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As-Needed Intranasal Ketamine Relieves Refractory Migraine Pain in Some Patients
Nearly half of patients with refractory chronic migraine interviewed about their use of intranasal ketamine considered the treatment “very effective,” and more than two-thirds said it improved their quality of life. Researchers reported their single-center study results in the journal Regional Anesthesia & Pain Medicine.
“Clinicians should only consider the use of a potentially addictive medication such as ketamine for significantly disabled patients with migraine…,” wrote corresponding author Michael J. Marmura, MD, Thomas Jefferson University Department of Neurology, Philadelphia, Pennsylvania, and study coauthors. “At Jefferson, we have more than 20 years of experience in ketamine infusion for chronic pain and headache and have written guidelines on ketamine use. Understanding the potential risk for outpatient intranasal ketamine use, we have established several strategies/safeguards to ensure patient safety.”
The retrospective study included 169 patients with refractory chronic migraine who received intranasal ketamine at the Jefferson Headache Center between January 2019 and February 2020. Patients in the study experienced a median 30 headache days a month and had tried 4 classes of preventive medications.
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“While effective treatment options are limited, as-needed intranasal ketamine seemed to have mitigated acute headache pain intensity and reduced other acute medication use,” researchers reported.
Overall, patients used 6 sprays of intranasal ketamine daily on a median 10 days a month. Some 49.1% of participants deemed the treatment “very effective,” and 39.6% found it “somewhat effective.” Intranasal ketamine led to a “much better” quality of life in 35.5% of patients and “somewhat better” quality of life in 42.6% of patients.
When interviewed for the study, 65.1% of the patients were still using intranasal ketamine. Nearly 75% reported at least one adverse event. Fatigue and double vision/blurred vision were the most common, followed by cognitive adverse events such as confusion/dissociation, vivid dreams, or hallucination.
“These adverse events were usually short-lasting,” researchers wrote, “and patients continued using intranasal ketamine with caution afterwards.”
While further studies are needed to confirm the findings, “this retrospective study suggests that intranasal ketamine may offer a pain-relieving effect with limited morbidity for refractory chronic migraine in the outpatient setting,” the authors advised.
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