The THINK (Treatment of Headache with Intranasal Ketamine) Trial: A Randomized Controlled Trial Comparing Intranasal Ketamine with Intravenous Metoclopramide

Sex-Specific Pharmacotherapy for Migraine: A Narrative Review

“…It is a centrally acting analgesic, although it may also exert some of its antimigraine effects by inhibition of neurogenic inflammation, as trigeminal afferent fibers express a subtype of the NMDA receptor (Wang et al, 2012). It is not clear whether ketamine is effective in migraine, although studies with intranasal ketamine suggest that it may reduce headache-related pain (Afridi et al, 2013;Etchison et al, 2018;Benish et al, 2019).…”

Status Migrainosus in Children and Adults

“…62 A small randomized control trial (RCT) of 17 patients with migraine found that a single dose of 0.08 mg/ kg of ketamine given subcutaneously resulted in a 50% reduction in acute pain compared to placebo. 66 Results showed that intranasal ketamine was not superior to IV metoclopramide; however, the study suggests that intranasal ketamine may have pain-reliving effects comparable to IV migraine abortive therapies. 64 Intranasal formulations of ketamine are available and have been studied in migraine treatment.…”

“…65 To evaluate intranasal ketamine's utility in the ED setting, the Treatment of Headache with Intranasal Ketamine Trial compared the following treatments in 53 subjects with primary headache disorders: (1) a combination of IV metoclopramide and diphenhydramine in normal saline and intranasal normal saline and (2) intranasal ketamine with IV normal saline placebo. 66 Results showed that intranasal ketamine was not superior to IV metoclopramide; however, the study suggests that intranasal ketamine may have pain-reliving effects comparable to IV migraine abortive therapies. A review of treatment trends in the ED found an increase in ketamine use in pediatric patients presenting with lacerations and skeletal fractures; 67 however, there is a lack of studies evaluating the use of ketamine specifically for acute migraine treatment in the pediatric population.…”

Comparison the Efficacy of Intranasal Ketamine Versus Intravenous Ketorolac on Acute Non-Traumatic Headaches: A Randomized Double-Blind Clinical Trial

“…The inclusion criteria were primary (Migraine, tension, and cluster) (19), being in the 18-65 age group, with self-reported severity of 4 or greater on a Visual Analogue Scale (VAS) (0-10), and willingness to participate in the study. Exclusion criteria were weight < 45 kg or > 115 kg, vital sign abnormalities including heart rate < 50 beats/min or > 150 beats/min, systolic blood pressure < 80 or > 200 mm Hg, oxygen saturation < 92%, or respiratory rate < 8 or > 30 breaths/min, patient with a history of alcohol abuse, intracranial hypertension, ischemic heart disease, human immunode ciency virus or immunosuppression, a renal disease requiring dialysis, liver disease, poorly controlled thyroid disease, active bleeding, or current use of anticoagulants (20). Also, patients with Functional neurological disorder (FND), headache with an impaired level of consciousness, headaches with comorbidity, pregnant and lactating women were excluded from our study.…”

“…At rst, the socio-demographic information form and the pain intensity of the patients were completed and recorded. After a practiced nurse placed the IV, ketorolac-treated patients received 30 mg IV ketorolac, and ketamine -treated patients received 0.75 mg/kg (maximum 75 mg) intranasal ketamine via a MAD Nasal™ intranasal mucosal atomization device a xed to a 10-cc syringe (Tele ex Medical Europe Ltd, Westmeath, Ireland) (20,26). A speci c medication was prepared, and its dose was determined by the triage nurse based on the patient's code.…”