Intranasal ketamine shows promise for migraine in kids

The intranasal delivery of ketamine appears to be effective in inducing pain relief in children with migraines, while minimizing side effects, a new study has found.

Researchers conducted a retrospective review of 34 paediatric migraine patients who were given therapeutic intranasal ketamine at doses ranging from 0.1 to 0.2 mg/kg/dose. Patients received up to five doses in total. A numerical pain scale running from 0 to 10 was used to evaluate pain scores; treatment response was defined as a drop in score by at least half, or to the range of 0–3 points.

Twenty-five participants (mean age, 14.6±2.6 years; 21 females) were deemed to be treatment responders, while the remaining nine (mean age, 16.2±2.3 years; nine females) failed to show substantial drops in pain. Baseline factors, including prior medication and the presence of aura, did not differ between response groups.

Notably, while both groups were given an average of 0.14 mg/kg/dose of intranasal ketamine, the total cumulative dose was significantly lower in responders (30.2 vs 45.8 mg; p=0.009).

Moreover, intranasal ketamine similarly induced pain relief immediately after administration, with a significantly stronger effect in responders (5 vs 7.4; p=0.0149). This effect persisted until the second (3.1 vs 7.3; p=0.001), third (2.9 vs 7.1; p=0.001), fourth (1.3 vs 7.4; p<0.001) and fifth (2.3 vs 6.9; p=0.009) ketamine doses.

The mean pain score at the final assessment was also significantly lower in responders vs nonresponders (1.4 vs 7.3; p<0.001).

This efficacy did not come with safety concerns; none of the side effects were limiting, nor did they show any dose dependency. Evidence of treatment abuse or tolerance was absent, and readmissions occurred comparably between groups.