Comparison of the efficacy of intranasal ketamine versus intravenous ketorolac on acute non-traumatic headaches: a randomized double-blind clinical trial

Abstract

Introduction Non - traumatic headaches are one of the most common causes of referral to hospital emergency. This study aimed to compare the efficacy of intranasal ketamine and intravenous ketorolac on acute non-traumatic headaches. Methods This randomized and double-blind clinical trial was conducted in 2019. One hundred and forty samples were randomly divided into intranasal ketamine (A) and intravenous ketorolac (B). Group (A) received ketamine intranasal (0.75 mg/kg, max 75 mg), and group B received intravenous ketorolac (30 mg). Headache severity was measured on arrival, 30, 60, and 120 min after intervention with Visual Analogue Scale (VAS). The side effects were recorded an hour after the intervention. Result The mean difference of pain intensity 30, 60, and 120 min after the intervention between the two groups was statistically significant (p < 0.001). In the first 30 min, significant changes were observed in the VAS levels of the two groups. These changes were significantly greater in the intranasal ketamine group (p < 0.001). Side effects such as fatigue, dizziness, general discomfort, nausea, increased heart rate, and hypertension were significantly higher in the ketamine group (p < 0.05). Conclusion Intranasal ketamine and intravenous ketorolac both effectively reduced headaches. However, more analgesic effects of intranasal ketamine in a short time can be considered as a selective approach to reducing headaches. Trial registration IRCT20180108038276N3, Registered 29 September 2019. Ethics committee reference number IR.KUMS.REC.1398.068.

Ketamine Applications for Migraines: A Scoping Narrative Review

“…The results of intranasal ketamine were more motley in nature than intravenous ketamine, with varied dosages, effects, and relief. Benish, with their 0.75 mg/kg (maximum 75 mg) first dose and 0.25 mg/kg (maximum 25 mg) second dose produced no significant difference in pain reduction compared to Afridi's 3 doses of 25 mg, Kaube's 1 dose of 25 mg, and Turner's serial dosing of 0.1-0.2 mg/kg/dose (up to 5 doses) for pediatric patients [32][33][34][35][36][37][38][39][40]42 . Benish did report a numerical decrease in reported pain value, however.…”

“…The three randomized-controlled trials included in this section collectively favor the use of intranasal ketamine for migraine management [37][38][39] . Sarvari et.…”

“…al. conducted a randomized, double-blinded, parallel design of 140 patients comparing a one-time intranasal 0.75 mg/kg ketamine (max 75 mg) to 30 mg intravenous ketorolac 37 . Investigators were blinded to patient medications; to blind the participants, subjects in the intranasal ketamine group also received 1000 mL of normal saline intravenously while; subjects in the ketorolac group also inhaled atomized saline.…”

Real-world study of intranasal ketamine for use in patients with refractory chronic migraine

“…Pain reduction was significantly greater in IN ketamine than in IV ketorolac at 30, 60, and 120 min. 21 These RCTs showed that IN ketamine may be as effective as the standard IV headache regimen. Apart from RCTs, Turner et al retrospectively reviewed 34 patients with status migrainosus receiving IN ketamine (0.1-0.2 mg/kg) in an inpatient setting.…”

“…Over the last few years, IN ketamine has been evaluated for acute pain management. 14,15 While there is some evidence behind IN ketamine as a treatment for headache disorders (e.g., migraine, cluster headache, non-traumatic headache) in several studies, [16][17][18][19][20][21] its role in treating rCM has not been well described nor validated. At our center, IN ketamine is often prescribed to patients with rCM who do not respond well to standard infusion treatments, including dihydroergotamine and lidocaine, before or after a scheduled ketamine infusion.…”