Ketamine‐Magnesium for Refractory Chronic Cluster Headache: A Case Series

Abstract

Objectives To evaluate the safety and efficacy of ketamine‐magnesium combination to reduce attacks in a series of patients with refractory chronic cluster headache (rCCH). Background Refractory chronic cluster headache (CCH) is a rare but highly debilitating condition that needs new treatment options. A previous publication reported that a single infusion of ketamine‐magnesium combination was effective in 2 patients with rCCH. Methods The treatment was proposed to consecutive patients with rCCH seen in 2 French hospitals between November 2015 and February 2020 and who were resistant to at least 3 preventive treatments. They received a single ketamine infusion (0.5 mg/kg over 2 hours) combined with magnesium sulfate (3000 mg). The main outcome was a comparison of the number of daily attacks 2 weeks prior to the ketamine‐magnesium infusion and 1 week after (on days 7 and 8). The second outcome was the percentage of responders (patients with ≥50% reduction in the frequency of daily attacks). Safety was assessed by the recording of adverse events during infusion. Descriptive statistics are presented as mean ± standard deviation. Results Seventeen patients (14 men), with an age of 35.2 ± 8.1 years, were included. They presented with CCH for 6.6 ± 4.3 years. The number of daily attacks decreased from 4.3 ± 2.4 before treatment to 1.3 ± 1.0 after treatment (difference: −3.1 (95% CI: −4.5 to −1.6), P < .001). Seventy six percent (13/17) were responders. Transient and mild sedation was reported by 7/17 patients (41.2%). Conclusions The ketamine‐magnesium combination seems an effective and well‐tolerated therapy for rCCH. Placebo‐controlled studies should be conducted to further confirm these findings.

Management of Trigeminal Autonomic Cephalalgias Including Chronic Cluster

“…In a small study of 13 patients with chronic cluster headache, low-dose intravenous ketamine was given every 2 weeks. 65 Half of the patients had a reduction in the number of cluster attacks. Pasireotide is a somatostatin analogue and was studied in a double-blind placebo-controlled trial in patients with episodic or chronic cluster headache.…”

“…Ketamine, a noncompetitive N -methyl- d -aspartic acid receptor antagonist, has been increasingly used in pain management in recent years. In a small study of 13 patients with chronic cluster headache, low-dose intravenous ketamine was given every 2 weeks . Half of the patients had a reduction in the number of cluster attacks.…”

Potencial terapéutico de los alucinógenos en las cefaleas: una revisión teórica

“…Es importante hacer referencia al número de dosis administradas, ya que en todos estos estudios se administraron varias dosis a la mayoría de los pacientes, y solo una investigación analizó la administración de la ketamina en una única dosis, la cual no consiguió reducir el dolor migrañoso, en comparación con el placebo (Etchison et al, 2018). Una investigación reciente se centró específicamente en la cefalea en racimos crónica, constatando la eficacia de la ketamina con una única dosis en poco más de la mitad de los pacientes (Moisset et al, 2020). Por último, podemos mencionar un estudio en pacientes con cefalea producida por la anestesia espinal en embarazadas, donde la ketamina se muestra eficaz inmediatamente y a las pocas horas tras la cirugía, sin embargo, su eficacia desaparece conforme pasa el tiempo (Zangouei et al 2019).…”

Drug Treatment of Cluster Headache

“…However, the study was not placebo controlled. A ketamine-magnesium combination was studied in an open trial in patients with chronic cluster headache who were resistant to at least three preventive treatments [ 65 ]. Seventeen patients received a single ketamine infusion (0.5 mg/kg over 2 h) combined with magnesium sulfate (3000 mg).…”