Ketamine Exhibits Effective Pain Relief for Refractory Headaches

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Ketamine is associated with significant pain relief among patients with refractory headaches.
The following article features coverage from Anesthesiology 2017 in Boston, Massachusetts. Click here to read more of Clinical Pain Advisor‘s conference coverage.

Ketamine is associated with significant pain relief among patients with refractory headaches, according to study findings presented at Anesthesiology 2017, held October 21-25 in Boston, Massachusetts.

“Headaches that have failed multiple treatments, known as refractory headaches, can have a major negative impact on quality of life,” said study investigator Eric S. Schwenk, MD, associate professor and director of orthopedic anesthesia at Jefferson University Hospitals, Philadelphia, Pennsylvania. “We found that patients with these types of headaches who received infusions of ketamine…experienced improved pain control during their infusions.”

In this study, researchers sought to determine the effect of ketamine in patients with refractory headaches at doses lower than the maximum dose rate.

The investigators performed a retrospective review of data from patients with admitted migraine and refractory headache (n=61) receiving infusions of ketamine for pain management. Average length of ketamine infusion was 5.1 days. Pain was reported using a 10-point numeric rating scale.

On admission, average pain rating as assessed by the Sounds, Eyes, and Motor (SEM) scale was 7.5±0.2 compared with 3.4±0.3 at discharge. Investigators found that the lowest pain rating was reported on day 4. In addition, reported pain scores were significantly different at treatment onset, lowest levels, and end of treatment (P <.001). Lowest pain ratings were achieved at an average 30.8±3.6 mg/hr less than the maximum dose rate. Only 1 patient discontinued therapy because of adverse events.

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“The findings of this retrospective study are exciting as [they] point to a potential treatment for patients who have failed essentially all other options,” concluded Dr Schwenk. “There is still a lot of work to be done to establish [whether this] will work for other kinds of headaches and refinements of dosing [must be accomplished] to improve both effectiveness and acceptance of this novel treatment.”

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Rangavajjula A, Hernandez M, Dayan AC, Schwenk ES, Viscusi ER. The use of ketamine infusions for refractory headaches: a retrospective analysis. Presented at: Anesthesiology 2017;  October 21-25, 2017; Boston, MA. Abstract A1065.