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Ketamine‐Magnesium for Refractory Chronic Cluster Headache: A Case Series
Author(s) -
Moisset Xavier,
Giraud Pierric,
Meunier Estelle,
Condé Sakahlé,
Périé Maud,
Picard Pascale,
Pereira Bruno,
Ciampi de Andrade Daniel,
Clavelou Pierre,
Dallel Radhouane
Publication year - 2020
Publication title -
headache: the journal of head and face pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.14
H-Index - 119
eISSN - 1526-4610
pISSN - 0017-8748
DOI - 10.1111/head.14005
Subject(s) - medicine , ketamine , refractory (planetary science) , adverse effect , sedation , anesthesia , magnesium , cluster headache , migraine , materials science , metallurgy , physics , astrobiology
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.