PMID- 29923953
OWN - NLM
STAT- MEDLINE
DCOM- 20190109
LR  - 20190109
IS  - 1532-8651 (Electronic)
IS  - 1098-7339 (Linking)
VI  - 43
IP  - 8
DP  - 2018 Nov
TI  - Ketamine for Refractory Headache: A Retrospective Analysis.
PG  - 875-879
LID - 10.1097/AAP.0000000000000827 [doi]
AB  - BACKGROUND AND OBJECTIVES: The burden of chronic headache disorders in the United 
      States is substantial. Some patients are treatment refractory. Ketamine, an 
      N-methyl-D-aspartate antagonist, provides potent analgesia in subanesthetic doses 
      in chronic pain, and limited data suggest it may alleviate headache in some 
      patients. METHODS: We performed a retrospective study of 61 patients admitted 
      over 3 years for 5 days of intravenous therapy that included continuous ketamine 
      to determine responder rate and patient and ketamine infusion characteristics. 
      Pain ratings at 2 follow-up visits were recorded. An immediate responder was a 
      patient with decrease of 2 points or greater in the numerical rating scale (0-10) 
      from start to final pain in the hospital. Sustained response at office visits 1 
      and 2 was determined based on maintaining the 2-point improvement at those 
      visits. Patients were assessed daily for pain and adverse events (AEs). RESULTS: 
      Forty-eight (77%) of the 61 patients were immediate responders. There were no 
      differences regarding demographics, opioid use, or fibromyalgia between immediate 
      responders and nonresponders. Maximum improvement occurred 4.56 days (mean) into 
      treatment. Sustained response occurred in 40% of patients at visit 1 (mean, 38.1 
      days) and 39% of patients at visit 2 (mean, 101.3 days). The mean maximum 
      ketamine rate was 65.2 +/- 2.8 mg/h (0.76 mg/kg per hour). Ketamine rates did not 
      differ between groups. Adverse events occurred equally in responders and 
      nonresponders and were mild. CONCLUSIONS: Ketamine was associated with short-term 
      analgesia in many refractory headache patients with tolerable adverse events. A 
      prospective study is warranted to confirm this and elucidate responder 
      characteristics.
FAU - Schwenk, Eric S
AU  - Schwenk ES
FAU - Dayan, Amir C
AU  - Dayan AC
FAU - Rangavajjula, Ashwin
AU  - Rangavajjula A
AD  - Department of Anesthesiology, Thomas Jefferson University Hospital.
FAU - Torjman, Marc C
AU  - Torjman MC
FAU - Hernandez, Mauricio G
AU  - Hernandez MG
FAU - Lauritsen, Clinton G
AU  - Lauritsen CG
AD  - Department of Neurology, Thomas Jefferson University, Philadelphia, PA.
FAU - Silberstein, Stephen D
AU  - Silberstein SD
AD  - Department of Neurology, Thomas Jefferson University, Philadelphia, PA.
FAU - Young, William
AU  - Young W
AD  - Department of Neurology, Thomas Jefferson University, Philadelphia, PA.
FAU - Viscusi, Eugene R
AU  - Viscusi ER
LA  - eng
PT  - Journal Article
PL  - England
TA  - Reg Anesth Pain Med
JT  - Regional anesthesia and pain medicine
JID - 9804508
RN  - 0 (Analgesics)
RN  - 690G0D6V8H (Ketamine)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Analgesics/*administration & dosage
MH  - Female
MH  - Follow-Up Studies
MH  - Headache Disorders/diagnosis/*drug therapy
MH  - Humans
MH  - Infusions, Intravenous
MH  - Ketamine/*administration & dosage
MH  - Male
MH  - Middle Aged
MH  - Pain, Intractable/diagnosis/*drug therapy
MH  - Retrospective Studies
MH  - Young Adult
EDAT- 2018/06/21 06:00
MHDA- 2019/01/10 06:00
CRDT- 2018/06/21 06:00
PHST- 2018/06/21 06:00 [pubmed]
PHST- 2019/01/10 06:00 [medline]
PHST- 2018/06/21 06:00 [entrez]
AID - 10.1097/AAP.0000000000000827 [doi]
PST - ppublish
SO  - Reg Anesth Pain Med. 2018 Nov;43(8):875-879. doi: 10.1097/AAP.0000000000000827.