• Written By: Michael Vaphiades, DO

    This double-blinded randomized controlled study demonstrated that intranasal ketamine significantly reduced the severity but not the duration of aura in migraineurs with prolonged aura. The authors note that this is the first study to demonstrate a reduction in the clinical severity of prolonged migraine aura with ketamine. They conclude that the study's data add clinical, translational evidence to support the notion that glutamatergic mechanisms may be important in the expression of the migraine aura.

    Eighteen migraineurs completed the study. They were instructed to treat three aura attacks with either 25 mg intranasal ketamine or 2 mg intranasal midazolam as an active control.

    Attacks lasted three hours shorter with ketamine than with midazolam. Attack severity appeared to decrease with ketamine treatment but did not appear to change at all with midazolam.

    The authors say the results suggest that ketamine may be useful in a select group of migraineurs with prolonged aura. They say the reduction in attack severity is clinically meaningful based on the patients' comments and the authors' clinical experience. However, the study does not endorse the widespread use of ketamine in migraine aura.