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Ketamine for Refractory Chronic Migraine: An Observational Pilot Study and Metabolite Analysis
Eric S Schwenk1, Marc C Torjman1, Ruin Moaddel2
1Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Journal of Clinical Pharmacology
|June 14, 2021
Summary
Intravenous ketamine infusions provided greater short-term pain relief for chronic migraine patients than lidocaine. Ketamine
Area of Science:
- Neurology
- Pharmacology
- Pain Management
Background:
- Refractory chronic migraine significantly impacts patients' quality of life.
- Limited treatment options exist for patients with chronic migraine who have failed multiple therapies.
- Intravenous lidocaine and ketamine infusions are used for aggressive treatment of chronic migraine.
Purpose of the Study:
- To compare the efficacy of intravenous lidocaine and (R,S)-ketamine infusions in patients with refractory chronic migraine.
- To analyze the metabolite profile of (R,S)-ketamine during infusions in this patient population.
- To investigate the role of (2R,6R)-hydroxynorketamine, a ketamine metabolite, in pain reduction.
Main Methods:
- Prospective, observational pilot study involving 6 patients with refractory chronic migraine.
- Administration of both lidocaine and (R,S)-ketamine infusions.
- Assessment of pain ratings using a 0-10 numeric rating scale before, during, and after infusions.
- Metabolite analysis of (R,S)-ketamine, focusing on (2R,6R)-hydroxynorketamine levels.
Main Results:
- Both lidocaine and (R,S)-ketamine infusions were well-tolerated with mild adverse effects.
- Lidocaine infusion showed a significant decrease in pain from baseline, but pain returned to baseline levels by 4 weeks.
- (R,S)-ketamine infusion resulted in a greater reduction in pain from baseline compared to lidocaine, though pain also increased by 6 weeks.
- Ketamine metabolite analysis confirmed (2R,6R)-hydroxynorketamine as the predominant metabolite during infusion.
Conclusions:
- Intravenous (R,S)-ketamine demonstrated a statistically significant, albeit minimally clinically significant, greater reduction in pain compared to lidocaine in this pilot study.
- The metabolite (2R,6R)-hydroxynorketamine was prevalent during ketamine infusions, aligning with animal study findings on pain reduction.
- Further research is warranted to explore the long-term efficacy and optimal use of ketamine infusions for chronic migraine management.
