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The THINK (Treatment of Headache with Intranasal Ketamine) Trial: A Randomized Controlled Trial Comparing Intranasal Ketamine with Intravenous Metoclopramide.
J Emerg Med 2019; 56(3):248-257.e1JE

Abstract

BACKGROUND

Headache is a common chief complaint in the emergency department (ED) setting.

OBJECTIVES

To compare analgesia with metoclopramide and diphenhydramine vs. intranasal ketamine among ED patients with primary headache.

METHODS

We enrolled a convenience sample of adults with a primary headache in a randomized, single-blind, placebo-controlled trial. We randomized patients to either a control arm (intravenous metoclopramide and diphenhydramine) or intranasal ketamine. The primary outcome was change in pain 0-100 mm visual analog scale (VAS) score measured at study start and 30 min post completion of initial medication administration. Secondary outcomes included side effects, hospital admission, and return to care within 48-72 h.

RESULTS

All 53 enrolled subjects completed the study, 26 of whom were allocated to the control arm and 27 to intranasal ketamine. The mean change in pain VAS score at 30 min post intervention was 22.2 mm in the control arm vs. 29.0 in the intranasal ketamine arm (effect size difference 6.8 mm, 95% confidence interval -5.8-19.4). The incidence of reported side effects was 65.4% in the control arm vs. 66.7% in the ketamine arm. Three patients (11.5%) allocated to the control arm required admission for headache pain control vs. 1 patient (3.7%) in the intranasal ketamine arm. Three (11.5%) additional patients in the control arm returned to the ED within 48-72 h for headache pain vs. none in the ketamine arm.

CONCLUSIONS

In this small randomized study, intranasal ketamine was not superior to standard therapy among ED patients with primary headache syndromes.

Authors+Show Affiliations

Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas.Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas.Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas.Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas.Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas.Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas.Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas.

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

30910061

Citation

Benish, Trisha, et al. "The THINK (Treatment of Headache With Intranasal Ketamine) Trial: a Randomized Controlled Trial Comparing Intranasal Ketamine With Intravenous Metoclopramide." The Journal of Emergency Medicine, vol. 56, no. 3, 2019, pp. 248-257.e1.
Benish T, Villalobos D, Love S, et al. The THINK (Treatment of Headache with Intranasal Ketamine) Trial: A Randomized Controlled Trial Comparing Intranasal Ketamine with Intravenous Metoclopramide. J Emerg Med. 2019;56(3):248-257.e1.
Benish, T., Villalobos, D., Love, S., Casmaer, M., Hunter, C. J., Summers, S. M., & April, M. D. (2019). The THINK (Treatment of Headache with Intranasal Ketamine) Trial: A Randomized Controlled Trial Comparing Intranasal Ketamine with Intravenous Metoclopramide. The Journal of Emergency Medicine, 56(3), pp. 248-257.e1. doi:10.1016/j.jemermed.2018.12.007.
Benish T, et al. The THINK (Treatment of Headache With Intranasal Ketamine) Trial: a Randomized Controlled Trial Comparing Intranasal Ketamine With Intravenous Metoclopramide. J Emerg Med. 2019;56(3):248-257.e1. PubMed PMID: 30910061.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The THINK (Treatment of Headache with Intranasal Ketamine) Trial: A Randomized Controlled Trial Comparing Intranasal Ketamine with Intravenous Metoclopramide. AU - Benish,Trisha, AU - Villalobos,Danny, AU - Love,Sue, AU - Casmaer,Monica, AU - Hunter,Curtis J, AU - Summers,Shane M, AU - April,Michael D, PY - 2018/09/15/received PY - 2018/11/26/revised PY - 2018/12/08/accepted PY - 2019/3/27/entrez PY - 2019/3/27/pubmed PY - 2019/7/16/medline KW - diphenhydramine KW - emergency department KW - headache KW - intranasal KW - ketamine KW - metoclopramide KW - migraine KW - primary headache disorder SP - 248 EP - 257.e1 JF - The Journal of emergency medicine JO - J Emerg Med VL - 56 IS - 3 N2 - BACKGROUND: Headache is a common chief complaint in the emergency department (ED) setting. OBJECTIVES: To compare analgesia with metoclopramide and diphenhydramine vs. intranasal ketamine among ED patients with primary headache. METHODS: We enrolled a convenience sample of adults with a primary headache in a randomized, single-blind, placebo-controlled trial. We randomized patients to either a control arm (intravenous metoclopramide and diphenhydramine) or intranasal ketamine. The primary outcome was change in pain 0-100 mm visual analog scale (VAS) score measured at study start and 30 min post completion of initial medication administration. Secondary outcomes included side effects, hospital admission, and return to care within 48-72 h. RESULTS: All 53 enrolled subjects completed the study, 26 of whom were allocated to the control arm and 27 to intranasal ketamine. The mean change in pain VAS score at 30 min post intervention was 22.2 mm in the control arm vs. 29.0 in the intranasal ketamine arm (effect size difference 6.8 mm, 95% confidence interval -5.8-19.4). The incidence of reported side effects was 65.4% in the control arm vs. 66.7% in the ketamine arm. Three patients (11.5%) allocated to the control arm required admission for headache pain control vs. 1 patient (3.7%) in the intranasal ketamine arm. Three (11.5%) additional patients in the control arm returned to the ED within 48-72 h for headache pain vs. none in the ketamine arm. CONCLUSIONS: In this small randomized study, intranasal ketamine was not superior to standard therapy among ED patients with primary headache syndromes. SN - 0736-4679 UR - https://www.unboundmedicine.com/medline/citation/30910061/The_THINK__Treatment_of_Headache_with_Intranasal_Ketamine__Trial:_A_Randomized_Controlled_Trial_Comparing_Intranasal_Ketamine_with_Intravenous_Metoclopramide_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0736-4679(18)31196-X DB - PRIME DP - Unbound Medicine ER -