Baclofen IV in the clinic: effective treatment for muscle spasm pain and migraines

IV baclofen was used to treat refractory cervical muscle spasm/pain associated with migraines/daily headaches in an outpatient headache clinic. IV baclofen is not commercially available in the USA. A sterile preparation of baclofen (2.5mg/ml, pH 6.6) was made with a compounding pharmacist, and studied to reduce neck pain/spasm accompanied by refractory migraine headaches. 63 patients were treated in the clinic with pulse oximetry monitoring. 5-10 mg of IV baclofen given at intervals of 10-15 minutes with rating of muscle pain/spasm and headache/migraine every 15 minutes. A 0-10 VAS was used to monitor severity. Average initial muscle spasm/pain was rated 9.1/10. Migraines/headaches were rated 7.9/10. Muscle spasm/pain was diminished to 1.6/10 (p< .001, 2-tailed t test). Some patients (n=19) were treated up to 6 times ; 21 were treated once. Headache severity diminished to 3.2/10 (p< .001) at end of treatment; migraine was absent (n = 24 pts). Muscle spasm 0/10 in 30 of 63 patients treated. Duration of response was 22.9 hrs (+/- 6.5 hrs) for muscle spasm and migraine headache. 11 patients had failed prior oral baclofen treatment. Transient drowsiness was seen in 14 patients, no other side effects were reported, and nausea was treated with ondansetron. IV baclofen is a very efficacious and safe treatment for refractory muscle spasm/pain, associated with migraines/headaches in an outpatient setting with monitoring. Both symptoms were reduced to a highly statistically significant degree. IV baclofen offers a unique approach to treatment in the clinic. Side effects were minimal and the medication was well tolerated. Double-blind studies for this medication are definitely warranted, given the impressive open-label results. Type B GABA receptor activity may be altered or reduced in muscle spasm pain and in associated migraines. Baclofen is postulated to play a promotive or modulatory role in this painful disorder.