PHILADELPHIA, Pa. — Finding relief from chronic migraines can be challenging, but a recent study suggests that a nasal spray containing ketamine may be a safe and effective solution. Unlike intravenous infusion, which is the standard method of administration, the nasal spray offers a more convenient alternative. However, researchers caution that it should be reserved for patients who have exhausted other treatment options, due to the potential for overuse.
Previous studies have shown the effectiveness of intravenous ketamine for chronic headaches, but its usage is limited to outpatient clinics and requires the expertise of a pain specialist. The question remained whether ketamine could also be a viable and safe treatment for chronic migraines that do not respond to conventional therapies.
To explore this, researchers conducted a retrospective review of patients who were prescribed nasal ketamine sprays for refractory chronic migraines at a specialized headache center. Out of 242 individuals, 169 agreed to participate in the study, primarily women with an average age of 44.
Most participants experienced daily headaches and had tried multiple preventive drugs without success. Their motivation for using the nasal spray included inadequate responses to pain relievers and preventive medications, previous positive experiences with intravenous ketamine, and unsuccessful attempts with intravenous lidocaine.
On average, patients used the nasal spray six times a month for a duration of 10 days, according to a media release. Nearly half of them reported the spray as “very effective,” while around 39.5 percent found it “somewhat effective,” leading to an improved quality of life. Compared to other pain relievers, a significant portion of participants considered the nasal spray to be superior.
The study revealed that most users experienced temporary side-effects, including fatigue, double or blurred vision, and cognitive effects like confusion or dissociation. However, these effects did not persist.
It’s important to note that this study was conducted at a single tertiary headache center and primarily included young White women, so the findings may not be universally applicable. Additionally, the use of the nasal spray alongside other medications made it challenging to evaluate its individual therapeutic benefits.
The researchers emphasize the need for further clinical trials to determine the most effective and safe dose, as well as the establishment of clinical guidelines. They also highlight the potential risk of dependency and advise careful consideration when prescribing ketamine for migraine treatment.
While this retrospective study suggests that intranasal ketamine may provide pain relief with limited side-effects for refractory chronic migraines in an outpatient setting, more research is needed to confirm these findings and guide its clinical use.
The study is published in the journal Regional Anesthesia & Pain Medicine.
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