Intranasal ketamine effectively reduced pain in children with migraine from hospital admission to discharge. Findings from this single-center study were reported in Pediatric Neurology.

Researchers performed a retrospective review of the electronic medical records of pediatric patients with migraine who were cared for at the Cook Children’s Medical Center. A total of 34 children with migraine who received intranasal ketamine at 0.1 mg/kg/dose to 0.2 mg/kg/dose for up to 5 doses were included in the analysis. Baseline and post-dose pain scores were also assessed. Additionally, researchers evaluated patients’ responses to therapy, defined as a pain score reduction of 0 to -3 and/or reduction of ≥50% on a 10-point scale.

On average, responders and nonresponders received intranasal ketamine doses of 0.14 mg/kg/dose. Approximately 73.5% (n=25) of patients within the retrospective cohort were considered responders. From admission to the end of treatment, the group had a mean pain score reduction of -7.2. Responders also received a significantly lower mean total dose compared with nonresponders (30.2 mg vs 45.8 mg, respectively; P =.009).

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Overall, there was a 66.1% reduction in pain scores among responders and nonresponders (83.7% vs 16.6%, respectively). Significant differences were observed between the mean pain scores of responders and nonresponders immediately after ketamine dose 1 (5 vs 7.4, respectively; P =.0149), dose 2 (3.1 vs 7.3; P =.001), dose 3 (2.9 vs 7.1; P =.001), dose 4 (1.3 vs 7.4; P <.001), and dose 5 (2.3 vs 6.9; P =.009).

Limitations of this study included its retrospective design as well as the inclusion of a small number of pediatric patients from a single center.

Based on these findings, the researchers suggested that “practitioners should consider integration of intranasal ketamine into abortive migraine therapy algorithms.”

Reference

Turner AL, Shandley S, Miller E, Perry MS, Ryals B. Intranasal ketamine for abortive migraine therapy in pediatric patients: a single-center review. Pediatr Neurol. 2020;104:46-53.