Summary: Ketamine nasal spray helps abort cluster headache attacks when other treatments fall short: in a small pilot study of 23 patients, pain dropped 59% at 30 minutes. Certain headaches, like cluster headaches, may be relatively difficult to treat, as doctors do not know what causes these headaches. Moreover, cluster headache specialists believe that such headaches are often experienced at nighttime, and the onset is sudden. Treatments like oxygen inhalation and sumatriptan injection help, but these procedures require visiting a doctor or emergency care. However, a new study shows that ketamine nasal spray may be pretty helpful in aborting cluster headache attacks.
Cluster headaches can cause significant distress and are sometimes hard to treat. In many cases, nothing seems to help. The cause of cluster headaches remains elusive, though these headaches are pretty common. Quite often, people experience cluster headaches at night. They start suddenly, and the pain is usually felt behind or around the eyes on one side. The pain may last for 15 or more minutes, but in some, the pain may last quite long. These pains often subside suddenly. Nonetheless, they have cyclic patterns like repeating weekly, monthly, etc. The cause of such headaches is unclear, yet several treatment options exist. For example, acute pains are treated with oxygen inhalation, local anesthetics, or triptans. Preventive measures include using drugs like calcium channel blockers, corticosteroids, and more. Unfortunately, though there are many treatment approaches to cluster headaches, they frequently fail to provide quick and sufficient migraine headache relief. Many people do not respond well to different treatments. Moreover, treatments like oxygen or sumatriptan injections cannot be taken at home, and it would require a visit to a doctor or calling for emergency help if the pain is too severe. Hence, there is a need to find novel treatments for overcoming cluster headache attacks at home.
Does ketamine nasal spray stop a cluster headache attack?
Recently a study was done showing the efficacy of ketamine in managing cluster headache attacks. It appears that the use of ketamine may help abort cluster headache attacks in many instances. The new study was a small pilot study. It enrolled 23 patients living with cluster headaches. They were given 15 mg of intranasal ketamine every minute and a maximum of five times to treat their headache. The primary endpoint was a minimum 50% pain reduction in 15 minutes. The findings of the study were fascinating. Firstly, the study failed to achieve significant benefits in 15 minutes and could reduce pain scores by just about 15% in 15 minutes. However, the results were quite encouraging at 30 minutes, when patients reported a pain reduction of 59%, which is a considerable benefit. Undeniably, the study was small and just a pilot study. Nevertheless, it showed that ketamine nasal spray works and could be the best headache treatment for cluster headaches. However, it does not appear to work as quickly as expected. It is more likely to help within 30 minutes and not 15 minutes—nonetheless, 30 minutes is not bad. Therefore, researchers think that their findings show a need for further clinical studies. It is time to test ketamine intranasal spray in more extensive clinical studies. Further, there is also a need to understand if ketamine can help with migraine headache relief. For example, it may be a good idea to explore the role of ketamine nasal spray in tension headaches and so on. It is quite likely that it may work faster for other types of headaches. Of course, there are some concerns, too. Ketamine is an anesthetic and also a drug of abuse. Thus, there are some significant safety concerns. In addition, there are worries that ketamine nasal sprays might be abused. However, there is some encouraging news, as studies suggest that ketamine is not addictive.
For patients across the St. Louis region in Missouri and Illinois, our ketamine therapy page explains how the route of administration 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, and 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 inhalation, local anesthetics and triptans such as a sumatriptan injection. They help, but oxygen and sumatriptan injections usually mean a visit to the doctor or a call for emergency help. That gap is why researchers tested ketamine nasal spray, 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 that point. 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 felt behind or around one eye, on one side of the head. Doctors still do not know what causes them, which 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 route of administration changes both the evidence and the risks.
Dr. Gurpreet Singh Padda, MD, MBA, MHP
