The humble chili pepper and its key constituents like capsaicin have been known for several centuries for their role in pain management. Ancient forms of medicine such as Ayurveda and Traditional Chinese Medicine as well as homeopathy recognize the role of capsaicin as an analgesic to treat headache-related pain. And, most recently, clinical research, including double blind controlled trials from the 1990’s onward, have shown the benefits of intranasal administration of capsaicin for the treatment of migraines and cluster headaches.[1] Though practiced since ancient times, the thought of treating migraine pain using capsaicin in the nose can sometimes boggle the minds of patients and healthcare professionals. However, there are several reasons this unique mechanism of action is highly beneficial to addressing the biggest key challenges today’s patient faces when using the limited treatment options such as triptans or over-the-counter pain relievers that are available to them. These challenges include:

  • Not achieving adequate pain relief quickly enough
  • Potential for adverse drug interactions
  • Potential for systemic side effects, including damage to the heart, liver or stomach

Understanding how intranasal use of capsaicin works

Intranasal administration of capsaicin work locally in the nose by desensitizing the trigeminal nerve, resulting in the reduction of CGRP, the neurotransmitter responsible for migraine pain.
Intranasal administration of capsaicin work locally in the nose by desensitizing the trigeminal nerve, resulting in the reduction of CGRP, the neurotransmitter responsible for migraine pain.
In the past decade, there have been major advances in understanding the therapeutic management of migraines by directly inhibiting the source of the headache pain in the brain—CGRP, a pain modulating neurotransmitter in the human nervous system which causes the swelling and inflammation of blood vessels around the brain. Intranasal administration of capsaicin binds directly to the receptors on sensory nerves in the nose, acting as an analgesic by depleting the build-up of CGRP in the brain and essentially, reducing the migraine or severe headache pain within a matter of several minutes.
In fact, a recent 2014 patient analysis presented at the American Academy of Neurology (AAN) annual meeting, found that 83 percent of patients treated with a non-prescription, homeopathic intranasal capsaicin nasal spray for migraine or severe headache (i.e., cluster, tension, rebound, etc.) noted onset of pain relief within three minutes or less. 44 percent of those patients reported immediate pain relief (<1 minute after use).[2] In comparison, prescription triptans such as Imitrex and Zomig—the most commonly used migraine treatments currently—may take up to an hour to display significant onset of relief.
Additionally, a nasal treatment that is specifically formulated using capsicum annuum (capsaicin), is intended to work locally in the nose to deplete CGRP. This mode of action means very minute amounts of medicine are actually used in the nose, resulting in no meaningful uptake in the bloodstream. For the difficult-to-treat patients, the outcome is a treatment option that does not interact with other medicines they may be taking or cause side effects in other organs such as the heart, liver or stomach.
As one can expect, when used correctly, intranasal administration of capsaicin will temporarily sting upon use. This stinging sensation is a standard part of this unique mechanism of action setting off the binding on the nasal sensory nerves—indicating that potential pain relief could be minutes away for the patient. Results from the 2014 AAN patient analysis found that all patients experienced the local adverse event of the nasal sting, which lasted on average, between two to 10 minutes. However, the majority of patients noted that the sting would not dissuade them from using the non-prescription nasal spray again for migraine pain relief.
For the nearly 12 million migraine sufferers in the U.S. who are crippled with pain and unable to function for hours or days at a time and show a sub-optimal response to currently available treatment options, it may be time to give the treatments using the humble chili pepper a look.
References:
Contributors:

  • Dr. Anjan Chatterjee, neurologist, founder of VR1, Inc. and lifelong migraine sufferer

Cited Sources:

[1] Fusco, BM, Barzoi, G, Agro, F. Repeated intranasal capsaicin applications to treat chronic migraine. British Journal of Anaesthesia.  2003.  90(6):812.
[2] Alexianu M., Chatterjee A. “Intranasal capsaicin (IC) rapidly relieves the pain of migraine and other severe headaches.” 66th Annual meeting of the American Academy of Neurology. 2014.


*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.