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February 12, 2013; 80 (7) Article

A randomized controlled trial of intranasal ketamine in migraine with prolonged aura

Shazia K. Afridi, Nicola J. Giffin, Holger Kaube, Peter J. Goadsby
First published January 30, 2013, DOI: https://doi.org/10.1212/WNL.0b013e3182824e66
Shazia K. Afridi
From the Headache Group, Department of Neurology, University of California, San Francisco. S.K.A. is currently affiliated with the Department of Neurology, Guy's Hospital, London, UK. N.J.G. is currently affiliated with the Department of Neurology, Royal United Hospital, Bath, UK. H.K. is currently located in Munich, Germany.
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Nicola J. Giffin
From the Headache Group, Department of Neurology, University of California, San Francisco. S.K.A. is currently affiliated with the Department of Neurology, Guy's Hospital, London, UK. N.J.G. is currently affiliated with the Department of Neurology, Royal United Hospital, Bath, UK. H.K. is currently located in Munich, Germany.
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Holger Kaube
From the Headache Group, Department of Neurology, University of California, San Francisco. S.K.A. is currently affiliated with the Department of Neurology, Guy's Hospital, London, UK. N.J.G. is currently affiliated with the Department of Neurology, Royal United Hospital, Bath, UK. H.K. is currently located in Munich, Germany.
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Peter J. Goadsby
From the Headache Group, Department of Neurology, University of California, San Francisco. S.K.A. is currently affiliated with the Department of Neurology, Guy's Hospital, London, UK. N.J.G. is currently affiliated with the Department of Neurology, Royal United Hospital, Bath, UK. H.K. is currently located in Munich, Germany.
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Citation
A randomized controlled trial of intranasal ketamine in migraine with prolonged aura
Shazia K. Afridi, Nicola J. Giffin, Holger Kaube, Peter J. Goadsby
Neurology Feb 2013, 80 (7) 642-647; DOI: 10.1212/WNL.0b013e3182824e66

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Abstract

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.

Classification of evidence: This study provides Class III evidence that intranasal ketamine is effective in reducing aura severity in patients with migraine with prolonged aura.

GLOSSARY

CSD=
cortical spreading depression

Footnotes

  • Go to Neurology.org for full disclosures. Funding information and dislcosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Received December 23, 2011.
  • Accepted October 10, 2012.
  • © 2013 American Academy of Neurology
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