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Ketamine for Migraine in the Emergency Department

Ketamine for Migraine in the Emergency Department Ketamine is utilized often in the emergency department (ED) for rapid sequence intubation, proce- dural sedation, and acute pain management. The treatment of migraine headache in the ED varies widely and is dependent on several factors including migraine cause, previous successful abortive methods, and provider preference. Several medications are currently employed to treat acute mi- graine including nonsteroidal anti-inflammatory drugs, triptans, antihistamines, prochlorperazine, and corticosteroids, among others. Interest in ketamine as an abortive agent to treat migraine has increased as evidenced by recent studies evaluating its use in the ED. This review examines the data regarding the use of ketamine to treat migraine headache. The concept of treating migraine headache with ketamine has been studied for more than 20 years. Early studies conducted primarily in the outpatient setting evaluated ketamine through multiple routes of administration and differing migraine causes with varying results. These early data seem to suggest that ketamine provides relief from headache severity but provides little information regarding the optimal dose and route of administration. Recent active comparator and placebo-controlled trials in the ED utilizing subdis- sociative doses of ketamine (0.2–0.3 mg/kg intravenously) show conflicting results. To confound the decision regarding its use further, ED providers encounter http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Advanced Emergency Nursing Journal Wolters Kluwer Health

Ketamine for Migraine in the Emergency Department

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References (30)

Publisher
Wolters Kluwer Health
Copyright
© 2020 Wolters Kluwer Health, Inc. All rights reserved.
ISSN
1931-4485
eISSN
1931-4493
DOI
10.1097/TME.0000000000000296
Publisher site
See Article on Publisher Site

Abstract

Ketamine is utilized often in the emergency department (ED) for rapid sequence intubation, proce- dural sedation, and acute pain management. The treatment of migraine headache in the ED varies widely and is dependent on several factors including migraine cause, previous successful abortive methods, and provider preference. Several medications are currently employed to treat acute mi- graine including nonsteroidal anti-inflammatory drugs, triptans, antihistamines, prochlorperazine, and corticosteroids, among others. Interest in ketamine as an abortive agent to treat migraine has increased as evidenced by recent studies evaluating its use in the ED. This review examines the data regarding the use of ketamine to treat migraine headache. The concept of treating migraine headache with ketamine has been studied for more than 20 years. Early studies conducted primarily in the outpatient setting evaluated ketamine through multiple routes of administration and differing migraine causes with varying results. These early data seem to suggest that ketamine provides relief from headache severity but provides little information regarding the optimal dose and route of administration. Recent active comparator and placebo-controlled trials in the ED utilizing subdis- sociative doses of ketamine (0.2–0.3 mg/kg intravenously) show conflicting results. To confound the decision regarding its use further, ED providers encounter

Journal

Advanced Emergency Nursing Journal – Wolters Kluwer Health

Published: Jun 1, 2020

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