IN Ketamine Migraines Summary
New research suggests that intranasal (IN) Ketamine could be a viable treatment option for individuals with chronic, refractory migraines who do not respond to other medications. A retrospective cohort study found that half of the participants who used IN Ketamine for chronic, treatment-refractory migraines reported it as “very effective,” and more than one-third noted an improvement in their quality of life. The study’s lead investigator, Dr. Hsiangkuo Yuan, explained that even with just a few uses per day, intranasal Ketamine demonstrated the potential to enhance patients’ quality of life. Dr. Yuan is an associate professor of neurology at Thomas Jefferson University and the director of clinical research at the Jefferson Headache Center in Philadelphia.
Daily Migraines, Failed Medications
The use of intranasal (IN) Ketamine for the treatment of chronic, treatment-refractory migraines has not been extensively studied, although it has been examined in patients with cluster headaches and migraines. Additionally, Ketamine has not yet received approval from the US Food and Drug Administration for migraine treatment. To gain further insight into the impact of Ketamine on individuals with chronic, treatment-refractory migraines, researchers conducted a retrospective analysis of electronic health records from patients at the Jefferson Headache Center. The study included 242 patients who had received IN Ketamine, and the research team followed up with 169 patients who agreed to participate in the study.
The study included patients with chronic, treatment-refractory migraines who had tried multiple preventive medications without success. They used a median of two medications, with the most common being a CGRP monoclonal antibody. The patients used intranasal Ketamine, on average, six sprays per day for about 10 days per month, with pain relief typically starting around 52 minutes after dosage.
Most patients experienced at least one side effect from Ketamine, such as fatigue, double/blurred vision, or confusion/dissociation, but these effects were usually temporary. The main reasons for starting Ketamine treatment were inadequate response to previous acute and preventive medications, as well as previous benefit from intravenous (IV) Ketamine.
Around half of the participants found intranasal Ketamine to be very effective, while 40% considered it somewhat effective. The majority reported an improvement in their quality of life, with 36% stating it was much better and 43% saying it was somewhat better. Among those who continued using Ketamine during the study follow-up, 82% reported it as very effective.
Compared to other acute headache medications, participants rated intranasal Ketamine as much better or somewhat better. Additionally, nearly 75% of participants reported using fewer pain relievers while using Ketamine.
The researchers acknowledged the potential for Ketamine to be addictive and emphasized that it should only be considered for severely affected migraine patients. They suggested the need for further research, including prospective, randomized controlled trials to assess the efficacy, tolerability, optimal dosage, and predictors of response to intranasal Ketamine in individuals with chronic, treatmentrefractory migraines.
Dr. Richard Lipton, a professor of neurology, psychiatry, and behavioral sciences and the director of the Montefiore Headache Center at Albert Einstein College of Medicine in New York City, commented on the study’s findings. He described the results as impressive, particularly for a population with chronic migraines that had previously failed multiple treatments. Dr. Lipton, who was not involved in the study, stated that the real-world data suggests Ketamine is an effective option for medically intractable chronic migraines.
He highlighted the high persistence rate of patients who started on Ketamine (65%) and the reported high effectiveness among those who continued using it (82%). Dr. Lipton expressed increased confidence in using intranasal Ketamine as a treatment option for difficult-to-treat patients and stated his intention to use it more frequently in the future.
*Both Dr. Lipton and Dr. Yuan emphasized the importance of conducting well-designed placebo controlled trials and rigorous comparative effectiveness studies to further investigate the efficacy and safety of intranasal Ketamine as a treatment for chronic migraines.