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Abstract Details

Intranasal Ketamine as a Promising Acute Treatment for Refractory Headache
Headache
Headache Posters (7:00 AM-5:00 PM)
015

Ketamine infusion has been used for treatment of refractory headache. IN ketamine offers an alternative option beyond the inpatient setting for acute treatment. However, its clinical efficacy and safety in this patient population has not been reported.

To study the efficacy of intranasal (IN) ketamine as treatment for refractory headache. 

We received International Review Board approval for our retrospective phone interview survey designed to assess the efficacy and adverse effects of IN ketamine, which was formulated at a local compounding pharmacy. Two hundred forty-five refractory headache patients prescribed IN ketamine from January 2019 through February 2020 were identified in our electronic medical records. 

We interviewed 168 subjects (134 female) with a mean age of 44.5±13.8 years old. One hundred forty-one (83.9%) had a primary headache diagnosis of chronic migraine, and 107 (63.7%) were current IN ketamine users. The mean usage was 11.8±8.9 days per month and 7.9±6.9 sprays per day. The mean headache intensity (0-10 numerical pain scale) pre- and post-IN ketamine was 7.6±1.7 and 4.7±2.2, respectively (p<0.01 by paired t-test). The mean time to experience headache relief was 74.1±262.9 minutes. IN ketamine offered relief 70.8% of the time. One hundred twenty (71.4%) subjects affirmed using less additional acute medication to treat pain attacks while using IN ketamine. Adverse events included diplopia or blurred vision (20.8%), fatigue (20.8%), nausea (15.5%), vivid dreams (10.1%), hallucinations (7.7%), vomiting (3%), tremor (2.4%), extreme fear (1.8%), and myoclonus (1.2%). Forty-four (26.2%) subjects denied any adverse effects. 

Based on our single-center retrospective study, IN ketamine can be a potential acute treatment for patients with refractory headache to reduce headache intensity with a few adverse effects.

Authors/Disclosures
Jade Suehyun Park, MD (Dept of Neurological Sciences)
PRESENTER
Ms. Park has nothing to disclose.
Aniket Natekar (OhioHealth) Mr. Natekar has nothing to disclose.
William B. Young, MD, FAAN (Jefferson Headache Center) Dr. Young has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Theranica. Dr. Young has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Allergan. Dr. Young has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biohaven Pharmaceuticals. Dr. Young has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eli Lilly and Company. Dr. Young has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Teva. Dr. Young has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Biohaven Pharmaceuticals Inc. Dr. Young has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Eli Lilly and Company. Dr. Young has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Teva. Dr. Young has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for Coalition for Headache and Migraine Patients. Dr. Young has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for Miles for Migraine. The institution of Dr. Young has received research support from Amgen. The institution of Dr. Young has received research support from Cumberland. The institution of Dr. Young has received research support from Eli Lilly. The institution of Dr. Young has received research support from Novartis. The institution of Dr. Young has received research support from PCORI. The institution of Dr. Young has received research support from Satsuma. The institution of Dr. Young has received research support from Scion. The institution of Dr. Young has received research support from Teva. The institution of Dr. Young has received research support from Zosano.
Eugene Viscusi (Thomas Jefferson University) Eugene Viscusi has received personal compensation in the range of $500-$4,999 for serving as a Consultant for AcelRx. Eugene Viscusi has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Innacoll. Eugene Viscusi has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Heron. Eugene Viscusi has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Salix. Eugene Viscusi has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Esteve. Eugene Viscusi has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Fresenius. Eugene Viscusi has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Shinogi. Eugene Viscusi has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Merck. Eugene Viscusi has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Heron. Eugene Viscusi has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Salix. Eugene Viscusi has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for ASRA.
Hsiangkuo Yuan, MD, PhD (Jefferson Headache Center) An immediate family member of Dr. Yuan has received personal compensation for serving as an employee of Merck. Dr. Yuan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Pfizer. Dr. Yuan has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Pfizer. Dr. Yuan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Salvia. Dr. Yuan has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Cerenovous. Dr. Yuan has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Regional Anesthesia and Pain Medicine. Dr. Yuan has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Current Headache and Pain Reports. The institution of Dr. Yuan has received research support from NIH. Dr. Yuan has received publishing royalties from a publication relating to health care. Dr. Yuan has received personal compensation in the range of $500-$4,999 for serving as a Grant reviewer with NIH.
Michael J. Marmura, MD, FAAN (Thomas Jefferson University) Dr. Marmura has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Lundbeck. Dr. Marmura has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Axsome. Dr. Marmura has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Lundbeck. Dr. Marmura has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Theranica. Dr. Marmura has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for Lilly. Dr. Marmura has stock in Curelator. The institution of Dr. Marmura has received research support from Teva. The institution of Dr. Marmura has received research support from AbbVie. Dr. Marmura has received publishing royalties from a publication relating to health care. Dr. Marmura has received publishing royalties from a publication relating to health care. Dr. Marmura has received publishing royalties from a publication relating to health care.