Outpatient IV ketamine therapy could improve pain in refractory chronic migraine

AUSTIN, Texas — In-clinic administration of IV ketamine significantly improved refractory chronic migraine pain intensity in a small cohort of patients, according to a poster presented here.

“Our idea here was to see if it was even possible, or plausible, to do this in an outpatient setting, rather than doing it in a hospital,” Aaron Bubolz, DO, co-founder and chief medical officer at the Mind+ Neurology Clinic in Mequon, Wisconsin, told Healio.

The six female patients (median age, 43 years) enrolled in this prospective, observational cohort study had failed a mean 41.3 preventative medications and 34.3 acute medications.

Each participant received an initial dose of 10 mg IV ketamine over the course of 10 minutes in a clinic setting. After another 10 minutes, pain was assessed and the process repeated until significant pain response was achieved, psychotomimetic symptoms developed or 80 mg was reached.

“It’s very different dosing for what each patient needs,” Bubolz said. “Some require very small doses, 10 mg or 20 mg, and some needed the full 80 mg, which is where I stopped based on prior literature.”

All six patients had positive responses, with five showing improvement in pain severity of 50% or more from baseline and three experiencing at least 75% improvement. Further, the infusion was generally well-tolerated, with the most common adverse effect being a transient, controlled episode of dissociation.

“In an acute setting, we are basically able to break headaches [for] people who have had the same headache for 20 years,” Bubolz said.

Researchers noted that larger, randomized, placebo-controlled studies are needed to determine the true benefit of IV ketamine therapy and whether scheduling preventive treatments is feasible.

“Hopefully the implications will be something tangible for these refractory folks, who have no other options, to gain some of their life back,” Bubolz said.