Intranasal ketamine for acute cluster headache attacks-Results from a proof-of-concept open-label trial

Area of Science:

• Neurology
• Pain Management
• Pharmacology

Background:

• Limited acute treatment options exist for cluster headaches (CH) unresponsive to standard therapies like oxygen and triptans.
• Intranasal ketamine has shown anecdotal success in alleviating CH attacks.

Purpose of the Study:

• To evaluate the safety and efficacy of intranasal ketamine for treating single cluster headache attacks.
• To assess pain reduction and patient preference compared to existing treatments.

Main Methods:

• An open-label pilot study involving 23 patients with chronic cluster headaches.
• 20 patients received 15 mg of intranasal ketamine every 6 minutes (max 5 doses) under observation.
• Primary endpoint: 50% pain reduction within 15 minutes of treatment initiation.

Main Results:

• The primary endpoint was not met; only a 15% pain reduction was observed at 15 minutes.
• Significant pain reduction (59%) occurred at 30 minutes post-first dose (p < 0.001).
• Half of the patients preferred ketamine over oxygen/sumatriptan; no serious adverse events were reported.

Conclusions:

• Intranasal ketamine may be an effective acute treatment for cluster headaches, particularly at the 30-minute mark.
• Larger, controlled studies are warranted to validate these findings.
• Awareness of ketamine's abuse potential is crucial for patients and clinicians.