Abstract
IntroductionNon - traumatic headaches are one of the most common causes of referral to hospital emergency. This study aimed to compare the efficacy of intranasal ketamine and intravenous ketorolac on acute non-traumatic headaches.MethodsThis randomized and double-blind clinical trial was conducted in 2019. One hundred and forty samples were randomly divided into intranasal ketamine (A) and intravenous ketorolac (B). Group (A) received ketamine intranasal (0.75 mg/kg, max 75 mg), and group B received intravenous ketorolac (30 mg). Headache severity was measured on arrival, 30, 60, and 120 min after intervention with Visual Analogue Scale (VAS). The side effects were recorded an hour after the intervention.ResultThe mean difference of pain intensity 30, 60, and 120 min after the intervention between the two groups was statistically significant (p < 0.001). In the first 30 min, significant changes were observed in the VAS levels of the two groups. These changes were significantly greater in the intranasal ketamine group (p < 0.001). Side effects such as fatigue, dizziness, general discomfort, nausea, increased heart rate, and hypertension were significantly higher in the ketamine group (p < 0.05).ConclusionIntranasal ketamine and intravenous ketorolac both effectively reduced headaches. However, more analgesic effects of intranasal ketamine in a short time can be considered as a selective approach to reducing headaches.Trial registrationIRCT20180108038276N3, Registered 29 September 2019.Ethics committee reference numberIR.KUMS.REC.1398.068.
Highlights
Non - traumatic headaches are one of the most common causes of referral to hospital emergency
More analgesic effects of intranasal ketamine in a short time can be considered as a selective approach to reducing headaches
Eighteen patients refused to participate in the study, and out of 140 eligible patients, 70 patients were randomly assigned to the intranasal ketamine group and another 70 to the intravenous ketorolac group (Fig. 1)
Summary
Non - traumatic headaches are one of the most common causes of referral to hospital emergency. This study aimed to compare the efficacy of intranasal ketamine and intravenous ketorolac on acute non-traumatic headaches. One of the most commonly used medications to control pain in the emergency room is Ketamine It is injected into intramuscular, intravenous, and intranasal forms [7, 8]. In addition to a significant reduction in pain, has been introduced as an effective remedy for headache control [9, 10]. Ketorolac is another common drug used in an emergency for headaches management and is used in intramuscular, intravenous, or oral forms [11, 12]. Numerous studies have been performed to evaluate these drugs’ effectiveness, but so far, no recommended drug in this regard has been selected [9, 13,14,15,16,17]
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