Pomeroy Jared L, Marmura Michael J, Nahas Stephanie J, Viscusi Eugene R
Thomas Jefferson University, Philadelphia, PA, USA.
Headache. 2017 Feb;57(2):276-282. doi: 10.1111/head.13013. Epub 2016 Dec 27.
Management of chronic migraine (CM) or new daily persistent headache (NDPH) in those who require aggressive outpatient and inpatient treatment is challenging. Ketamine has been suggested as a new treatment for this intractable population.
This is a retrospective review of 77 patients who underwent administration of intravenous, subanesthetic ketamine for CM or NDPH. All patients had previously failed aggressive outpatient and inpatient treatments. Records were reviewed for patients treated between January 2006 and December 2014.
The mean headache pain rating using a 0-10 pain scale was an average of 7.1 at admission and 3.8 on discharge (P < .0001). The majority (55/77, 71.4%) of patients were classified as acute responders defined as at least 2-point improvement in headache pain at discharge. Some (15/77, 27.3%) acute responders maintained this benefit at their follow-up office visit but sustained response did not achieve statistical significance. The mean length of infusion was 4.8 days. Most patients tolerated ketamine well. A number of adverse events were observed, but very few were serious.
Subanesthetic ketamine infusions may be beneficial in individuals with CM or NDPH who have failed other aggressive treatments. Controlled trials may confirm this, and further studies may be useful in elucidating more robust benefit in a less refractory patient population.
对于那些需要积极门诊和住院治疗的慢性偏头痛（CM）或新发性每日持续性头痛（NDPH）患者，其管理具有挑战性。氯胺酮已被提议作为针对这一难治性人群的一种新的治疗方法。
这是一项对77例因CM或NDPH接受静脉注射亚麻醉剂量氯胺酮治疗的患者的回顾性研究。所有患者此前积极的门诊和住院治疗均告失败。对2006年1月至2014年12月期间接受治疗的患者记录进行了审查。
使用0至10分疼痛量表，入院时头痛疼痛平均评分为7.1分，出院时为3.8分（P < .0001）。大多数患者（55/77，71.4%）被归类为急性反应者，定义为出院时头痛疼痛至少改善2分。一些急性反应者（15/77，27.3%）在随访门诊时维持了这种获益，但持续反应未达到统计学显著性。平均输注时长为4.8天。大多数患者对氯胺酮耐受性良好。观察到一些不良事件，但严重不良事件极少。
对于CM或NDPH且其他积极治疗失败的个体，亚麻醉剂量氯胺酮输注可能有益。对照试验可能会证实这一点，进一步的研究可能有助于阐明在难治性较低的患者群体中更显著的获益情况。
