NEW Study in Pediatric Neurology: Intranasal Ketamine Reduces Pain in Children Hospitalized for Migraine

Neuromuscular Dentist in Chicago, IL Accepting Patients Nationwide & Worldwide

Posted: March 18, 2020

Self-Administered (Parent Administered) Sphenopalatine Ganglion (SPG) Blocks should be considered as a First line Approach for Pediatric Migraine!

A new study in Pediatric Neurology looks at the use   of Intranasal Ketamine Reduces Pain in Children Hospitalized for Migraine.

This is exciting as children should never have to suffer debilitating pain.  However, due to the high efficacy of Sphenopaltine Ganglion Blocks in treating and preventing migraine a prudent step would be to compare the use of Trans-Nasal cotton-tipped catheters to deliver 2% lidocaine prior to use of Ketamine.

This author has a recent paper published in CRANIO Journal with an extensive review on the subject of Sphenopalatine Ganglion Blocks, Self-Administered Sphenopalatine Ganglion Blocks and Neuromodulation of the Sphenopalatine Ganglion.

 2019 May;37(3):201-206. doi: 10.1080/08869634.2019.1592807. Neuromuscular Dentistry and the role of the autonomic nervous system:  Sphenpalatine Ganglion Blocks and Neuromodulation.  An International College of CranioMandibular Orthopedics (ICCMO) position paper.  

The full text of that article is available on the blog site at:

The research was a retrospective review of the electronic medical records of pediatric patients with migraine.  The study showed that Intranasal ketamine effectively reduced pain in children with migraine from hospital admission to discharge. This retrospective study looked at a total of 34 children with migraine who received intranasal ketamine at 0.1 mg/kg/dose to 0.2 mg/kg/dose for up to 5 doses were included in the analysis.

Almost three quarters of the patients were considered (25 of 34).  Responders showed a mean pain score reduction of -7.2

Responders also received a significantly lower mean total dose compared with nonresponders (30.2 mg vs 45.8 mg, respectively; =.009). 

Ketamine Nasal Spray approved for treating depression is Esketamine.  Critics are urging caution in it's use to to limited trials and evidence.

Self-Administered SPG Blocks can also treat anxiety and maybe depression utilizing only safe an anesthetic used commonly in medicine and dentistry, Lidocaine, a natural anti-inflammatory.  In Greece studies have shown that SPG Blocks can eliminate about 1/3 of essential Hypertension cases.  The blocks apparently turn off Sympathetic Overload and the Fight or Flight reflex and let the Parasympathetic reflexes dominate. 

The use of prophylactic SPG Blocks may prevent many hospital admissions for pediatric migraine.

The Sphenopalatine Ganglion is the largest parasympathetic ganglion of the head and has sympathetic fibers arising the the sympathetic cervical chain pass thru it, including fibers from the Stellate Ganglion.  The SPG  also has somatosensory nerves that pass thru it.

There are a wide variety of patient videos discussing the use of self-administered SPG Blocks for many different issues and can be found searching Google for Self-Administered SPG Blocks and checking Video results.

 2020 Mar;104:46-53. doi: 10.1016/j.pediatrneurol.2019.10.007. Epub 2019 Nov 29.

Intranasal Ketamine for Abortive Migraine Therapy in Pediatric Patients: A Single-Center Review.

Turner AL1Shandley S2Miller E3Perry MS4Ryals B4.



Ketamine has recently emerged as a promising therapeutic alternative for abortive migraine therapy, likely secondary to N-methyl-d-aspartate antagonism. Most reports examine adults and the intravenous route. Fewer utilize intranasal administration or pediatric populations. Given the limited evidence for intranasal ketamine in pediatric migraine populations, we retrospectively reviewed our experience to further characterize safety and efficacy of intranasal ketamine in this population.


A retrospective review in a free-standing, pediatric medical center was performed examining the utilization of intranasal ketamine at 0.1 to 0.2 mg/kg/dose up to five doses in pediatric migraineurs. Pain scores (scale = 0 to 10) were recorded at baseline and after each dose. Response was characterized as pain score reduction to 0 to -3 and/or reduction of at least 50%.


Twenty-five encounters (25 of 34; 73.5%) were responders (mean pain score reduction of -7.2 from admission to treatment completion). Overall pain reduction from admission to discharge in the entire study population was 66.1%. Side effects were mild and transient.


Our experience with intranasal ketamine has promising outcomes in both pain relief and side effect minimization. When other therapeutic options are unavailable, practitioners should consider intranasal ketamine.

Copyright © 2019 Elsevier Inc. All rights reserved.


Adolescents; Children; Efficacy; Headache; Ketamine; Migraine; NMDA antagonist; Treatment