Headaches

* Re your July 24 article regarding migraine headaches and their response to topical anesthetic nosedrops: The implication is that lidocaine has a direct effect on the headache; I do not agree with this.

For years I have been using topical anesthetics and vasoconstrictors (lidocaine and Afrin) as test vehicles to monitor reaction to severe headache symptoms. The patients who respond quickly invariably have compressive anatomy in their nasal cavities, i.e. bone spurs, soft tissue swelling, etc.

Removal or surgical modification of these structures frequently eradicates these painful “rhinogenic headaches” permanently. People who benefit from these topical treatments should be examined by a qualified otolaryngologist (ear-nose-throat physician).

MICHAEL L. MERRIN MD