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[Ketamine i. v. for the treatment of cluster headaches : An observational study]
L Granata1,2, H Niebergall3, R Langner4
1Schmerzmedizin Zürich, Trichtenhauser Str. 12, 8125, Zollikerberg, Schweiz. livia.granata1961@gmail.com.
Insights
Low-dose ketamine infusions effectively treated refractory cluster headaches. Episodic cluster headache patients achieved 100% remission, while chronic cases saw 54% symptom relief, suggesting neuroplasticity mechanisms.
Area of Science:
- Neurology
- Neuroscience
- Pharmacology
Background:
- Cluster headaches affect 1-3 per 10,000 individuals, with a higher prevalence in males.
- Despite not being life-threatening, cluster headaches cause severe pain and disability.
- Pathophysiology involves the hypothalamus, brainstem, and genetic factors; current treatments are often ineffective for refractory cases.
Purpose of the Study:
- To evaluate the efficacy of low-dose ketamine infusions in patients with treatment-refractory cluster headaches.
- To compare outcomes between episodic and chronic cluster headache subtypes.
Main Methods:
- A controlled study treated 29 patients (16 episodic, 13 chronic) with refractory cluster headaches.
- Intravenous ketamine (NMDA receptor antagonist) was administered at low doses over 40-60 minutes, repeated up to four times every two weeks.
- Patient outcomes were monitored for remission and duration of relief.
Main Results:
- 100% of patients with episodic cluster headaches experienced complete abortion of attacks.
- 54% of patients with chronic cluster headaches achieved complete attack abortion.
- Symptomatic relief was sustained for 3-18 months post-treatment.
Conclusions:
- Low-dose ketamine is a highly effective treatment for refractory episodic cluster headaches and shows significant efficacy in chronic forms.
- The observed long-term remission suggests potential neuroplastic brain repair and remodeling as underlying mechanisms.
- Ketamine offers a promising therapeutic option for patients with debilitating, treatment-resistant cluster headaches.
Abstract:
Cluster headaches have an incidence of 1-3 per 10,000 with a 2.5:1 male-to-female gender ratio. Although not life threatening, the impact of the attacks on the individual patient can result in tremendous pain and disability. The pathophysiology of the disease is unclear, but it is known that the hypothalamus, the brainstem, and genetic factors, such as the G1246A polymorphism, play a role. A distinction is made between episodic and chronic cluster headaches. In a controlled setting, we treated 29 patients with cluster headaches (13 with chronic cluster and 16 with the episodic form), who had been refractory to conventional treatments, with a low dose of ketamine (an NMDA receptor antagonist) i.v. over 40 min to one hour every 2 weeks or sooner for up to four times. It was observed that the attacks were completely aborted in 100 % of patients with episodic headaches and in 54 % of patients with chronic cluster headaches for a period of 3-18 months. We postulated neuroplastic brain repair and remodulation as possible mechanisms.
