Intranasal ketamine reduces pain and drug use in refractory headaches

The following article is part of the conference coverage of the American Academy of Neurology (AAN) 2021 Annual Virtual Meeting. The Neurology Advisor staff will provide breaking news related to research by leading experts in neurology. Check out the latest news from the AAN 2021 virtual annual meeting again.

Those with refractory headaches may benefit from treatment with intranasal ketamine spray. These results from a retrospective study with a center will be presented at the American Academy of Neurology’s 2021 annual virtual meeting, April 17-22, 2021.

To evaluate the clinical efficacy and safety of using intranasal ketamine for the acute treatment of refractory headache beyond the inpatient setting, study researchers at Thomas Jefferson University conducted a telephone interview study. Patients (N = 245) who were prescribed intranasal ketamine from January 2019 to February 2020 were identified through electronic patient records. A total of 168 of these patients took part in the telephone survey.

Continue reading

The patients had a mean age of 44.5 (± 13.8) years and the majority (n = 134) were women. The most commonly documented diagnosis was chronic migraine (83.9%; n = 141), and most patients were currently using intranasal ketamine (63.7%; n = 107).

The mean consumption of intranasal ketamine was 11.8 (± 8.9) days per month. On each day of use, the patients administered an average of 7.9 (± 6.9) ketamine sprays. The mean headache intensity on a 10-point scale was reported to be 7.6 (± 1.7) before ketamine intake and 4.7 (± 2.2) after intake (P <0.01) . After spraying headache relief occurred an average of 74.1 minutes.

Patients reported that headache relief from ketamine was successful in 70.8% of cases, and 71.4% (n = 120) reported that they had fewer additional acute medications for relief while using intranasal ketamine used by headaches.

Over a quarter of the patients (26.2%; n = 44) reported no side effects. The other patients reported tiredness (20.8%), blurred vision or diplopia (20.8%), nausea (15.5%), vivid dreams (10.1%), hallucinations (7.7%), vomiting (3%), tremors (2.4%), extreme anxiety (1.8%) and myoclonus (1.2%).

The limitations of this study included the retrospective single-center design and the fact that the responses were self-reported.

The study’s authors concluded that intranasal ketamine spray has the potential to be an acute treatment for patients with refractory headaches. Most patients who used this therapy reported headache relief and reduced use of other pain relievers with little risk of serious side effects.


Park J., Natekar A., ​​Young W., Viscusi E., Yuan H., Marmura M. Intranasal ketamine as a promising acute treatment for refractory headache. Presented at: American Academy of Neurology 2021 Annual Virtual Meeting; 17.-22. April 2021. Abstract P10.015

Related Articles