IV ketamine reduced pain by 50% in pediatric patients with refractory headache

Key takeaways:

• Researchers conducted a retrospective chart review of 58 encounters of 38 pediatric patients with refractory headache.
• Treatment with IV ketamine led to 50% pain reduction at discharge.

AUSTIN, Texas — Treatment with IV ketamine for pediatric refractory headache resulted in a 50% reduction in pain at discharge, with nearly two-thirds of patients not requiring rescue care within 1 month, according to a poster presentation.

“Patients with severe and refractory headaches often have few options for treatment despite ongoing pain and significant disability,” Scott Rosenthal, MD, a child neurology resident in the department of pediatrics at University of Colorado Anschutz Medical Campus, and colleagues wrote. “Ketamine has emerged as a potential therapeutic option and had demonstrated benefit in other chronic pain syndromes.”

Researchers conducted a retrospective chart review of 58 encounters of 38 patients aged 5 to 21 years (median age, 15.8 years; 76% girls) who were admitted to Children’s Hospital Colorado between 2019 and 2022 for treatment of refractory headache with continuous IV ketamine.

The primary outcome was percent pain reduction at discharge compared with baseline, headache recurrence within 72 hours, headache recurrence within 30 days of discharge, side effects of medication and serious adverse events.

According to results, treatment resulted in a 50% median pain reduction at discharge, with 64% of patients reporting no headache recurrence within 1 month of hospital discharge.

Among patients with recurrence, median time was 7 days, with 9% experiencing recurrence within 72 hours.

While no serious adverse events were reported, 7% of encounters stopped treatment because of side effects.

“Intravenous ketamine is an effective, safe and well-tolerated treatment option for refractory pediatric headaches and status migrainosus,” Rosenthal and colleagues wrote.