BACKGROUND: Management of chronic migraine (CM) or new daily persistent headache (NDPH) in those who require aggressive outpatient and inpatient treatment is challenging. Ketamine has been suggested as a new treatment for this intractable population. METHODS: This is a retrospective review of 77 patients who underwent administration of intravenous, subanesthetic ketamine for CM or NDPH. All patients had previously failed aggressive outpatient and inpatient treatments. Records were reviewed for patients treated between January 2006 and December 2014. RESULTS: The mean headache pain rating using a 0-10 pain scale was an average of 7.1 at admission and 3.8 on discharge (P < .0001). The majority (55/77, 71.4%) of patients were classified as acute responders defined as at least 2-point improvement in headache pain at discharge. Some (15/77, 27.3%) acute responders maintained this benefit at their follow-up office visit but sustained response did not achieve statistical significance. The mean length of infusion was 4.8 days. Most patients tolerated ketamine well. A number of adverse events were observed, but very few were serious. CONCLUSIONS: Subanesthetic ketamine infusions may be beneficial in individuals with CM or NDPH who have failed other aggressive treatments. Controlled trials may confirm this, and further studies may be useful in elucidating more robust benefit in a less refractory patient population.
BACKGROUND: Management of chronic migraine (CM) or new daily persistent headache (NDPH) in those who require aggressive outpatient and inpatient treatment is challenging. Ketamine has been suggested as a new treatment for this intractable population. METHODS: This is a retrospective review of 77 patients who underwent administration of intravenous, subanesthetic ketamine for CM or NDPH. All patients had previously failed aggressive outpatient and inpatient treatments. Records were reviewed for patients treated between January 2006 and December 2014. RESULTS: The mean headache pain rating using a 0-10 pain scale was an average of 7.1 at admission and 3.8 on discharge (P < .0001). The majority (55/77, 71.4%) of patients were classified as acute responders defined as at least 2-point improvement in headache pain at discharge. Some (15/77, 27.3%) acute responders maintained this benefit at their follow-up office visit but sustained response did not achieve statistical significance. The mean length of infusion was 4.8 days. Most patients tolerated ketamine well. A number of adverse events were observed, but very few were serious. CONCLUSIONS: Subanesthetic ketamine infusions may be beneficial in individuals with CM or NDPH who have failed other aggressive treatments. Controlled trials may confirm this, and further studies may be useful in elucidating more robust benefit in a less refractory patient population.
Authors: Eric S Schwenk; Basant Pradhan; Rohit Nalamasu; Lucas Stolle; Irving W Wainer; Michael Cirullo; Alexander Olsen; Joseph V Pergolizzi; Marc C Torjman; Eugene R Viscusi Journal: Curr Pain Headache Rep Date: 2021-07-16
Authors: Steven P Cohen; Anuj Bhatia; Asokumar Buvanendran; Eric S Schwenk; Ajay D Wasan; Robert W Hurley; Eugene R Viscusi; Samer Narouze; Fred N Davis; Elspeth C Ritchie; Timothy R Lubenow; William M Hooten Journal: Reg Anesth Pain Med Date: 2018-07 Impact factor: 6.288
Authors: Eric S Schwenk; Eugene R Viscusi; Asokumar Buvanendran; Robert W Hurley; Ajay D Wasan; Samer Narouze; Anuj Bhatia; Fred N Davis; William M Hooten; Steven P Cohen Journal: Reg Anesth Pain Med Date: 2018-07 Impact factor: 6.288
Authors: Ashley R Etchison; Lia Bos; Meredith Ray; Kelly B McAllister; Moiz Mohammed; Barrett Park; Allen Vu Phan; Corey Heitz Journal: West J Emerg Med Date: 2018-09-10