Ketamine Infusions for Treatment Refractory Headache

Background Management of chronic migraine (CM) or new daily persistent headache (NDPH) in those who require aggressive outpatient and inpatient treatment is challenging. Ketamine has been suggested as a new treatment for this intractable population. Methods This is a retrospective review of 77 patients who underwent administration of intravenous, subanesthetic ketamine for CM or NDPH. All patients had previously failed aggressive outpatient and inpatient treatments. Records were reviewed for patients treated between January 2006 and December 2014. Results The mean headache pain rating using a 0‐10 pain scale was an average of 7.1 at admission and 3.8 on discharge ( P < .0001). The majority (55/77, 71.4%) of patients were classified as acute responders defined as at least 2‐point improvement in headache pain at discharge. Some (15/77, 27.3%) acute responders maintained this benefit at their follow‐up office visit but sustained response did not achieve statistical significance. The mean length of infusion was 4.8 days. Most patients tolerated ketamine well. A number of adverse events were observed, but very few were serious. Conclusions Subanesthetic ketamine infusions may be beneficial in individuals with CM or NDPH who have failed other aggressive treatments. Controlled trials may confirm this, and further studies may be useful in elucidating more robust benefit in a less refractory patient population.