Lidocaine Combined With Platelet-Rich Plasma for Stellate Ganglion Block in Chronic Migraine: A Multicenter, Prospective, Propensity Score-Matched Cohort Study.

OBJECTIVES

To explore the association of stellate ganglion block with platelet-rich plasma plus lidocaine with clinical outcomes in adults with chronic migraine, in comparison to lidocaine alone.

METHODS

This multicenter prospective exploratory study enrolled 200 adults with chronic migraine scheduled for stellate ganglion block across three hospitals from October 2024 to September 2025. Treatment allocation was based on patient preference within a prespecified quota design, with 100 patients per group receiving either platelet-rich plasma plus lidocaine or lidocaine alone. Propensity score matching was performed to balance confounders. The primary outcome was the mean change from baseline in monthly headache days at 1 month post-intervention. Secondary outcomes included headache frequency, pain intensity, headache duration, response rate, analgesic consumption, functional status, and safety.

RESULTS

After propensity score matching, 66 patients per group were analyzed. At one month, the platelet-rich plasma plus lidocaine group showed a significantly greater reduction in monthly headache days compared with lidocaine alone (mean difference, 1.84 days; 95% confidence interval [CI], 0.68-2.99; p = 0.002). This advantage persisted at two and three months. The combination group also demonstrated superior improvements in pain intensity, headache duration, response rate, and analgesic reduction at all time points, along with better functional status at 1 and 2 months (all nominal P < 0.05). Baseline disability was a negative predictor of one-month response. No significant differences in safety outcomes were observed.

CONCLUSION

In this exploratory study, stellate ganglion block with platelet-rich plasma plus lidocaine was associated with clinically meaningful improvements in headache outcomes and functional status compared with lidocaine alone in patients with chronic migraine, with a favorable safety profile. These findings warrant validation in a definitive randomized trial.