A randomized controlled trial of intranasal ketamine in migraine with prolonged aura.
OBJECTIVE
The aim of our study was to test the hypothesis that ketamine would affect aura in a randomized controlled double-blind trial, and thus to provide direct evidence for the role of glutamatergic transmission in human aura.


METHODS
We performed a double-blinded, randomized parallel-group controlled study investigating the effect of 25 mg intranasal ketamine on migraine with prolonged aura in 30 migraineurs using 2 mg intranasal midazolam as an active control. Each subject recorded data from 3 episodes of migraine.


RESULTS
Eighteen subjects completed the study. Ketamine reduced the severity (p = 0.032) but not duration of aura in this group, whereas midazolam had no effect.


CONCLUSIONS
These data provide translational evidence for the potential importance of glutamatergic mechanisms in migraine aura and offer a pharmacologic parallel between animal experimental work on cortical spreading depression and the clinical problem.


METHODS
This study provides class III evidence that intranasal ketamine is effective in reducing aura severity in patients with migraine with prolonged aura.
Headache Group, Department of Neurology, University of California, San Francisco, USA.
Shazia K
SK
Afridi
Nicola J
NJ
Giffin
Holger
H
Kaube
Peter J
PJ
Goadsby
D000281:Administration, Intranasal / Q000379:methods*; D000328:Adult; D000700:Analgesics / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D007649:Ketamine / Q000008:administration & dosage*; D008137:Longitudinal Studies; D008297:Male; D008874:Midazolam / Q000627:therapeutic use; D008875:Middle Aged; D020325:Migraine with Aura / Q000188:drug therapy*; D010045:Outpatients; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
D000700:Analgesics; D007649:Ketamine; D008874:Midazolam