089 Breaking the cycle of chronic daily headache with a low-dose subcutaneous lignocaine and ketamine infusion
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Le résumé fourni par la source
Introduction Management of chronic migraine includes correcting analgesic rebound headache and implementing suitable medication for prevention and acute episodes. However, in many cases this management paradigm oversimplifies the complexity of chronic migraine, particularly the entrenched central pathways that perpetuate chronic migraine. Intravenous lignocaine can curtail chronic migraine and analgesic rebound headache (1). Further, ketamine provides short-term analgesia and enables reduction in central sensitisation of pain pathways, particularly in the setting of codeine/opiod overuse (2). This paper describes use of subcutaneous lignocaine and ketamine infusion in chronic migraine. Methods A prospective observational cohort study was undertaken in patients with chronic migraine. Patients received a prolonged subcutaneous lignocaine and ketamine infusion (mean duration 11 days) and underwent evaluation at four-time points over six months. The effects on the excitability of motor axons in the median nerve were documented using standard procedures. Results Fourteen patients were recruited. The infusion was well tolerated; no major side effects were seen. There were no significant long-term changes in the excitability of motor axons. At six months, 13/14 patients had sustained benefit. Three of 4 patients remained free of analgesic rebound headache. One patient remained headache-free. Conversion to episodic migraine occurred in 6/14. Improvement in chronic migraine was reported by 6/14. Three of six were able to return to work, with 1 returning to studies. Benefit was greater in those with depression and history of opiod/codeine use. Conclusion Subcutaneous lignocaine and ketamine can help break entrenchment in chronic migraine as part of a structured management plan.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- 089 Breaking the cycle of chronic daily headache with a low-dose subcutaneous lignocaine and ketamine infusion
- Date Crossref
- 01/07/2019
- Éditeur
- BMJ
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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The University of Notre Dame Australia pays non établi dans la noticeUniversité ou école supérieure
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St Vincent's Hospital Sydney Department of Neurology pays non établi dans la noticeÉtablissement de santé
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The University of Sydney Department of Medicine pays non établi dans la noticeUniversité ou école supérieure
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Royal Prince Alfred Hospital Department of Neurology pays non établi dans la noticeÉtablissement de santé
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UNSW Sydney pays non établi dans la noticeUniversité ou école supérieure
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University of NSW Department of Medicine pays non établi dans la noticeUniversité ou école supérieure
The University of Notre Dame Australia, Department of Neurology — St Vincent's Hospital Sydney et Department of Medicine — The University of Sydney, avec 3 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.