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November 20, 1996

Intranasal Lidocaine for Treatment of Migraine

JAMA. 1996;276(19):1553. doi:10.1001/jama.1996.03540190025021

To the Editor.  —In my otolaryngology clinical practice, I have identified and treated patients with middle turbinate headache syndrome (MTHS),1 which may simulate symptoms of acute migraine. These patients have enlarged middle turbinates often due to pneumatization (concha bullosa). It is theorized that contact between an enlarged middle turbinate and either the septum or lateral nasal wall may cause headache referred to the ophthalmic division of the trigeminal nerve. These patients also typically respond to lidocaine or cocaine introduced intranasally with temporary relief of pain and headache. The diagnosis of MTHS is suspected with nasal endoscopy and is confirmed with a coronal computed tomographic (CT) scan of the sinus that demonstrates concha bullosa. Since the clinical presentation can be similar to migraine headache, I would recommend a coronal CT scan of the sinus and turbinates be performed in patients with headaches of questionable etiology.Treatment of MTHS is directed at relieving the