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. 2023 Dec;48(12):581-587.
doi: 10.1136/rapm-2022-104223. Epub 2023 May 30.

Real-world study of intranasal ketamine for use in patients with refractory chronic migraine: a retrospective analysis

Hsiangkuo Yuan  1 , Aniket Natekar  2 , Jade Park  3 , Clinton G Lauritsen  1 , Eugene R Viscusi  1 , Michael J Marmura  4
Affiliations

Real-world study of intranasal ketamine for use in patients with refractory chronic migraine: a retrospective analysis

Hsiangkuo Yuan et al. Reg Anesth Pain Med. 2023 Dec.

Abstract

Introduction: Subanesthetic ketamine infusion has been used for managing refractory headache in inpatient or outpatient infusion settings. Intranasal ketamine may be an alternative option for outpatient care.

Methods: A retrospective study was conducted at a single tertiary headache center to assess the clinical effectiveness and tolerability of intranasal ketamine in patients with refractory chronic migraine. Candidates who received intranasal ketamine between January 2019 and February 2020 were screened through an electronic medical record query. Manual chart reviews and structured telephone interviews were conducted on obtaining informed consent.

Results: Of 242 subjects screened, 169 (79.9% women) of median (IQR) age 44 (22) years were interviewed. They reported a median (IQR) of 30 (9) monthly headache days and tried 4 (1) classes of preventive medications. Overall, they used 6 (6) sprays per day, with a median (IQR) of spray use of 10 (11) days per month. Intranasal ketamine was reported as 'very effective' in 49.1% and the quality of life was considered 'much better' in 35.5%. At the time of the interview, 65.1% remained current intranasal ketamine users and 74.0% reported at least one adverse event.

Conclusion: In this descriptive study, intranasal ketamine served as an acute treatment for refractory chronic migraine by reducing headache intensity and improving quality of life with relatively tolerable adverse events. Most patients found intranasal ketamine effective and continued to use it despite these adverse events. Given the potential for overuse, it should be reserved for those clearly in need of more effective rescue treatment with appropriate safety precautions. Well-designed prospective placebo-controlled trials are necessary to demonstrate the efficacy and safety of intranasal ketamine in patients with migraine.

Keywords: Ambulatory Care; Pain Management; Treatment Outcome.

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Conflict of interest statement

Competing interests: Within the past 24 months, HY has received funding from NIH (R44NS115460), institutional support for serving as an investigator from Teva and Abbvie, and royalties from Cambridge University Press and MedLink. AN and JP have no conflicts of interest. CGL has received consulting fees from Impel. ERV has received consultation fees from Heron, Esteve/Kowa, and Salix. MM has received compensation for consultation from Alder/Lumbeck, Axsome, Supernus, Theranica, Upsher-Smith, and Satsuma. He has participated in speaker bureaus for Eli Lilly and Amgen/Novartis and has received institutional support for serving as principal investigator from Teva, GammaCore, and Allergan/AbbVie. He has received payments for authorship or royalties from Demos Medical, Cambridge University Press, and MedLink.

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