Intranasal Ketamine for Abortive Migraine Therapy in Pediatric Patients: A Single-Center Review

Turner, Adrian L.; Shandley, Sabrina; Miller, Ean; Perry, Μ. Scott; Ryals, Brian

doi:10.1016/j.pediatrneurol.2019.10.007

Cited by 10 publications

(7 citation statements)

References 22 publications

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“…IN ketamine reduced the severity (p=0.032) but not the duration of the aura, whereas midazolam had no effect. 17 Twenty-five (73.5%) were responders with an average pain score reduction of -7.2 from admission to discharge, 19 suggesting potential utility in severe migraine. Petersen et al also showed that IN ketamine 15mg every 6 minutes (max 5 uses) could reduce pain intensity of 1.1 (95%CI −0.6 to 2.7) in 15 minutes and 4.3 (95%CI 2.4-6.2) in 30 minutes among 20 cluster headache patients.…”

Section: Resultsmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Yuan

Natekar

Park

et al. 2022

Preprint

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Subanesthetic ketamine infusion has been used for managing refractory headache in inpatient or outpatient infusion settings. Intranasal (IN) ketamine may be an alternative option for outpatient care. We performed a retrospective study at a single tertiary headache center to assess the clinical effectiveness and tolerability of IN ketamine in patients with refractory chronic migraine (rCM). Candidates who received IN ketamine between January 2019 and February 2020 were screened through an electronic medical record query. Manual chart reviews and structured phone interviews were conducted upon obtaining informed consent. Among 242 subjects screened, 169 (age 44.3 ± 13.8; female 79.9%) were interviewed. They reported 25.0 ± 8.7 monthly headache days and tried 6.9 ± 3.1 preventive medications. Overall, they used roughly 7.8 ± 7.0 sprays (ie., 78 mg) per day and 11.6 ± 8.9 days per month. Intranasal ketamine was reported as "very effective" in 49.1% and quality of life (QOL) was considered "much better" in 35.5%. However, 74.0% reported at least one adverse event (AE). In this retrospective study, IN ketamine can serve as an acute treatment for rCM by reducing headache intensity and improving QOL with relatively tolerable AEs. Most patients found IN ketamine effective and continued to use it despite these AEs. The study is limited by its single-center design and selection/recall biases. Well-designed prospective placebo-controlled trials are necessary to demonstrate the efficacy and safety of IN ketamine in patients with migraine.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Yuan

Natekar

Park

et al. 2022

Preprint

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“…It should be noted that in three retrospective studies on chronic refractory migraines and new daily persistent headaches, positive results were shown in those cohorts of patients using ketamine infusions [ 18 27 40 ]. In another retrospective study using intranasal ketamine in a pediatric population, the intervention showed promising outcomes in both pain relief and side effect minimization [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

Efficacy of ketamine in the treatment of migraines and other unspecified primary headache disorders compared to placebo and other interventions: a systematic review

Chah

Jones

Milord

et al. 2021

J Dent Anesth Pain Med

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Background Migraine headaches are the second leading cause of disability worldwide and are responsible for significant morbidity, reduction in the quality of life, and loss of productivity on a global scale. The purpose of this systematic review and meta-analysis was to evaluate the efficacy of ketamine on migraines and other primary headache disorders compared to placebo and other active interventions, such as midazolam, metoclopramide/diphenhydramine, and prochlorperazine/diphenhydramine. Methods An electronic search of databases published up to February 2021, including Medline via PubMed, EMBASE, Web of Science, and Cochrane Library, a hand search of the bibliographies of the included studies, as well as literature and systematic reviews found through the search was conducted to identify randomized controlled trials (RCTs) investigating ketamine in the treatment of migraine/headache disorders compared to the placebo. The authors assessed the risk of bias according to the Cochrane Handbook guidelines. Results The initial search strategy yielded 398 unduplicated references, which were independently assessed by three review authors. After evaluation, this number was reduced to five RCTs (two unclear risk of bias and three high risk of bias). The total number of patients in all the studies was 193. Due to the high risk of bias, small sample size, heterogeneity of the outcomes reported, and heterogeneity of the comparison groups, the quality of the evidence was very low. One RCT reported that intranasal ketamine was superior to intranasal midazolam in improving the aura attack severity, but not duration, while another reported that intranasal ketamine was not superior to metoclopramide and diphenhydramine in reducing the headache severity. In one trial, subcutaneous ketamine was superior to saline in migraine severity reduction; however, intravenous (I.V.) ketamine was inferior to I.V. prochlorperazine and diphenhydramine in another study. Conclusion Further double-blind controlled studies are needed to assess the efficacy of ketamine in treating acute and chronic refractory migraines and other primary headaches using intranasal and subcutaneous routes. These studies should include a long-term follow-up and different ketamine dosages in diagnosed patients following international standards for diagnosing headache/migraine.

