Ketamine-Magnesium for Refractory Chronic Cluster Headache: A Case Series

Area of Science:

• Neurology
• Pain Medicine
• Pharmacology

Background:

• Refractory chronic cluster headache (rCCH) is a rare, debilitating neurological disorder requiring novel therapeutic strategies.
• Previous case reports suggest potential efficacy of ketamine-magnesium combination in rCCH.

Purpose of the Study:

• To evaluate the safety and efficacy of a single ketamine-magnesium combination infusion for reducing headache attacks in patients with rCCH.
• To assess the response rate and tolerability of this combined therapy.

Main Methods:

• A consecutive series of 17 patients with rCCH resistant to at least three prior treatments received a single infusion of ketamine (0.5 mg/kg) and magnesium sulfate (3000 mg).
• The primary outcome measured was the change in the number of daily attacks two weeks before versus one week after treatment.
• Secondary outcomes included the percentage of responders (≥50% attack reduction) and adverse events.

Main Results:

• The mean number of daily attacks decreased significantly from 4.3 ± 2.4 before treatment to 1.3 ± 1.0 after treatment (P < .001).
• A substantial responder rate of 76% (13/17 patients) was observed.
• Transient and mild sedation was the most common adverse event, reported by 41.2% of patients.

Conclusions:

• The ketamine-magnesium combination shows promise as an effective and well-tolerated treatment for refractory chronic cluster headache.
• Further validation through placebo-controlled studies is warranted to confirm these findings and establish its role in clinical practice.