When should headache treatment be escalated to inpatient IV lidocaine?

Overall, there is a lack of data (few studies) supporting the use of IV lidocaine. There are safety concerns, especially in the pediatric population. The other barrier is lack of expertise, most institutions need a sedation/anesthesia team for IV lidocaine administration even if it's done in outpatient-based infusion centers. After addressing these barriers, there may be some role in cases like NDPH, status migrainous not responding to the usual ED cocktail, etc. If it is used instead of DHE, it...

My personal experience with IV lidocaine for headache or migraine going back to the 1980s is that it does not work. It certainly should never be a reason for hospitalization; we administered it in an outpatient clinic.