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“…Algunos autores examinaron la acción de la ketamina por vía intranasal, aunque contemplaron diferentes aspectos como el aura de la migraña, la cefalea primaria y la migraña en jóvenes, lo cual dificulta la comparación de los resultados obtenidos. Aun así, cabe mencionar que produjo una reducción en la intensidad del aura, aunque no en su duración (Afridi et al, 2013), y no se mostró superior al tratamiento estándar en la cefalea primaria (Benish et al, 2019); mientras que en la migraña de la población pediátrica careció de eficacia en la mayoría de los pacientes de la muestra del estudio (Turner et al, 2020). En esta revisión bibliográfica, solo una investigación incluyó la vía intramuscular en la administración de la ketamina (Krusz et al, 2008a), resultando ser eficaz para la disminución del dolor agudo y la migraña refractaria.…”

Section: Discussionunclassified

“…Por último, podemos mencionar un trabajo reciente que examina el tratamiento de la migraña pediátrica con ketamina (Turner et al, 2020). Se describe una serie de pacientes que acudieron al departamento de urgencias de un centro médico pediátrico con ataques de migraña, recibiendo ketamina intranasal cada 15 minutos hasta llegar a 5 dosis y registrándose las puntuaciones de dolor en una escala al inicio y tras la aplicación de la dosis.…”

Section: Alucinógenos Y Cefaleasunclassified

Potencial terapéutico de los alucinógenos en las cefaleas: una revisión teórica

Collantes¹,

Navarro

2021

Escritos Psicología

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Los alucinógenos incluyen a un grupo heterogéneo de sustancias que provocan cambios en la percepción sensorial, el pensamiento y la consciencia. El potencial terapéutico de diversas drogas alucinógenas está recibiendo un interés creciente en los últimos años. En este trabajo presentamos una revisión bibliográfica centrada en el posible uso de los alucinógenos (LSD, psilocibina y ketamina) en el tratamiento y prevención de las cefaleas. Para ello, se ha realizado unabúsqueda (sin límite temporal) en las bases de datos de Web of Sciences, Scopus y Pubmed, además de una búsqueda manual en las referencias de los artículos. Los resultados constatan la eficacia del LSD, especialmente a nivel profiláctico, mientras que la ketamina podría ser de utilidad para abortar los ataques agudos y la psilocibina ha demostrado ser efectiva en ambos aspectos. Los estudios existentes se han llevado a cabo principalmente en pacientes con migraña y con cefalea en racimos, entre otros tipos de cefaleas. Asimismo, se señalan diversas limitaciones metodológicas que pueden dificultar la generalización de los resultados, y se sugiere la necesidad de realizar futuras investigaciones en este campo emergente.

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Intranasal Ketamine for Abortive Migraine Therapy in Pediatric Patients: A Single-Center Review

Cited by 10 publications

References 22 publications

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

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

Efficacy of ketamine in the treatment of migraines and other unspecified primary headache disorders compared to placebo and other interventions: a systematic review

Potencial terapéutico de los alucinógenos en las cefaleas: una revisión teórica

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