, scraping the surface, my study as well as the literature out there is all positive, and the stuff that I’ve read about is in very small numbers but very conclusive that this works,” he said.

While Mandato argued that the procedure is minimally invasive and that X-ray technology allows for a more precise application of lidocaine, neurologists expressed skepticism over the technique.

Peter Goadsby, a neurology professor at the University of California, San Francisco— who specializes in the diagnosis and treatment of headache disorders, including migraines and cluster headache and other forms of chronic daily headache— cautioned migraine patients, as the study was retrospective.

“I see no sense in complicating what can be done with a cotton swab on the physician’s couch,” Goadsby told FoxNews.com.

Lawrence Newman, director of the Mount Sinai-Roosevelt Headache Institute, also noted the importance of a double-blind study. He added that less-invasive techniques, such as the application of long-acting lidocaine via a small needle at the occipital nerve— located slightly above the neck at the back of the head— has shown similar results for relieving migraine pain.

“That’s not to say that this procedure isn’t good and doesn’t work, but you can’t make any grand claims based on a study that’s open-label and has a mix of patients,” Newman told FoxNews.com.

But he added that due to a lack of funding, treatments for severe headaches are few and far between, so finding new preventative solutions is essential.

“All the drugs that we currently use for migraine were found just by chance. Someone had another condition and then the drug was found to reduce their migraine,” Newman said. “There’s a dearth of funding and studies for this. I wouldn’t turn down anything as potentially promising; it just needs to be validated.”

Mandato and his team are presenting their findings at the 2015 Interventional Radiology's Annual Scientific Meeting.