Summary: Ketamine nasal spray helps stop cluster headache attacks when other treatments fall short. In a small pilot study of 23 patients, pain dropped 59% at 30 minutes. Some headaches, like cluster headaches, can be hard to treat, because doctors do not know what causes them. Cluster headache specialists also note that these headaches often strike at night and start suddenly. Treatments like oxygen and sumatriptan shots help. But they mean a trip to the doctor or emergency care. Now a new study shows ketamine nasal spray may help stop cluster headache attacks.
Cluster headaches cause real distress and can be hard to treat. In many cases, nothing seems to help. The cause is still unknown, even though these headaches are fairly common. They often strike at night. They start suddenly, and the pain is usually behind or around one eye. The pain may last 15 or more minutes, and in some people much longer. The pain often stops suddenly. But the headaches come back in cycles, such as weekly or monthly. The cause is unclear, yet there are several treatments. Attacks are treated with oxygen, numbing medicine, or triptans. Prevention uses drugs like calcium channel blockers, steroids, and more. Sadly, even with all these options, they often fail to give fast and full migraine headache relief. Many people do not respond well. And treatments like oxygen or sumatriptan shots cannot be taken at home. If the pain is severe, you need a doctor visit or emergency help. So we need new treatments that can stop cluster headache attacks at home.
Does ketamine nasal spray stop a cluster headache attack?
A recent study looked at how well ketamine works for cluster headache attacks. It seems ketamine may help stop attacks in many cases. The new study was a small pilot study. It enrolled 23 patients with cluster headaches. They were given 15 mg of intranasal ketamine every minute and a maximum of five times to treat their headache. The main goal was at least a 50% drop in pain within 15 minutes. The findings were striking. First, the study missed its goal at 15 minutes. Pain dropped only about 15% in 15 minutes. But the results were encouraging at 30 minutes. Patients reported a 59% drop in pain. That is a big benefit. To be fair, the study was small and only a pilot. Still, it showed that ketamine nasal spray works and could be the best treatment for cluster headaches. But it does not seem to work as fast as hoped. It is more likely to help within 30 minutes, not 15 minutes. Still, 30 minutes is not bad. So researchers think larger clinical studies are needed. It is time to test ketamine nasal spray in bigger studies. We also need to learn if ketamine can help with migraine headache relief. For example, we could study ketamine nasal spray in tension headaches and others. It may well work faster for other types of headache. Of course, there are concerns too. Ketamine is an anesthetic and also a drug of abuse. So there are real safety concerns. Some worry ketamine nasal sprays might be abused. But there is some good news. Studies suggest ketamine is not addictive.
For patients across the St. Louis region in Missouri and Illinois, our ketamine therapy page explains how the way the drug is given changes both the evidence and the risks.
Frequently asked questions
How long do cluster headaches last?
A cluster headache attack usually lasts 15 minutes or more. In some people the pain lasts much longer. Attacks tend to stop as suddenly as they start. The headaches also run in cycles, coming back in patterns such as weekly or monthly.
What is the fastest way to stop a cluster headache?
The standard treatments for an attack are oxygen, numbing medicine and triptans such as a sumatriptan shot. They help. But oxygen and sumatriptan shots usually mean a doctor visit or a call for emergency help. That gap is why researchers tested ketamine nasal spray. It is something a patient could use at home when an attack starts.
How quickly does ketamine nasal spray work for cluster headaches?
Not as fast as researchers hoped. In the pilot study of 23 patients, pain fell only about 15% at 15 minutes. So the study missed its goal of a 50% drop by then. By 30 minutes, pain was down 59%. The spray is more likely to help within half an hour than within 15 minutes.
Where and when do cluster headaches hit?
Cluster headaches often strike at night and start suddenly. The pain is usually behind or around one eye, on one side of the head. Doctors still do not know what causes them. That is one reason they are hard to treat, and why many people do not respond well to the usual options.
Is ketamine nasal spray safe?
Ketamine is an anesthetic and also a drug of abuse. So there are real safety concerns, including the worry that a nasal spray kept at home could be misused. The pilot study was small, and its authors call for larger clinical trials. Our ketamine therapy page explains how the way the drug is given changes both the evidence and the risks.
Dr. Gurpreet Singh Padda, MD, MBA, MHP
