[P02.168] IV Ketamine in the Clinic To Treat Cluster Headache
John Claude Krusz, Dallas, TX
OBJECTIVE: To investigate the utility of IV ketamine in treating cluster headache in an outpatient clinic. Cluster headaches are difficult to treat and additional treatment strategies are most desirable for this disabling disorder. BACKGROUND: Ketamine, in subanesthetic doses, has been shown to be useful in treating neuropathic pain syndromes and, in small open-label studies, refractory migraine headaches. Ketamine, at the doses employed, is an antagonist of NMDA-type glutamate receptors. DESIGN/METHODS: 4 cluster headache sufferers, all male, were treated with IV ketamine in a headache clinic during an active cluster period. The average age was 42.3 years of age. An antecubital line was placed and pulse oximetry monitoring was used in all cases. 0.4mg/kg of ketamine was infused over 90-120 minutes. In 3 cases, a second 90 minute infusion was also given. RESULTS: IV ketamine abolished the ongoing cluster headache episodes in all 4 cases treated. The average length of time that cluster headache episodes ceased was 3.4 days (range = 1.5-12 days). No patient fell asleep during treatment with ketamine. 3 patients reported transient lightheadedness during the IV infusion, lastging an average of 18 minutes. No hallucinations or dysphoria were reported by any patient. CONCLUSIONS/RELEVANCE: This results of this open-label study suggest that ketamine may have a utility in treating ongoing cluster headaches. It further suggests that NMDA glutamate receptors may play a role in the cluster headache process, possibly in the maintenance of aberrant neuropathic pain signaling. IV ketamine, in subanesthetic doses, is well tolerated and efficacious in treating disabling cluster headaches. Ketamine should be studied in a double-blind manner in this this condition.
Category - Headache - Therapeutics
Tuesday, April 28, 2009 11:30 AM
Poster Session II: Headache I (11:30 AM-2:30 PM)
Source: 61st Annual Meeting of the American Academy of Neurology 2009 - Abstracts Category Headache -
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