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Ketamine Infusions for Treatment Refractory Headache
Jared L Pomeroy1, Michael J Marmura1, Stephanie J Nahas1
1Thomas Jefferson University, Philadelphia, PA, USA.
Headache
|December 28, 2016
Summary
Subanesthetic ketamine infusions show promise for treating chronic migraine (CM) and new daily persistent headache (NDPH) in patients resistant to other therapies. This treatment significantly reduced pain scores, offering a potential option for intractable headache cases.
Area of Science:
- Neurology
- Pain Management
- Pharmacology
Background:
- Chronic migraine (CM) and new daily persistent headache (NDPH) pose significant management challenges, especially in treatment-refractory patients.
- Intractable headache conditions often necessitate exploring novel therapeutic avenues.
Purpose of the Study:
- To evaluate the efficacy and safety of intravenous, subanesthetic ketamine for patients with CM or NDPH who have failed aggressive treatments.
- To assess pain reduction and response rates in this difficult-to-treat population.
Main Methods:
- Retrospective review of 77 patients with CM or NDPH treated with intravenous, subanesthetic ketamine.
- Data collected from January 2006 to December 2014 for patients with a history of failed aggressive outpatient and inpatient treatments.
- Analysis of pain ratings, response definitions, duration of infusion, and adverse events.
Main Results:
- Mean pain rating decreased from 7.1 at admission to 3.8 at discharge (P < .0001).
- 71.4% of patients were acute responders, with at least a 2-point pain improvement at discharge.
- While 27.3% experienced sustained benefit at follow-up, this did not reach statistical significance. Most patients tolerated ketamine well with few serious adverse events.
Conclusions:
- Intravenous, subanesthetic ketamine may offer benefits for CM and NDPH patients who have not responded to other intensive treatments.
- Further controlled trials are warranted to confirm efficacy, particularly in less refractory patient groups.