Efficacy of ophthalmic tetracaine for acute migraine relief: A randomized, placebo-controlled trial in the emergency department.

OBJECTIVES

To assess the efficacy of ophthalmic tetracaine for treating migraine headaches in the emergency department (ED).

METHODS

In this randomized, double-blind, placebo-controlled study, ninety patients were randomly assigned to two groups: ophthalmic tetracaine (0.5 mg/mL), vs placebo (artificial tear), both of which were administered by a blinded resident. Headache intensity was measured via a visual analog scale (VAS) before treatment and at 1-, 3-, and 5-minutes post-administration, with patients monitored for six hours for efficacy and side effects.

RESULTS

Ninety patients were enrolled, with no significant baseline differences between groups. Mean pain scores were similar at baseline (8.80 ± 1.52 vs. 7.00 ± 2.43; P = 0.46) but were significantly lower in the tetracaine group at 1 min (5.28 ± 2.71 vs. 7.33 ± 2.46), 3 min (4.53 ± 3.53 vs. 7.31 ± 2.45), and 5 min (4.13 ± 3.20 vs. 7.28 ± 2.42) (all P < 0.001). Blurred vision (37.7% vs. 2.2%) and eye irritation (82.2% vs. 4.4%) were more frequent with tetracaine, while other adverse events were similar between groups.

CONCLUSIONS

Although ophthalmic tetracaine was associated with a rapid reduction in migraine pain intensity in this study, the findings should be interpreted cautiously given the small sample size, incomplete patient blinding, and short follow-up period. While these results suggest a potential role for tetracaine as an early adjunctive therapy in the emergency setting, further large-scale, multicenter studies are needed to confirm its effectiveness, safety, and clinical applicability.